Article on Shoulder Dystocia

[Emmeline II]

Found this on another board; thought it would be intersting to y'all.

http://newcms.aafp.org/afp/20040401/1707.pdf

The
single most common risk factor for shoulder
dystocia is the use of a vacuum extractor
or forceps during delivery.2 However, most
cases occur in fetuses of normal birth weight
and are unanticipated, limiting the clinical
usefulness of risk-factor identification.6

[Munchkimo]

Wow. Thank you for sharing this. My son's birth was a homebirth transfer due to my inability to stop pushing before becoming fully dialated. I was 7cm and had been having contractions spaced no further than every 7 minutes for three days prior. I was just too tired to resist the urge to push, so for fear of rupturing my cervix, I went to the hospital. I received a spinal block, the pushing urge stopped, and I dialated completely. The OB at the hospital felt I was too tired and too numb to push so vacuum extraction was used. I could have declined, but didn't. The next thing I knew, the doctor was asking the nurses to apply suprapubic pressure while he pulled on the baby with the vacuum extractor. The nurses later told me I was lucky that my son didn't end up with a broken collar bone.

I am expecting my second child, due in May and have not yet decided whether I will try to give birth at home this time. I have been worried about the possibilty of shoulder dystocia. This information has helped silence that fear and reinforce my suspicion that more complications are caused by hospital proceedures than solved by them.

[Full Heart]

Wow, I am seriously impressed with that article. Not only did it mention Gaskin manouver but it recommended attending deliveries of mothers on all fours so as not to be disoriented during the gaskin manouver.

[lotusdebi]

Thanks for the article! DH is reading everything he can about shoulder dystocia. Our son got stuck on the way out, and I had to be turned to hands and knees and DS was turned and pulled out of me. DH and I both believe that the outcome wouldn't have been so great if I had been in the hospital under an OB's care rather than in a birth center under the care of midwives. We're having a midwife-assisted homebirth this time, but the possibility of another shoulder dystocia still looms over us.

[Emmeline II]

Since this article is so helpful maybe we could sticky it; something like "homebirth complications resources"?

[wombat]

I had a SD with a forceps delivery. I couldn't push the baby out during a planned HBAC (first c/s was for posterior baby/FTP) Pushing stage was about 7 hours at home, then transferred to hospital and after another 7 hours at the hospital baby was born so it was an awfully long pushing stage.

So I'm in 2 minds about SD during assisted vaginal deliveries. 1. when they're used unnecessarily, I'm sure they do increase the risk of SD. But 2., a badly positioned baby is difficult to push out, and therefore you're more likely to end up in a situation requiring forceps/vacuum. Is the risk then due to the initial problem or the forceps/vacuum? I had ideal conditions to push my baby out at home, unrushed, experienced mw - baby would crown and go back in. So I'm not sure the SD in my case was due to the forceps. I tend to think it would have happened anyway, well assuming I ever could have pushed that baby out.

And the risk factors for SD didn't apply in my case - I'm not short, I didn't have GD, no previous SDs, I have 6lb babies. Only risk that applied to me was a long pushing stage.

[nizhoni]

A few years ago I was the midwife for a client having her first baby at home. The midwife assisting me actually had to cover for me for most of this client's labor because I was attending another lady's birth, so she continued to act as primary when I arrived during our lady's second stage. Our client was only comfortable pushing in a dorsal recumbent position, interestingly, and we ended up with a moderately severe shoulder dystocia. Since the other midwife had less experience with SD, I stepped in and had to work pretty hard to get our baby out. We did have a good outcome though I think we both had more gray hairs as a result!

When this client became pregnant for the second time, she and her husband opted for a homebirth again, but they were pretty worried about another shoulder dystocia. We talked a lot about options for second stage and I made some recommendations about positioning. Mostly, however, I did my best to reassure them that this was another experience, another baby, another labor, and to remind them that shoulder dystocia is about angles as well as size. Our lady worked on trusting her body and the process.

The day of our client's labor finally arrived and all went very well. She labored almost entirely in the water and when she reached full dilation she felt compelled to leave the tub. She began pushing in a kneeling position as she felt the urge. Very soon a little girl--bigger by a few more ounces than her older brother--slipped out just as easy as could be! Seeing that little shoulder sliding out was a wonderful sight! The experience was very healing to both parents and I think they are no longer worried about shoulder dystocia.

It's good to be prepared, but history doesn't have to repeat itself!

Hugs to all,
Marla