shoulder dystocia-OB breaks clavicle?

[JaneSmith1010]

Is it sometimes neccessary to break baby's clavicle to deliver when there is shoulder dystocia? Is shoulder dystocia avoidable with proper diet? Can't you usually use the Gaskin Maneuver to deal with this problem?

[Midwife Kris]

Yes it is sometimes necessary to break the clavicle in order to "collapse" the chest (flexing the shoulders in) to guide the truly stuck baby out. I can't speak for all midwives or OBs but you do whatever position (and sometimes all of the positions and repeat!) to get the baby out.

My worst case of sticky shoulders was on a 6 lb baby so I don't imagine diet would've help him any better.

[ThreeBeans]

I was taught by a midwife that breaking the clavicle was a last ditch attempt if the Gaskin maneuver has failed. Shoulder dystocia is more about position than size, so I don't think diet would help.

[hetaera]

oh my. The thought of this makes me shudder....

yikes.

[SublimeBirthGirl]

This is one reason I'd much rather have SD happen at home, where that would be the last resort and not the first. I don't believe diet has much to do with SD at all. It's a lot more likely if mom is in the lithotomy position.

[blissful_maia]

I don't think it would be anyone's first choice, first they would go through the manoevres, the McRoberts, applying suprapubic pressure, etc. But if the baby really, really isn't coming, I can see why a doc would do it.

As far as diet, there's no factors that can be used to predict SD prenatally. They used to think perhaps macrosomia, but not anymore.

[wifeandmom]

Originally Posted by jhow32000

Is it sometimes neccessary to break baby's clavicle to deliver when there is shoulder dystocia? Is shoulder dystocia avoidable with proper diet? Can't you usually use the Gaskin Maneuver to deal with this problem?

Yes, No, and sometimes. In that order.

[BetsyS]

Originally Posted by wifeandmom

Yes, No, and sometimes. In that order.

Exactly.

[blissful_maia]

Originally Posted by wifeandmom

Yes, No, and sometimes. In that order.

:

[cathicog]

I caught a 12 lber at home one time, and the previous baby had sticky shoulders,it was a birth clinic, and they scared the parents half to death. That was the reason for wanting a hb with the next baby. So when this one came, I was prepared for sticky shoulders, and got baby out fine w/ Gaskins manuever. Didn't think he was *that* big, til we weighed him! Mom's Positioning is vital to avoid sticky shoulders, and shoulder distocia.

[applejuice]

My SIL 's DD was born with shoulder dystocia in December, 1960; she was an eight pound baby and they dislocated the shoulder to get her out. My SIL did not know that they dislocated her shoulder until she got the bill for it.

[liseux]

Breaking the clavicle is not always easy to do though, it is a last resort, and usually does free the baby, but not always in time. The Gaskin & McRoberts are similar, and if its not a true dystocia the Gaskin should work right away. I wish there really was a simple solution for s.d., like avoid labor on your back or do the GD diet. Sometimes you do everything right and it still happens.

[Charmie981]

Originally Posted by liseux

Sometimes you do everything right and it still happens.

:

[midwifetx]

I once caught a baby who had a shoulder dystocia and was wedged in the pelvis with both arms behind her back which "squared" her shoulders in a way that nothing could move. She was pushing on hands and knees, we moved her several different ways, then I went in to try to unscrew the baby, but she was so stuck that there was no way to free either the posterior or anterior shoulder. I ran two fingers along the baby's posterior arm (which, you will remember was behind her back) bracing it while trying to sweep her arm and hand around to deliver that posterior arm, all the while resisting the urge to stick my finger in that little armpit and pull. The pressure of my fingers from trying to get the arm around the body caused her little upper arm to snap. That feeling is something I will never forget. As soon as her arm snapped, it broke the tension that was holding her body so stuck inside and she was born.

The baby needed a couple of puffs of PPV, and pinked right up, nursed great and didn't even favor the arm, which was mind boggling to me. The Ortho we took the baby to said that he sees about five of these each year, and that it just heals right back up. He also praised the delivery and told the parents exactly how bad a brachial plexus injury can be stemming from deliveries of babies like this when the provider isn't careful about it.

It would never ever be my preference to break any baby's bone, and I certainly didn't do this on purpose, but in some births, it is the lifesaving last resort.

[JaneSmith1010]

Thanks for clearing this up ladies. The reason I asked about diet is because I believe I read somewhere that babies that are "obese" or "overweight" before birth put disproportionate weight on at the upper body/shoulder area and that this can contribute to shoulder dystocia. Is this entirely inaccurate? I understand that the baby can sometimes just be large or in a difficult position.

[liseux]

It really is a bone thing & position problem, the flesh can move and squish and fit. Its hard to know who will have it and how bad. Most experienced doctors and mw's know that s.d is impossible to predict and only luck will get the baby free in time. These days it is the fear of lawsuits that has doctors and scientists scrambling to find a pattern or a list of risk factors in severe s.d.

It has been proven that doing a preventative c/s would not stop enough s.d cases to make it worth doing c/s on any woman suspected of having a macrosomic baby. But, if a woman has had a severe s.d and wants to have a c/s in the future, that is understandable.

[Girlprof]

I'm no expert in these matters, but I had a baby whose clavicle broke during birth. He was pretty big (9.5 pounds), but no one ever said anything about him being stuck. I think I would have known if he were stuck! The clavicle was kind of horrifying to find out about, but really absolutely no big deal in our case. Now, no one broke it on purpose, which might be a different matter.

[doctorjen]

I recently had a birth like that, too, where the clavicle broke spontaneous. Mom was pushing on hands and knees and I had my hands on the head as she pushed the baby out to prevent her dropping on the hard hospital floor and I felt a pop as the clavicle broke, but there was no shoulder dystocia or even sticky shoulders, really - so sometimes it can just happen. spontaneously. Fortunately in little babies, broken bones mend rapidly and usually even if the clavicle is very displaced, it heals without even leaving evidence of a fracture.

Breaking the clavicle is one of those things considered as a last ditch effort to free a very stuck shoulder dystocia. The thing is, it's easy to say but hard to do! It's hard to get into a position where you can reach the clavicle well, and then very hard to break it at the angle you are able to get a hand on it. The one time I ever wanted to consider it, I couldn't get a good position on the clavicle. Baby was stuck for 5 minutes after birth of head, and had a brachial plexus palsy which was fortunately temporary. Very, very, very scary.

[JaneSmith1010]

doctorjen, are you an MD or OB? If so I am surprised to hear you say you had a mom pushing on hands and knees. Where do you work?

[doctorjen]

I'm a family doc (MD by training.) I work in north central IL, in a small town.
The majority of my clients birth squatting, standing, or hands and knees by their choice.