Shoulder Dystocia

[Carlyle]

I hope it's okay for a non-birth-professional to post a question here. If not, sorry! I'm curious whether a mom (okay, me) who had a shoulder dystocia with her first baby is more likely to have it again with a second baby.


In case it helps, here's the "brief" synopsis of my daughter's birth (okay, I lied, it's not brief, but it could have been longer):

1:00 am Nov 14th: water broke, contractions started 10-15 minutes later and were fairly strong within the first hour.

I also threw up for the first time within the first 2 hours of labor and kept throwing up the entire time. By 10am-noon (??) or so, I was dilated to about 5-6 and my ctx suddenly got less frequent (went from every 2-3 mins or so, to a brief period of totally unpredictably random intervals that I mistakenly hoped was transition--hah, then backed off to every 8 mins or so).

My mw was worried that I was getting dehydrated because of throwing up so much and not keeping any liquids down. So she started an IV and said things should pick up soon.

No dice--Exam showed that baby was posterior--mw tried turning the baby by putting her hand up inside me (ouch!). We did this twice several hours apart, but no turning and still ctx are far apart.

I got out of tub, tried walking, shower, nipple stimulation, lots of stuff, but ctx still would not come faster.

Finally at 1am the next day, I start worrying about infection (lots of vag exams, water broken long time) and am scared anyway. We decide to go to hospital for pain relief, pitocin, and abx.

After getting to the hospital, Nubain for pain relief was the only time fetal heart rate went down (I didn't like it either--felt suffocated) and went on O2. Not relaxing, so next tried epithecal shot (around 9am?). Bliss. I was finally able to nap, and during nap, baby turned anterior, and dropped, and I dilated to all but a lip.

Started pushing at 1:00 or so, baby was born at 5:10. Head came out (after small? episiotomy) and then "she stopped as though she had hit a wall" as my mom put it. MW and Labor nurse jumped up and pushed down just above my pubic bone and doctor started rocking my pelvis back and forth (I think he was grabbing baby's arm or something?) and I remember the following exchange very clearly: they were saying "PushPushPushPushPush" Me: "But I'm not having a ctx right now." Them: "That's okay, this is the part where you push without a contraction." Fortunately I had no idea what was going on (beyond--"Huh, I don't remember this part in the birth videos")! And she came out pretty quickly I think (30-90 seconds after the hullabaloo and jumping on my belly??? My mom said it seemed like "ages" and baby's face looked blue), but this was her first time at a vaginal birth.

And my daughter was (and is) totally healthy, great apgars, beautiful , and I got to hold her after just a couple of minutes, and nurse, and everything was bliss. Oh, and she weighed in at 10lbs 7oz (don't know how much that was inflated by IV fluid and pitocin).

SO (gosh, I haven't written this out before...), since then I've learned a lot about shoulder dystocia (that would be "a lot" compared to the "nothing" I knew before) and it's really scary!!! I'm not pregnant now, but do hope to have another sometime--and I REALLY want to have the next one at home if at all possible. But I'm scared about having the shoulder dystocia again. Do y'all have thoughts??

Thanks, and again, sorry if this is posted in the wrong place.
Carlyle

[SublimeBirthGirl]

Pushing on your back like that decreases the size of your pelvic outlet and reduces the effectiveness of pushing, so SD is more likely. At home, a midwife would likely put you on all 4s to free a dystocia (gaskin maneuver) and this usually works. Prior SD wouldn't get me to the hospital. I'd much rather deal with SD at home, personally, since in the hospital the mother and baby are more likely to be injured (episiotomy, broken bones) during the treatment of SD.

[JessicaE]

I attended a SD midwife-attended birth in the hospital last summer (10 lbs 5 oz baby). I found it scary too, with a lot of tugging on the baby and pushing on mom's belly, desperate call for the OB, OB and nurses coming running into the room, etc. Mom was unmedicated and was pushing on all fours, too!

It freaked me out with regard to my own home birth (I was due about a month and a half after this birth). Especially since mom was unmedicated and already on all fours. My midwife told me that the trick isn't necessarily to be on all fours (yes, Gaskin Maneuver), but to change positions. So if mom is on all fours, get her into a full squat, or vice versa, or from side-lying to something else, etc. It's the changing-up that frees the baby, she said. So there was a possibility of a few different midwives being at my birth (long story), so I was sure to specify in my birth plan that I wanted the chance to change position before any tugging/pulling/pushing/panic.

I think that the hospital environment/response was what freaked me out as much as anything -- it could have been handled in an equally effective, but much calmer way, IMO. I *THINK* they have up to 7 minutes to get the baby out after the head emerges? Double-check that, of course, that just seems to stick in my head. But there was full-blown panic within seconds.

Anyhow, I know that doesn't answer your question about greater likelihood. I think there is certainly a greater likelihood that you'll have another big baby, so another SD would seem in the realm of possibility. Definitely something to discuss with your midwife when you're pregnant again. And if you're at home you'll be unmedicated so therefore more free to move to another position if needed. I agree with the previous poster that I'd rather be at home in the case of SD. There's really nothing more they can do in the hospital than at home if it happens, from what I understood after asking all my questions last summer.

[Carlyle]

Thanks for your thoughts! It's reassuring to hear that you don't think it's much higher risk to be at home with SD than at hospital.

They were letting me labor on my side for a long time (even after the doctor got there--he was willing to catch with me on my side), but then mw's and doctor said that it seemed like the pushes were more effective when I was on my back so we switched. I do feel like the hospital folks were outwardly calm about the whole thing (the "pushpushpush" was no different from how it had been all along!), although I think there was a great deal of rocking/tugging. I didn't realize that anything was scarily wrong until several hours afterwards when one of the nurses explained what "could" have happened and my mom told it from her perspective--yikes! Next time I will switch to all 4s, and talk to my mw ahead of time about SD!

I'd love to be at home next time for all kinds of other reasons (not having the cord cut right away, not having baby cleaned off, dim lights, etc)...

[Lizzo]

I had a 12lb 12oz baby at home who was a very frightening 5.5 minute shoulder dystocia. It is the flipping that usually gets the baby out. My son though also needed his arm to be broken and pulled out, then I changed positions twice more and he came out.
It is scary. But I feel was handled so much better at home.

[sunshine's mama]

i had about a 4 minute dystocia with my first (only know that bc i recently asked how long she was stuck there) and they didn't do he gaskin bc i had had an epidural and couln't do it......

this time, i sat up more, not on my back with feet in stirrups and held my legs back kinda behind my knees...this dd was posterier too but turned alot sooner during labor than her big sister....

no dystocia this time. it was the thing that scared me most and why i had Dp drive us to the hospital when i was almost in transition bc i didn't think we coulda handle it at home......but all was ok.

i truely believe it's very positional and all in how you push. i look back at labor pics of me pushing 3 years ago and can't belive my legs r where they are, my back so flat and my arms so straight when pushing.....and nobody told me it was wrong.....

[MamaKalena]

Carlyle - I came here with the same questions. I, too, am not a birth professional so I hope this is okay. My son, now almost 3, was a shoulder dystocia baby and born at home. I am preg now with my second and plan to birth at home again. But like you, I wonder what the chances are for another SD birth?

In a nutshell, here's what happened. After 4-5 hours of pushing, my son's head was born, but not the rest of his body. Apparently his little hand was visible by his cheek and his elbow was bent up and out, keeping him from fully coming out. I was in a squatting position, propped up under my arms by DH. Everyone in the room helped me flip over onto all fours. Our super-hero midwife reached in and pulled out my son's arm and he came sliding out. He was not breathing, but thank heavens, the midwife was able to resuscitate him right away. I think maybe 2-3 minutes (?) passed between his head and body being born.

The previous PP thought maybe positioning/pushing determined shoulder dystocia, but I have to disagree. I tried a gazillion positions over the course of 4-5 hours. I was like a naked acrobat! During labor, our midwife knew something was up, since his head would come down the canal repeatedly, and then retreat. But I was holding up well and so was the baby so we pressed on.

My son was an average-sized baby - 7 lbs, 13 oz. My husband and I are smaller people. I'm 5'3 and 115 lbs and small boned. My midwives measured my pelvic cavity later and said it was completely normal. Everything I've read points to shoulder dystocia babies being larger babies or their mother having diabetes, but not true for me.

DH is still freaked out about the birth even years later and I know he's not sure about doing it at home again. (He had been told to call 911, even though we ended up not needing them, so that didn't help his nerves.) I believe he feels that it would have been safer to have a c-section after a couple hours of pushing, which probably would have been the case had I been in a hospital. I doubt they would have let me push for that long -- or that I would have been made comfortable enough to be able to push that long. If so, I'm sure the procedures for getting the baby out would have been much more forceful and harmful with a worse outcome.

I have always felt fortunate that I did have a homebirth because I truly believe a midwife is the most skilled person to handle situations like these. My midwife in particular was especially experienced (way more than any hosp. doc could dream of being!) and had been delivering babies for over 30 years. I know both myself and baby will be safer here at home. I was so amazed at how calmly, gently but swiftly our midwife handled the situation. My son was born healthy with normal apgar scores and thankfully no damage.

All that said, I still want to know what the odds are of this happening again so I can be better prepared. I did find one stat (from another thread posted a couple months ago) saying that there's a 10-15% chance of having subsequent shoulder dyst. birth. I'd like to get more input from other birth professionals, however. So if anyone's had any experience with shoulder dystocia, I'd really like to hear about it.

[GatorNNP]

If you think it is due to the size of the baby then the chances are higher that you would have it again since second and third babies are usually larger than the first. However the rapid turning late in labor may have contributed to the shoulders not being able to get into the best position if there wasn't as much room for them to turn. It doesn't sound like that long of a dystocia especially if you were in hospital on your back etc etc, things may have gone better at home. Hosptial people tend to freak out depending on the culture and the physician. I have worked with RNs who stay very calm etc and MD/MW who stay calm. However at the tertiary hospital where there is less experienced staff the RNs seemed to get much more freaked out, even though there is 24 hr pediatrician coverage. Without epidural or that type of thing you are more able to move about and assist the birth attendant with the maneuvers, and that is more likely at home.