Question about surgery report - shoulder dystocia?

[Climbergirl]

Ok, I have read the stupid thing several times. Every time, I get mad. But, I noticed something else in my records.

My coding diagnosis sheet says the following:
1. bony pelvic obstruction
2. fetopelv disproportion (CPD)
3. shoulder dystocia
(and a few items that make sense)

I am curious about #3. Shoulder dystocia? Now, I have limited knowledge of that area of the body during birth, but how could his shoulders be hung up on my pelvic bones? Did that mean his head had made it through my cervix? The swollen cervix that did not make it past 9cm (according to my records, although I know I only had a lip so in my mind, that means basically 10cm, with a lip). Did he make it down and they got to the OR and realized he was really far down ("wedged in the pelvis" was the wording in the report). Yes, the surgical report said shoulder dystocia, but when I asked my OB (not the delivery OB, my OB was out of town), she said that had to be a mistake. Now, I am not so sure.

Seriously, what the hell was going on that day?

[womenswisdom]

Maybe the SD refers to something that happened during the c/s? After the head was born, the shoulder was stuck? Or maybe it was just a mistake...

[Climbergirl]

I know it took them a long time to get his head out of my pelvis (4 minutes according to the report, but it felt like FOREVER). But I can't find anywhere where shoulder dystocia refers to getting stuck on the way out of an abdominal incision.

I am just confused. Especially when I did documents for a biomedical company, documentation was EVERYTHING and you did not make mistakes on it. A mistake could cost millions of dollars and the FDA coming down hard on you. I guess I feel that doctors should be held to the same standards and it is unacceptable if it is just a "mistake". This is surgery and that surgery almost cost me my life, so you should be careful and document it properly.

Argh.

[MNHall]

My first thought is, "was it REALLY SD?" Like, my OB claimed that my pelvis must have just been too small to birth a baby...I guess she never said CPD to me, who knows if it was in my chart though....but WHO says that? It's just at their discression right? I've never looked in my chart or my c/s records, while I'm curious, I almost don't want to know either..so, I never asked and honestly, neither my OB with my VBAC DD or my new OB with this pregnancy have asked for my records!!!!

Anyway, I just really wonder what standards diagnose this? Is it just something the OB visually looks at and says, oh yeah, let's just call it SD, or is there a way to REALLY diagnose??? I don't know....but, I just seem to doubt what so many doctors say these days, that was my first thought!

[Climbergirl]

MNHall, I guess the question for me is this. SD usually means that the head is delivered (i.e. out of the vagina), and the shoulders are "stuck" on the pelvis. It is dangerous to push the baby back up. So part of me is wondering if there was really SD, wouldn't that mean the baby was basically being born? I would hope they would do an exam for this sort of thing prior to cutting me open.

But it also says the head was wedged into the pelvis, which does not make sense for an SD. Either the head was in the pelvis, or the shoulders, not both.

I know, I will never have the answer.

[sharr610]

So...the OB for my c/s said that there was "mild shoulder dystocia" during the c/s delivery. When the backup OB I'm using this time read that, he furrowed his brow in confusion. I *think* what she meant was that DS had bigger shoulders than head and it made it hard to deliver him.
My friend who is a nurse said that Dr.s often use a certain level of extremities in explaining certain things so that if the patient ever feels that they've been operated on unjustly, there are some big scary buzzwords in the reports that make it seem more necessary...

[AustinMom]

The only thing that makes remote sense is a type of transverse/severe acynclitic lie. EX: turn your head to the side like you are talking on the phone and holding the phone with your shoulder, the side of your neck that is stretched would be the part of the baby's head on your cervix, but I don't see how you would get to 9 or 10cm with that. But it would be a long labor, it'd be pretty intense due to malpresention, and you would most likely have a lip, but then again, MANY MANY mom have all of these symptoms but it not be malpresention reason.

Personally, I don't trust the OB who did my CS and her knowledge, she couldn't even guesstimate the baby's size before the CS and our MW told her 8lbs (she was being kind, he was 9 1/2lbs) and she put down 'suspected macrosomia' which is either 8lb 15oz or greater (the lower weight suggestion for fetal macrosomia). She also made my incision lopsided, and was really rude, and tore the inside of my vagina during a vaginal exam. So, I don't think she's all that trained (like most OBs) in 'reasons' for CS. Especially with as many moms that are given the CPD crap now days. So, yes, I'd say the most logical reason for it being in the report is 'ignorant Obstetrician'. Is it crappy? Yes. But that's sadly how most are today.