Shoulder Dystocia

[Montse]

I had my weekly appointment with my midwife today and she said because I have a big baby (she's estimating over 9lbs), I may need a c-section. I burst into tears, of course. She said my ultrasounds place my baby in the 90th percentile in terms of size. I retorted that ultrasounds are inaccurate at determining prenatal weight. She said yes, but based on my baby's growth trend, she believes my baby is over 9lbs. She felt my belly and asked what I thought and I said 8.5 lbs and she said no, over 9lbs based on what she was feeling. She said since this is my first baby, there is no way of knowing if my pelvis can handle it! :

My official due date is next Friday and I'll be 39 weeks tomorrow. If I don't go into labor before then, I'm at greater risk of having a more difficult delivery because of continued growth and she'll have to strongly recommend induction. : So, I am going to walk every night and get down with DH to encourage labor before the 19th. Since shoulder dystocia is a problem in only 5-20% of big babies, I have to proceed with my plan and believe in my body. I'm so disappointed in this news.

I have another appointment on Monday and then Thursday. She wants to check to see if my baby engaged yet. She said big babies don't engage easily either! She couldn't feel my cervix today! Is there anything I can do?

Have any of you had this issue? I'm so scared of having a c-section and not being able to breast feed, bond, dying etc. Am I am being crazy?

[amitymama]

Your midwife is insane, not you sweetie. Is this an independent midwife? I can't believe the crap she is spewing, she sounds like your typical OB! :

She's making you second guess yourself because you've never done this before but I'm sure you already know that the weight of a baby is impossible to determine before birth, that a big baby does not automatically equal difficult birth or shoulder dystocia and that an 'unproven pelvis' is code for 'we don't trust you or your body and don't think you should either.' Unless your MW can prove that this baby is ginormous and that your pelvis is misshapen or too narrow to conceivably handle a vaginal delivery, I'd just tell her to back off the induction/c-section talk and allow things to continue as they are. Are you birthing at home or in the hospital? Either way, it shouldn't be a problem to at least 'allow' you a trial of labour. If things don't progress or it seems the baby is distressed or stuck, decisions can be made at that point. There is no need to jump the gun and assume the worst now.

Chin up mama, don't let her get you down and arm yourself with lots of empowering knowledge and confidence to confront her at your next appointment.

[earthmama369]

My youngest had a shoulder dystocia birth. Yes, he was big -- 10 pounds, 4 ounces. But that's not the main reason it happened. His cord was short, which tethered him in place and didn't allow him to rotate into the right position for descent. That's a very rare defect and not something that only happens to big babies. His weight had nothing to do with that.

I labored in the water after about 5 cm and changed position often. Mostly I stayed upright. The feeling that he was stuck was unmistakable compared to my first birth. DD slid back and forth as I pushed until she just slid right out. DS got his forehead out and stopped. He didn't slide back at all and I couldn't get him forward. I told my resident what was happening, he confirmed and called for help, and within seconds, we had someone helping me get ds born. There are maneuvers to deal with that situation. In our case, a McRoberts and corkscrew did the trick. DS suffered no shoulder or collarbone damage. We had other problems going on because of the short cord, but the shoulder dystocia itself was quickly resolved with no further consequences.

Is shoulder dystocia a risk? Sure. And yes, it's scary. But there are things you can do to mitigate that risk without jumping right to a c-section, which carries its own risks. Labor in positions that open your pelvis up as much as possible, and change positions frequently. Feel comfortable with someone who knows how to handle a shoulder dystocia and is conversant with all the maneuvers that can be done to resolve it. And don't let anyone tell you that big baby automatically equals a shoulder dystocia or a c-section. Plenty of women have given birth to big babies, and plenty of those have been first-time mothers, too. You don't grow babies bigger than your body can handle. Shoulder dystocia is about positioning more than size -- either your size or your baby's.

[lotusdebi]

Not in your DDC, but...

I have two children. Both had shoulder dystocias. Both were successfully delivered with the help of midwives - one CNM at a birth center (9lbs 9oz), one CPM at home (10lbs 8oz). Both used the Gaskin manuever.

If your midwife isn't comfortable with her ability to help deliver a big baby or a shoulder dystocia baby, you need to find a new midwife.

[cellarstella]

I have to agree with everyone, here. The whole reason I would have a midwife is to avoid this kind of fear-mongering. There are some midwives that feel like if they don't warn you about all the bad things that can happen, then you will blame them if they do. Instead they just cause a lot of unnecessary worry and interventions. Relax, breathe, and enjoy your last week(s) of having the baby on the inside! Birth will happen, and you will get through it, there is no reason to make it any harder than it is on it's own.

For my first birth, I had a midwife I found out I didn't like in the last weeks of pregnancy, and I didn't want to find a new one at that point so I stuck with her. I still had the home-waterbirth I wanted, but every time I think about that birth I just really wish she wasn't there. During the birth I pushed her away a lot and that made her energy more negative, but as long as I was in another room I could just shut her out and be in labor land. I was upset at myself for having her there up until the beginning of this pregnancy when I had to really reflect, and now I'm at peace with it. It's just how things happened.

[ssolberg99]

No advice. Just

[winginit]

This last guy was big for me...9 pounds 4 ounces...and I have petite 5 foot frame. We had a few scary moments with shoulder dystocia but my midwife was familiar with the Gaskin maneuvre as well (only medical procedure named for a midwife!). I'd make sure your midwife was experienced..but they know how to deal with the situation. Unless you're diabetic your body is going to make a baby that will fit through your pelvis..perhaps your midwife is just a newer one? I've had clients and friends birth babies over 11 pounds at home!!

I asked my midwife what they would have done at the hospital and she thinks they would have been flustered...I think midwives are much more prepared to deal with this particular situation then an OB will be!

[MommytoHHH]

I had an U/S at 37w5d that showed baby measuring 40 weeks and weighing 8lbs12oz. Since almost 9lbs seems kind of large for 37 weeks, I asked my OB about it. He said that 1) he wouldn't put any stock in it and 2) there's no reason I can't deliver a big baby. I guess I'm surprised that a midwife would be putting that much emphasis on a c-section. My OB is pretty mainstream and he never said a thing about a c-section or shoulder dystocia to me. He also will not do anything to induce until after my due date - despite the fact that my baby does seem to be big. This is my second child, but my DD was a puny 7lbs at birth...

[dimibella]

and another successful shoulder dystocia baby born at home here.

[snowgirl]

Originally Posted by Montse

She wants to check to see if my baby engaged yet. She said big babies don't engage easily either!

Not in your DDC, but have to share...My Sil just delivered(last week) a 9lb baby. The baby was in engaged and was born unmedicated, vaginally. She was 9 days past her due date. She was induced by breaking her water.(I didn't agree with this decision as there was no reason to induce, but anyway...)

I don't understand why you can't try anyway? Why does it have to be so drastic. I believe in your body to birth and I am sure you do to.

I agree with the other posts as well. Stay strong, stay confident, you can do it!!

[~Demeter~]

Not in your ddc, not pregnant either! But I wanted to tell you, our midwife doesn't sound very competent at all. I had a shoulder dystocia baby (he was actually my smallest), born vaginally.. unfortunately my doctor wasn't to in to the Gaskin maneuver and broke my baby's collar bone.. had I known then what I know now things would have been different. SD is not an automatic c/s so don't let her talk you in to that and if she feels like she's not capable of assisting you with that possibility I would definitely be looking in to finding another mid-wife.

[mama to 2 girls]

I'm not in your DDC but I just wanted to give you 's and to say you should find another m/w!

I just had a 10lber at home on July 11th with a m/w and yes he did have shoulder dystocia but it was handled very well and calmly by my m/w. So even if it does happen it's not the end of the world. Like the op said it is scary but if you have a good m/w who knows how to handle it, it's all good!

ETA: palpation is sooo inaccurate....my m/w's swore up and down that my "little" guy was only 8lbs!

[DocsNemesis]

I agree, there is NO reason to schedule a cesarean or even an induction just because they *think* the baby is big. They really have no way of knowing A.) if the baby is actually large and B.) if your body can handle a large baby.

I had an OB for my first and I once asked him about this myself. This is a Harvard educated, been in practice for 30 years, OB. He said that womens bodies do not grow babies too large to be birthed except in very rare cases and most of the time, that is due to other issues (ie uncontrolled diabetes, genetic issues, etc). He told me that, at the time (this was 8 years ago now), he had NEVER seen a baby be too large to be birthed vaginally. Yes, he had had cases of shoulder dystocia, but he had always had no problems managing it. I think he's one of the few OBs I've heard of that actually uses the Gaskin maneuver himself. The one time he was worried was with a teensy Asian woman who's dh was a BIG Samoan. But even with her, the baby was only 7 pounds and there were no issues.

I think you either need to be prepared for a fight and be confident in your body so you arnt second guessing yourself, OR you really need a new provider. Do some research, check out the risks and know you are making the right decision. I had my first cesarean 6 weeks ago and while I would do it again, it isnt something you want to just do because. It was hard, I wont lie-but it would've been even harder if I hadnt needed it. (And even as it is, I cant help second guessing my decision to go ahead with it) Please, look into finding a new provider who wont be freaking you out like this!

[Serenyd]

http://www.mothering.com/discussions...9#post12145839 here's a SD thread from the UC forum.

Have you considered switching midwives? This one doesn't sound very natural birth friendly.

[immamama]

First of all - the issues you are worried about are really not something you should be fretting over.

I have had NO TROUBLE whatsoever nursing all my babes and have had c-sections. Bonding was never an issue.

As with any surgery and even natural childbirth - death can happen, but it is rare these days.

Praying for you!

[GriffsKat]

That's a bunch of bull-honkey about big babies not descending. My midwife estimates my baby is 8lbs+ and she felt his head today via cervix. He's been engaged for over a week now. You can do this. Don't believe a word she says.