shoulder dystocia

[naturegirl7]

Do you find that shoulder dystocia will occur again with subsequent labors??

I had heard it is largely positional - but I am thinking that maybe mine was hereditary too...


With my son, delivery was a bit tricky. He had shoulder dystocia - the MW had to manually reach in and rotate him off my pubic bone (OUCH!), then I was able to deliver him on hands and knees.
He was a big baby at 9.9 but the big factor in him getting stuck was that his head was large and his shoulders were wider than his head! I think they said his shoulders were one full inch bigger than his melon head. almost every nurse remarked on it. This is something I am told is quite uncommon yet my mother said I was the same way although tinier at 7.7 (resulting in a C/S for her though). My son did have "minor" Erbs palsy as a result, which has cleared up thanks to chiropractic care.

I am worried about the next one(s) having shoulder dystocia as well and all the problems that came with it - erbs palsy (perhaps we wont get so lucky next tim with it resolving), bfing problems, being unable to sleep, obvious pain.....

[mendomidwife]

A few months ago I attended a conference with a shoulder dystocia discussion. They said the chance of re-occurence is 0.5%.
They quoted that from a website.....this is the link.....it has quite a bit of information on shoulder dystocia. In your case it could be the way you or your partner is built. I remember laboring a women once who was quite small. She had a long second stage and at one point I looked at her husband from behind and his shoulders were very wide....I mentioned it to my midwife partner and we both nodded. She had a very large baby......with moderate SD.


http://www.shoulderdystociainfo.com/anticipated.htm


Carla

[USAmma]

I know someone in real life who had that in her labor. She has a bicornate uterus. The baby was saved but she bled a lot and required transfusion. I think that in cases like hers it is more likely to repeat. I am not an expert on this but that's what I heard.

[blissful_maia]

Some practitioners believe that there is, and are really cautious with clients who have a history of shoulder dystocia. The research that I read insists that there is no way to predict who will and will not have a shoulder dystocia, including a history. Could happen to anyone.

[wombatclay]

A few months ago I attended a conference with a shoulder dystocia discussion. They said the chance of re-occurence is 0.5%.
They quoted that from a website.....this is the link....

I've been doing a lot of reading since my dd2's birth (with SD). The website you linked to is awsome! So much info!

However, the studies listed on that site actually say that the risk for SD is roughly .5% in the general population...for mamas who have had a SD in a previous birth the risk of a SD repeat is MUCH higher:

The risk of a woman having a repeat shoulder dystocia once having had one, as reported from various authors, is:

Smith (1994) 12%
Ginsburg (2001) 11%.
Gherman (2002) 11.9%

This compares with the baseline risk for shoulder dystocia of 0.5%. Because of this significant increase in risk -- approximately 20-fold -- some obstetricians have proposed "once a shoulder dystocia, always a cesarean".

Of course, 12% isn't rotten in terms of risk, and I wouldn't plan a c/s because of it, but it's important to know the stats so you can plan accordingly!

[naturegirl7]

thanks for that link - it has so much helpful info! Now I have more concrete info to add to my list of interview questions for my new MW.

I am just afraid that the next one will have the shoulders/chest larger than head issue too......

[mwherbs]

the stats I have are from 7-10 % for repeat
it is also important to note that even though there is a % repeat that it is not predictable who will have a repeat-

[blueeydvixen]

-

my son was 7 15oz had sd
my girl was 7 13oz had sd
i am due in a few weeks and my dr. is concerned this guy will have it also. my dh is 6ft. with very wide shoulders though

[pamamidwife]

I do think that sd is largely positional. I don't think it has to do with the size of babies - nearly half of all babies born with sd are under 9lbs.

get off the bed, don't have providers pull or rotate the baby and typically things will be fine. I also think that many SDs are called SD but are just a matter of impatient providers and maybe some sticky shoulders.

[ErinBird]

I have a friend who had her third baby five months ago. She had a epidural and was induced with her second baby (pretty much a standard medical hospital birth). Her second was stuck coming out, but was resolved fairly quickly.

HEr third was a planned HB with MWs. Labor was short and (obviously) unmedicated. While her first two were born at 38/39w and weighed 8.5lbs each, her third was 10lbs 2 oz and delivered around 42w. This baby had a large head, huge shoulders (like her brothers) and that, combined with her fat and potentially mom's pelvis led to a pretty sticky dystoica. It took a few mintues to unstick the baby and mom had some hemmoraging after the baby was out.

Thinking ahead to her next birth, my friend is planning to seek chiropractic care throughout the pregnancy to reduce the chance of her pelvis causing issues. She also intends to seriously limit sugars (never has been dx with GD, but feels it can't hurt). She'd also like to try to get labor going earlier next time. Since she obviously grows babies with large head sand shoulders, she wants to urge her body into labor before baby gets too fat.

[mama to 2 girls]

Originally Posted by ErinBird

Since she obviously grows babies with large head sand shoulders, she wants to urge her body into labor before baby gets too fat.

Obviously the more a baby weighs the more likely it is to have bigger measurments but.....fat squishes! My cousin just had a 9lb. 10oz. boy and she even said to me he didn't look that big, that's because his measurments were the same as my 8lbers! So just because a baby is fat doesn't mean he is "big".

Sorry to get off topic.......I truely believe that *most* of the time it has to do with positioning.

[pamamidwife]

Originally Posted by ErinBird

While her first two were born at 38/39w and weighed 8.5lbs each, her third was 10lbs 2 cy to reduce the chance of her pelvis causing issues. She also intends to seriously limit sugars (never has been dx with GD, but feels it can't hurt). She'd also like to try to get labor going earlier next time. Since she obviously grows babies with large head sand shoulders, she wants to urge her body into labor before baby gets too fat.

Let's just be clear here: babies gain, on average a quarter of a pound to MAYBE a half a pound a week in the last month. induction at 37 weeks isn't going to create a baby that much smaller that the risk of SD goes down dramatically. what will decrease the risk of SD is being upright - not sitting on her tailbone - during pushing.

Bones are the issue here, not fat. Bones don't grow in the last month of pregnancy. The fat on a baby's body helps them regulate their body temperature. Induction carries with it it's own risks of SD, fetal distress and cesarean.

I'd take an unhindered, woman-led, active labor on its own time over any of that for the safety of my baby.

[mwherbs]

I am also thinking that waiting until the woman feels the urge to push instead of coached pushing changes how the baby twists and turns in there- and no fundal pressure in addition to no pulling

if you are lying down then on your side leaves more room for the baby to come out

[liseux]

"I also think that many SDs are called SD but are just a matter of impatient providers and maybe some sticky shoulders." Pamamidwife

This is very true and I do think that a true severe s.d. has a higher chance of repeating, severe being where the baby is stuck for more than 10 minutes. Size really has very little to do with it, I don't think restricting any foods in the end of pregnancy will make much of a diffference.

[naturegirl7]

I started out lying on my side. And I was the one who decided to push - not that I had much choice. I was resting, and suddenly felt the need to push. Freaked Dh out cuz I would not let him leave the room to go get the MW. LOL But she heard me vocalizing as I was pushing and came in. It was pretty instinctual at first.
Then he was stuck - head crowning and then sucking back in....MW went in and manually rotated him and I still had trouble pushing him out. That is when she said we should try hands and knees, I quickly did just that, supported by my beloved birth ball and within 2 pushes he slid right out. rather blue and needing a little suction and oxygen - Being on hands and knees over the birth ball - I couldnt even see anything. I was trying to look to either side or between my legs but all I saw was blood and blue baby legs. And hearing the MW ask for suction, oxygen, watching her rubbing his little blue body.....Asking over and over "is the baby okay?" and no one answering cuz they were so busy with him - not even DH.
It was terrifiying - I thought my sweet baby was either dead or dying - it was no longer is my baby a boy or a girl but is my baby alive. When he finally cried, it was the sweetest sound ever. it was probably only 30-60s but it seemed like eternity.....and honestly it is that feeling that has me scared that another baby will also have SD. that has me feeling like I need to research and prepare as best I can so that I never had to feel that again....

[naturegirl7]

also my son ended up with erb's palsy as a result of his shoulder dystocia - so I do believe it was a real case of SD and not just a sticky shoulder.

[wombatclay]

My dd was okay, but she was stuck (head out and pulled back/turtle sign) for a few seconds shy of 4 minutes (after pushing for ~4 hrs). The birth was unmedicated, pushing was all me, and we were trying lots of positions both before the SD and then in an attempt to release the SD. Nothing worked until they tried the Woods Screw technique which got her loose and out, though I tore badly. She was purple and floppy, but was okay after some oxygen and massage. She was anterior, only 9 lbs, and her head circumfrence was only 13.5 inches...

So in my case I don't think there were positioning issues for either me or my dd other than the obvious "her shoulder got stuck".

For me the risk of a repeat SD hasn't scared me off from a home birth in the future, but it has made me realize I'll never be comfortable with a UC. And I would probably try the GD diet just in case it helped, and start natural birth motivating techniques (EPO, RRL, acupuncture, etc) sooner.

Hugs naturegirl...I know how scary it can be!

[naturegirl7]

Originally Posted by wombatclay

My dd was okay, but she was stuck (head out and pulled back/turtle sign) for a few seconds shy of 4 minutes (after pushing for ~4 hrs). The birth was unmedicated, pushing was all me, and we were trying lots of positions both before the SD and then in an attempt to release the SD. Nothing worked until they tried the Woods Screw technique which got her loose and out, though I tore badly. She was purple and floppy, but was okay after some oxygen and massage. She was anterior, only 9 lbs, and her head circumfrence was only 13.5 inches...

So in my case I don't think there were positioning issues for either me or my dd other than the obvious "her shoulder got stuck".

For me the risk of a repeat SD hasn't scared me off from a home birth in the future, but it has made me realize I'll never be comfortable with a UC. And I would probably try the GD diet just in case it helped, and start natural birth motivating techniques (EPO, RRL, acupuncture, etc) sooner.

Hugs naturegirl...I know how scary it can be!

This sound so similiar to my story. And I put myself on a diabetic type diet due to insane family history of regular diabetes - I wanted to prevent GD as much as I could, which worked. I also did chiropractic thru my pregnancy, drank pregnancy tea, towards the end took EPO and RLL/cohosh tea - I was only 2 days past my due date.....
If I was still in PA with the MW who caught DS - I would not be scared, but now we have moved and I need to find a new MW and I have no idea how she will *really* handle the situation - I mean, she may have all the right answers during the interview, but it is in that moment that counts.....

When I interview a new MW - would it be rude to ask to speak with some of her clients that experience severe SD to see how they felt about the birth??

[wombatclay]

I think it would be totally fine to ask a care provider about their past experiences with SD and how they would handle SD in the future. However, since SD is fairly rare and there's no good way to determine who will or wont develope SD...it's possible that none of the care providers in your area will have much personal experience.

If you really click with a care provider (MW, Family Practice, OB, whatever) and they don't have a lot of experience (and they really shouldn't have a lot of experience...if a lot of their clients have SD then something is out of whack. My own OBs have been in practice 20+ years and have only had a handful of SD clients, and my MW aunt has caught babies for 30+ years and only seen three SD mamas.), perhaps just stress your concerns and history and make sure you all are prepared for a possible SD?

I hope you find an awsome care provider!

[mwherbs]

there are other studies that show that glycemic control does not change infant size-- but this one is to the point as far as SD--
dietary changes are not going to make a change-

Obstet Gynecol. 2004 Nov;104(5 Pt 1):1021-4.

Anthropometric parameters in infants of gestational diabetic women with strict glycemic control.
Salim R, Hasanein J, Nachum Z, Shalev E.
Ha'Emek Medical Center, Obstetrics and Gynecology, Afula, Israel.
OBJECTIVE: Differences in weight and body composition have been reported between infants of nondiabetic and diabetic mothers. These differences may explain the propensity for shoulder dystocia in the diabetic population. We investigated whether differences in anthropometric measurements still exist between infants of nondiabetic and diabetic mothers following strict glycemic control. METHODS: This was a prospective cohort study. The study group included infants of well-controlled gestational diabetic mothers (mean capillary glucose less than 100 mg/dL). Controls were infants of nondiabetic mothers matched for gender, gestational age, ethnicity, and birth weight. Only singleton term pregnancies were included. Both groups were studied within 24 hours of delivery. The following measurements were obtained: birth weight, infant length, femur length, head, chest, abdomen and thigh circumferences, and biacromial distance. Student t tests were used to compare the measured parameters between groups. P < .05 was considered significant. A sample size of 63 subjects in each group was needed to
demonstrate a difference of 0.5 cm (+/- 1.0 cm) of the biacromial distance
between the 2 groups, which we considered clinically significant, with a
probability of 95% and power of 80%. RESULTS: Sixty seven infants in each group were included in the study. Anthropometric measurements did not differ significantly between the groups. We did a secondary analysis on neonates who weighed 4,000 g or more at birth. Anthropometric measurements again did not differ significantly between the groups. CONCLUSION: Anthropometric measurements of infants of mothers with well-controlled gestational diabetes do not differ from infants of nondiabetic mothers. LEVEL OF EVIDENCE: II-2.

PMID: 15516395 [PubMed - indexed for MEDLINE]