UC after shoulder dystocia?

[Skim]

We are planning a home birth, but I am trying to find the confidence to decide I am comfortable with an UC this time around. Tentatively we have pursued hiring a local hb midwife, and have interviewed one, but I am not 100% pleased with her. In my heart, I want a UC this time. I think dp would support me if I were confident.

If this were my first, I wouldn't bat an eye with UC. However, dd was born with shoulder dystocia. Granted I did not get the chance to get on all fours during my labor with her, and our midwife had to pull dd out after two minutes. This resulted in a partial third-degree tear. I did not hemorrage, but I did have to transfer to get stitched by my doc.

What I am specifically looking for here is anyone who had an UC after a previous birth resulting in shoulder dystocia. OR any midwives who have counseled moms who are considering uc after a shoulder dystocia hb.

Any advice is welcome, but I would really like to know what factors made up your mind for you - what made you feel the most confident, regardless of your decision for a hb with a mw or an UC.

Kim

[Ame]

My story is not specifically what you are looking for - but I believe it is relative.

here is my most recent birth story http://www.mothering.com/discussions...d.php?t=231816

I had two standard hospital births followed by a UC where my daughter was born with multiple "abnormalities" and I questioned whether UC was right for this last baby or not...not because UC had anything to do with my daughters situation BUT because after her births the "whats is" were magnified.

My son was "stuck" and weighed 11# and I birthed him without medical assistance and without tearing (thanks to waterbirth) or any other serious complication.

I think with UC you really have to process all your fears and doubts even if you remain uncertain of whether UC is right for you right up to the very end...and then follow your instincts. If you resolves all of your "issues" your instincts will lead you in the right direction.

[laurata]

first UC 3/02 , shoulder dystocia, post-birth transport
http://smartaustin.com/~laura/unabirth.html
elliotts birth, UC 12/10/04
http://smartaustin.com/~laura/elliottsbirth.html

[loved]

I think knowing whether it was a true shoulder dystocia or not is very important.

I have seen a true shoulder dystocia - baby's head turned a dark purple, sucked back in, would not restitute and needed resucitation. It was also CAUSED by the birth practitioner trying to hurry the birth by pulling and turning the baby thereby causing the shoulder to become impacted. Scary!

I have also seen sticky shoulders where the baby did restitute, but just took some strong pushing to birth the shoulders (and sometimes belly and legs!!). Not shoulder dystocia, but some practitioners panic and label it as such. I also know some who, once the head is born, want the rest of the baby to hurry out, even without a contraction, and will call it shoulder dystocia if it doesn't.

Shoulder dystocia, in my mind is defined as baby's head sucking back in, becoming suffused with blood, usually takes more than one manuever to dislodge shoulders and, chances are, needs resuscitation after birth.

That all aside, even if you are certain you had a true shoulder dystocia, you need to prepare for your baby's birth just as carefully and thoughtfully as you would anyway. Does your partner want that role? Do you and he want to take full responsibility regardless of what may or may not happen?
Educate yourselves as to how to recognize the signs and what to do - just like with a hemorrage or resucitation or.....and then talk about it, pray on it, sit with it.

I really believe that if you listen with your gut, your baby will lead the way.

[Skim]

loved-

I totally agree about knowing if it was simply stuck shoulders or true SD. Based on my feelings soon after the birth, when I researched it (because of internal doubts I had) and your own post, I strongly feel it was not "true" SD, but rather stuck shoulders. Especially since we only tried one way of getting the baby out after my squatting position didn't work. My babe was really healthy after birth, except that her face bruised a lot from when I had to sit from exhaustion when she was coming down the canal... No breathing problems, we did not have to resuscitate her, she did not get sucked back in after poking her head out, none of that.

My dp and I have been discussing this a lot, and he supports what I want to do, and will be more comfortable with the idea of UC once we read a couple books on how to handle emergencies that may arise. He has listened to my concerns and heart-felt passions, and I know he is ready to attempt UC, and I know it will be what we are both looking for. We both agree that whatever decision we make will be made with full acceptance of the risks and consequences.

My joy was when he said, unprompted, "And the best thing is that this (UC) will really help us bond as a family."

I am certainly less fearful, and can't wait to give him reading materials to ease his lingering uncertainties through information. Every day I feel more and more that UC is the only way I can feel comfortable.

Thank you all for your replies, it has been so helpful.

[Skim]

Ame and laurata - I forgot to thank you for sharing your beautiful and encouraging birth stories. DP liked to hear about big babies being born at home, and about where siblings go/what they do during labor.

We have an almost-three yo who will love to be present, and will probably really help the birth. I feel strongly that she is very present and aware about this baby, and will be more than happy to witness its birth.

I cannot wait to read more UC birth stories!

Kim

[feebeeglee]

My newest son, Gil, was wedged right good at the shoulders. It was an unexpected feeling for me because in my previous three births once the head was born the rest of the baby was born basically immediately. He was a full 3 pounds larger than my first child too

I got up on my hands and knees almost instinctively and REALLY PUSHED (oof! I had red specks in my eyes the next day) and DH worked his shoulders out over my completely intact perineum. I did have my first hemorrhoids ever tho, I'm sure caused by the <grunt> extremely <aaaargh> hard <oof> pushing <uuunnngh!> but they resolved quickly.

As far as UCing after SD, or stuck shoulders I definitely would because I feel certain I would have been laid wide open by someone with a scalpel or surgical scissors, had they had them to hand, whereas with nonviolent techniques I was able to birth him just fine.

[pamamidwife]

You might want to check out this birth story: http://pages.ivillage.com/coatlicue/...eofsamuelrune/ - and be sure to scroll down to read the story of their first baby, Grey Forest Walt, a birth with "stuck" shoulders handled by midwives.

It might be encouraging for you.



The women here are sooooo wise!

[Mama2Lennon]

All I can add is that I have just finished reading a new book by Ina May Gaskin, which discusses shoulder dystocia. The maneuver to deal with it is called the Gaskin maneuver (sp?), which is cool in itself since she is the only womun to have an obstetrical maneuver named after her. It is simply getting into the hands and knees position. She does mention what the mw, or other birth attendant can do, to speed up delivery once you are in hands and knees. If your partner will be there, he can help get the baby out. I think you just slip your fingers into the armpit of our shoulder and gently tug. Maybe someone else knows more about this? Ina May is a good source for info about this, look her up!

[applejuice]

My first was a posterior with shoulder dystocia, and only six pounds two ounces, no tears

My second was posterior with a deflexed head and shoulder dystocia, six pounds even, no tears.

My third was easy...so easy! six pounds fourteen ounces...

My fourth was so easy and a UC - seven pounds four ounces...yeah!

[mehndi mama]

My first was born in the hospital, up on a bed, propped up on my tailbone, and got stuck at the shoulders. His head *did* turn purple, and it took a corkscrew maneuver by the OB & some forced pushing on my part to get him out. He was a little over 9 lbs.
All my other babies were born on hands-and-knees, and I did not tear and nobody else got stuck - even our last baby who was 9 lbs and even bigger in the shoulders than my first. That was my first UC. I was VERY confident that the shoulder-sticking problem would not repeat itself, just because I knew that being in a bad position, scared, and high up on a table contributed to the SD of my first baby. Being grounded and in an instinctual pushing position has a lot to do with your success, IMO.

[majazama]

I agree with the PPer, if you are not on your tailbone, it's a lot easier to get those babies out of there. If you feel the baby is stuck, go on your hands and knees and the baby will be born soon enough.

[gothmommy]

To be honest with you, one simple and EXTREMELY effective way to deal with dystocia is to be able to change positions. In my experience (as a L&D nurse), the docs would rather eat a piece of poop than "allow" a mom to actively birth, inculding changing her position to deal with a shoulder dystocia. I personally would think you have a better chance at a normal birth (even with a history of shoulder dystocia) at home, UC or with a traditional midwife (not a nurse midwife!!) if you were really uncomfortable with UC.

[Skim]

Howdy!
I've been away from the forum for a while, dealing with in-law family health stuff in a far away city, but I have been lurking here reading your responses. Such great advice, mamas!

Yes, baby #1 was a SD baby at home. I read my lay midwife's notes recently and discovered that my babe did turn purplish before her shoulders were out, which I did not know. But she did not have trouble breathing or anything after birth. I was in a squat during labor and not the hands and knees position because my midwife didn't attempt to and/or couldn't physically move me to an all-fours. Our bedroom was *really* small! There was barely room for her to catch the babe.

The bottom line is that DP and I decided to go UC soon after I posted my original question, and he is now as much as an advocate as I am about UC. It's truly amazing how much the culture has infiltrated our otherwise free-thinking brains about birth, as I've discovered as we have gone through the decision-making process. We're both very comfortable with our choice/decisions now, and I didn't have to do any convincing at all. He just listened openly to my heart's desires and heard the truth there. He concluded, unprompted, "You know what the best thing about doing it unassisted will be? We'll really bond better as a family." I just love this man!

Now that I feel completely in charge of my birth and labor, I am not concerned about being moved into an all-fours or other complications; I believe I will do what is necessary, and DP will be accessible to assist if absolutely necessary (and to make sure dd gets to see her sibling born!).

I would still love to read more SD/stuck shoulder birth stories if you have them, or other words of advice. I've appreciated and really learned a lot from everyone's experience so far.