shoulder dystocia

[Adasmommy]

My first baby had shoulder dystocia. Midwife performed the Gaskin maneuver and helped pull her out. Before that, I was reclined on my bed and I figured that was the problem--opening wasn't big enough.  Baby was perfectly fine.

Second birth was a cesarean, so no clues there.

Third birth was a home water birth and after the baby's head was born, midwife says it didn't rotate, so they picked me up out of the pool and put me on my couch, where midwife manually turned the baby and baby was born, perfectly fine.

Preparing for my next birth, and I just saw this video: http://www.youtube.com/watch?v=uXuwy8dXTGA&feature=related&has_verified=1

So, the baby's head doesn't turn and several minutes pass before the body is born (my understanding is that after two minutes, it's considered dystocia), and it's not a problem!  This leads me to wonder whether my babies would have been born naturally, peacefully, and safely without anyone doing anything at all. 

I've realized that this is something I need to resolve for myself before I go into labor in the Spring because it might be normal for me to have babies with "dystocia."  So I need to know whether I believe it is a medical emergency or a variation of normal.

Does anyone here have any thoughts or information to share with me?  How do I know if my babies' shoulders were stuck or if they were just slower coming out?  I don't remember in either case feeling a problem--just had the problem diagnosed by the midwife.  How long can the head be out before the body before it's dangerous?

[rhiandmoi]

There is no way to know from the information you've given whether you had a true SD or not. However, if the midwives diagnosed a SD and proceeded to manage your positioning I would lean towards saying that there was SD in those births. SD is not about the speed of delivering the body after the head, it is the impaction of the collarbone or shoulders against the mother's pelvic bones.

http://www.youtube.com/watch?v=_QiKngd0pXc&NR=1&feature=fvwp

Here is an animation of what happens during SD so you can get an idea. If you have a history of sticky babies you might want someone there who can go through the maneuvers with you and do infant resuss if necessary. Do you have a midwife available that could be hands off until you go to the pushing stage?


Also, it is definitely a variation of normal - because birth injury and stillbirth are variations of normal. We can understand and accept the different risks of birth, but because we have higher thinking we can also manage those risks and take reasonable steps to control them. It's not an easy choice to manage how much of our freedom and and autonomy to give up for safety.

[Adasmommy]

Thanks.  My first daughter had shoulder dystocia.  At the second homebirth, no one mentioned dystocia.  I just found it a coincidence that again the head was born fine and then intervention was "needed" before the body emerged.  So I wonder if there is something physical to do with my body or births that both incidents had in common, or possibly even something emotional/spiritual that needs addressing, or if it is coincidence as the two scenarios were not the same.

I'll watch the video you linked to.  But I wonder if I will be able to tell if a shoulder is stuck, as I do not remember noticing this with the case that was labeled dystocia.

I am going to have a midwife, but I need to decide whether I want her to intervene in the case of a similar scenario.  So I appreciate your input very much!  I wish the midwife from my first birth was still around for me to question, although I guess the details would not be so clear to her after so many births since then!

[rhiandmoi]

I don't think the mother can usually detect a dystocia from her angle on the birth. A true sd is a medical emergency and can result in serious birth injury. Maybe talk to your midwife about coaching you through the gaskin manuever as soon as the head is born to hopefully get the baby to turn completely and allow the shoulders to be born. I think it works because you swing your weight around and that helps the baby rotate. Of course you would have to be in some kind of reclining position to start with for that. McRoberts is actually very good for resolving sd because it changes the pelvic angle but it's probably not as comfortable as switching to hands and knees. Maybe if it is discussed ahead of time that you want to deliver the head and then roll to hands and knees you would be able to stay in the pool for the whole birth.

[mamagranola28]

spinningbabies.com is a good resource for possibly preventing shoulder dystocia.  It also talks about ways to resolve it.  You might want to explore whether the position you were in as baby was moving down could have been a factor.  In a true dystocia the head actually "turtles" or pulls back in a bit.