Was this Shoulder Dyst or something else?

[chocolatefish]

Hoping that some MW can help me out here!

I had an interesting convo with my MW this am. I am currently 35 weeks pg, baby is measuring big and my gynae is already murmuring about induction at term for a big baby. We are in France, which has an ultra cautious approach to all birthing matters and a protocol for everything... including big babies which are any shown by US to be 4kg plus.

Anyway my MW (who is very pro natural birth - as much as she can be here) was talking through my first birth. DS was 4.2kg, unexpectedly big but a natural, normal labour up to a point. After getting to the point of pushing i.e. 2nd stage everything just ground to a halt. He nearly crowned many times - my husband remembers seeing the top of his head emerge - then retract. this went on for at least 1 hour. At one point an obs told me that if he wasn't out in the next 15 minutes, they would move onto forceps. My MW at the time knew that I seriously wanted to avoid this - as did she. Within a short time and after a few more unsuccessful pushes AFAI can remember she hit the emergency button, the room filled with people, she performed an episiotomy, MacRoberts, fundal pressure and what she called a corkscrew maneuver (which I now know to be the Woods screw) - all the moves to deal with a shoulder dystocia. DS shot out in one great whoosh with this. in convos afterwards my (very experienced) MW told me it was an SD.

When I described this to my current MW she told me that this was not a SD. I know from reading that the classic SD is the baby's head delivers then gets pulled back as the shoulder gets wedged under the pelvic arch as the baby turns. DS was not like this - as I say his head was not delivered first, he came out all in one great rush.

The reason I want to know is that a previous incidence of genuine SD seems to count for a lot when considering what to do with this 'big baby'.
Any thoughts would be very welcome!

[mwherbs]

So there are midwife and old labor and delivery room nurse's tricks that have to do with repositioning a baby . She did several things to try and bring this about, McRobers sometimes is the only way to get a bobbing head to enter the pelvis , popular views now is there is no reason to be lying in this position during labor but sometimes it is what works, add to that some firm steady pressure, I would have mom pushing not use fundal pressure, but in this case that is what she did, and the giggling spinning thing she did was to the baby's head not the shoulders, Once the baby lined up/ responded to the position changes he shot out. she most likely did this as a quick last ditch effort before the doc prepped you for the interventions he had in mind. It doesn't always work good to know you had someone in your corner.
It was not a shoulder dystocia, most likely some degree of asynclitic head position, possible some degree of pendolous could be pubic bone is angled inward at the brim instead of flaring outward like a funnel... Most likely this baby will fit through better, babies alter your pelvis putting groves into the bone, if the baby droops over your pubic bone at the end of pregnancy consider wearing a belly band to help the baby into position and relieve backache

[mwherbs]

Sorry about the smiley it was unintentional ... I am using a touch screen and one fidget makes all the difference....

[chocolatefish]

Wow thank you so much for this, what you describe fits so much better with what I can recall of the actual birth.

So I am going to stop reminding my gynae about the so-called SD (I suspect that the expected big baby will trump most things for him anyway in his plans) and be considerably more confident about pushing for another natural birth and not being on my back this time.

I was on my back the first time because I was knackered I think - 3 days pre labour pain, 10 hours 'proper' labour then pushing for 1.5 hours. I think I would have needed a crane to get on all fours by then! But maybe if I had stayed off the bed and on a mat it might have been easier... we shall never know I guess.

Thanks again.

[mwherbs]

I have used mcroberts in a similar way, in particular I can think of women who walked and kneeled for hours on end and what worked finally was to have her lay down and in that position the gravity helps to get the baby into the pelvis . For the births I am talking about upright and hands and knees was allowing a baby's body to pull outward so that when the uterus contracted q""it is doing a lot of lifting in addition to effacement and dilation, then when the contraction was done the baby would sag forward: over the pubic bone pulling the head back out of the pelvis so hard to know if being upright would have helped you at that point during that birth. You actually had an average length of active labor, nothing overly long at all, the days of prodromal labor seems to be pretty average too. This birth will probably not take quite as long.