Previous Shoulder Dystocia, What to do with current large baby?

[stephanie95]

Help calm me down please! I need some help from like-minded mamas.

My last baby was 10 pounds 8 ounces. He was a normal vaginal birth in the hospital. When I went for my 6 week post-partum check-up, my OB (who did not deliver baby) told me that we had mild shoulder dystocia. I didn't notice at the time. I just wanted baby out. My husband said he knew baby had gotten stuck.

I am 35 weeks today. I am measuring 2 weeks ahead. My 3rd baby measured 3-4 weeks ahead at this point. My 2nd baby measured 2 weeks ahead for most of the pregnancy.

When I got pregnant (unexpectedly) this time my OB said to watch my weight gain. I started this pregnancy 63 pounds lighter than my last one. However, I have gained about 50 pounds. I didn't mean too and tried to watch it, but I haven't done so well. I also have a history of gaining more than I should, 60 with #1, 45 with #2 & 3, 50 with this one so far. With pregnancies #2 & 3, I started the pregnancy at 195 and 210 pounds. With this one, I was at 165.

So I tell all this because I am worried and trying not to freak myself out. My OB is getting nervous. He's pretty easy going and doesn't push much intervention etc. Next Thursday, I see him again. I'll be exactly 36 weeks. He said we will see how I measure. He wants to do an ultrasound to guesstimate a weight. Then based on that I have 3 options, induce at 38 weeks (if baby looks big), induce at 39 weeks (if baby looks average) or have a c-section (if baby looks huge or the cervix is not favorable for induction).

I have had 3 natural births. I have 3 children running around at home. I really DO NOT want a c-section. However I really DO NOT want a baby to get stuck. I asked about what happens if baby's head is delivered and the body gets stuck. The outcomes are horrifying. I realize that ultrasounds are not the most accurate estimators of baby's size. My OB is aware of this too but he says it's better than just a measuring tape. He'll also be the one doing the ultrasound. With my daughter (baby #2), I had an US at 37 weeks. They said she would be big (9 lbs+). When she was born at 38w 2d, she was 6 lbs 15 oz. So yes, I know they are not the most accurate.

If you've made it to here, thanks for sticking with me through my ramble. What would you do? If I didn't have the shoulder-got-stuck scenario, I wouldn't worry. My body won't grow a baby it can't birth right? But then it can be a very real concern and frankly if the baby really does get stuck, it can be very bad. So I don't want to take this lightly, but I don't want to run for a c/s either (and neither does my OB). Thank you in advance for any advice.

[kcparker]

Here are my two cents:

1. Quit eating ANY sugars, no apples, no fruit juice, and certainly no refined sugars. Quit eating refined carbs - eat only whole grains, and those in moderations. No more bread, no cookies, no pretzels, no crackers. Try to limit your weight gain to 0 at this point because baby is done building organ systems and is primarily packing on weight at this point. Eat really, really healthy - high quality proteins, lots and lots of greens and veggies, complex carbs that will take a long time to digest, and NO SUGARs.

2. Plan to have a vaginal delivery in the hands and knees position. Bring some Gaskin maneuver info. in for your doctor to look at, tell him that you don't want an unnecessary surgery, you are confident that you can do this, and here's the position you are going to do it in.

I'd hold out for a spontaneous vaginal birth if you can too, and if you do have to induce, wait as long as possible. Negotiate, really think about what you will feel comfortable and safe agreeing to, and keep checking in with your mama-instinct to know if you are doing what you really think is right, not just responding from worry or pressure from the HCP.

[stephanie95]

Thank you for the feedback. I know I have been lazy about watching my nutrition.  I had been really disciplined for a year to lose weight and then gave myself a free pass. ugh.... I just didn't realize how much everything was interrelated because my nutrition wasn't any better than with my first 2. I need to get some easy super healthy snacks. Grazing and emotions are my downfall regarding food choices.

Yes I'd rather have spontaneous labor. Thank you for the link to the Gaskin article. I had spoken to my Dr. about positions. He said they do try some. Then I panicked when I got the answer to my question of what happens if the head comes out and the shoulders really do get stuck. I am going to take the print-out of the article when I go next week.

The good thing is my OB doesn't want to do a c/s as course of first action. My friend had an OB who would have insisted on c/s and that would have been that. My OB is much more moderate.

Also, after reading the article, I think my case with my DS2 is very mild. They did have to manipulate him but there wasn't anything remarkable. I know we squished my legs up like the first maneuver mentioned but I remember doing something similar with my other 2.

Thank you again. I'm off to research a better diet.

[jeninejessica]

I might bring up with the dr as well the possibility of delivering in the OR, as a vaginal birth. In the high risk ward in my hospital, they have the the ORs, and then they have one 'trauma room' that can essentially be turned into an OR if needed, and anything with breech, twins, etc, delivers in there. In a true emergency, a good doctor can see the emergency and have you put out, and the baby out by c-section in a matter of minutes. You may have to concede some things like having them put in an IV when you start to push, and obviously having more people in the room, but birthing in the OR slows down the "response time" if you did have an issue with dystocia, without you having to be induce early or have a planned c-section. That way you could plan the birth as normal, not induce, and let your body do its thing, and then perhaps move to the OR for delivery just in case, still having the option to try a few position changes, maneuvers, etc, before moving to a c-section. But if you did need one, the 'access' would be a lot quicker. 

But of course, focus on prevention like you said, watching your nutrition, keep walking and moving the baby down, and pay attention to your position during labor as well. I wouldn't outright refuse the ultrasound, but keep in mind what you know-- it can be grossly off. Do you want that extra fear going into labor knowing that it could all be simple mis-measurement? 

Above all, trust your body. You've had natural births. Your body does know how to birth, and trust your instincts. If anything feels off, then trust that, but if you feel good, then try to trust that too. Maybe last time the reason you didn't even notice is because you didn't need to-- your body was doing exactly what it needed to by staying relaxed and pliable to help the baby find his way out. That's not a bad thing. 

[cinderella08]

I've seen 11lb babies with dystocia, and 6lb babies with dystocia.  Don't let "big baby" scare you necessarily. 

Maternal weight gain isn't a good indication of fetal weight - keep that in mind, don't beat yourself up over weight gain.

Also - shoulder dystocia CAN be very dangerous, but it can also just be a simple complication that, with the right maneuvers and staff, is resolved easily with no lasting effects.  There have been numerous studies I've read that show - statistically - the injuries that occur with shoulder dystocia are very, very rare - quite a small percentage of dystocia's result in injury.   Many, many, MANY more injuries to the baby occur during c-sections (including many more brachial plexus injuries which is the most common injury with SD).

[LiLStar]

I wouldn't agree to induction or elective c-section. I would actually think that natural labor would reduce the chance of SD

A couple questions.. I don't know how easy it is to switch providers late in the game if necessary in Canada, or if its an option for you at all. Ideally I'd want an OB/midwife who has experience with SD and isn't going to have a fear based reaction. But what is your OB's general personality? Will he balk at you pushing on hands and knees? Is he familiar with the gaskin maneuver? SD is most likely to occur if you are on your back. If your goal is to prevent SD, regardless of baby's size, it is absolutely vital that you are "allowed" to push in other positions. Will your OB support you in this? Another thing is seeing if you can get into a chiropractor who is experienced with pregnant women. Webster is ideal, but take what you can get :) You want your pelvis to be in perfect shape prior to labor to make sure your lo has the smoothest descent possible, and also is in the most ideal position. There are women who've had SD with their "small" baby but not their "big" baby. Sometimes its just some kind of positional funkyness.. even if subtle. I'd work to prevent that. 

I'll share my story. I have a 10lb 2oz baby. vbac, at home. I pushed for foreeever it felt like :) I was having trouble getting him past my pubic bone and the only position that was working for me was on my back, on the floor. In hindsight, it would have been prudent to change positions once I got him past my pubic bone, but I stayed put. he was very slow to crown, had the "turtle sign" while crowning. Midwives think he was just a tiny bit asynclitic. He had a true SD.. I definitely knew there was something wrong! I flipped to hands and knees and it took 4 minutes to free him. Yes, he was stuck, and stuck pretty good! He was slow to start, needed some oxygen, lots of stimulation, a bit of suctioning to perk up. All this was done with the cord attached and pulsing, so he was receiving oxygen. He had no injuries and fairly quickly was doing excellent. Bright eyed, alert, pink, nursing well! Perfect baby :) I'm pregnant again and my general plan is to watch sugar/carbs, especially in the 3rd tri. Regular chiro care. Push in positions besides my back, and if I *do* need to be on my back again for the baby to clear the pubic bone, once thats accomplished I'll switch to hands and knees or a squat.