Shoulder Dystocia

[WriterMama]

What has been your experience with shoulder dystocia? Also, at what point do you consider a situation "dystocia" as opposed to just tight shoulders? What do you have your ladies do in that case?

[candiland]

I've seen one dystocia birth firsthand, and one of my good friends developed s.d. with her second homebirth.
I think one of the most important things to do is try to visualize a healthy, positive outcome every chance you get. I am a firm believer that we can manifest physically both what we most desire AND what we fear. If you give too much energy to a negative outcome, the chances are that much greater of it coming true. Do a cleansing, maybe each night before going to bed, of your "ideal" crowning/birth experience. Really feel it, smell it, sense it, make it seem like you are THERE. You will really start to believe in a good outcome and override your fear. Trust me, I did it with my first ;)
Secondly, stick to a really healthy diet and exercise routine. It will keep unwanted poundage off you and your baby. It will also make you feel very confident that you will have a healthy, happy birth experience.
Thirdly, birth in the hands-knees position. It would probably ease your fear and help reduce the chances of it happening again. Although, many midwives believe that it is the movement of the woman - and not necessarily the birth position - that frees the stuck shoulder.
I think that these three things would practically guarantee a successful outcome. Good luck!

[WriterMama]

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[birthinglau]

I wanted to speak to the "Gaskin Manuever" that Ina Mae Gaskin uses. I haven't seen it in practice, but among midwifery circles it is well regarded as a great way to get stuck shoulders out. I've also listened to Ina Mae talk about it, and watched a birth video of Carol, another of the Farm midwives, when she had her own birth with shoulder dystocia. Her baby was a bit over 10lbs and as she flips from semi sitting to hands and knees the baby corkscrews out, thanks to the movement of mom and the new position widening her pelvic outlet. It's actually being taught to OB students in some places, as a way to get those stuck babies out without instruments or episiotomies.

Also, this baby could be smaller, or have a different shoulder diameter. In that case it won't be an issue at all (but I understand completely worrying about those kinds of things, I do it too).

-Lau

[WriterMama]

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[lilyka]

For some reasons babies around here are born with nourmous shoulders and it seems many of my friends have given birth to babies with shoulder dystocia. It seems to be commanly aggreed upon by these mommies that hands and knees are the only way to go. It is the only position I have delivered in and I have never had a problem even with my larger than life second child :)

[tmarina]

One thing to keep in mind is that most midwives agree that no one thing works all of the time for shoulder dystocia. It's best not to choose a preferred method like the Gaskin maneuver now, because it will just be one in a series of maneuvers your midwife should go through if a shoulder dystocia occurs. For a lot of midwives, it is the first and possibly the best in a series of maneuvers, but it does not work ALL of the time. It didn't work in my second birth, which was coincidentally my second shoulder dystocia. I hesitate to write that because I don't want you believing on any level that it will happen again for you. Just remember that shoulder dystocia occurs in something like only 1 in 1000 births...and keep with your positive visualizations.

[marymom]

I too, hesitate to say anything but...I am going to because it is before me to do~ I believe we have discussed this before WM in PMs, if that wasnt you and you want to PM me please do :)
I just recently spent alot of timeboth posting on the international brachial plexus message board ( http://www.UBPN.org ) and writing on the small private email support group that I help moderate discussing this very subject with moms -explaining to them that elective c sections did NOT have to be done for every subsequent birth <rolleyes> the support group is for mums who have children with erbs palsy, all except one that are in our group of about 30 resulted from shoulder dystocia, the injury stat is about 1 in 1000, 1-3 actually, dystocias are more common in my opinion, I have both experienced one(my son has erbs-it was a homebirth) and been to a birth where there was one, also an injury but it wasnt permanent. Of all the mums I know that have subsequent birth only 3 have had vaginal deliveries...Those women will tear you up on a message post if you even suggest vaginal birth...well they are getting better but <sigh>
that said...
If you are still very nervous about this it IS possible that your intuition is directing you...likely it is your fear, but perhaps it is helpful guidance from your higher power, I believe strongly thatthis sometimes happens for us, I want to strongly urge you to discuss this with your midwife, if she is a licensed experienced homebirth midwife,(ok even if she isnt licensed, the emphasis is experienced and well versed, good reputation )she should tell you how she likes to handle this, how she has handles it in the past and so forth, if she thinks you should go to an OB likely she will tell you, likely she would have an educated and valuable opinion about this...
I agree strongly with the others about all 4s, I personally believe that my son's injury and more than half of the others I have heard about could have been avoided with the all 4s manuever, -I was at THE FARM and have seen Ina Mays dystocia video also, I think she has done more wirk on educating midwives about dystocia resolution than most and I commend her for that -
When are you due? Think O O O O open do squats, prenatal yoga...low carbs you know the drill-
blessings of a wonderful birth, I apologize if my material is alarming, it is sincerely meant only to support you.

[KeysMama]

I have seen it as a doula and homebrith assistant. Just changing mom's position and keeping calm does wonders. As the assistant my job is to time birth of the head and birth of the body.

As a homebirth MOM, I had a shoulder dystocia. Her body cam 5 min after her head. She was looking like a real purple grape needless to say. APGARS fine though. I was alreayd in the Gaskin position, so I stood up and lunged side to side doing pelvice thrusts until MW could get under an armpit and help her out. At the time , everything just froze. I had no idea what was really happening, only a truly instictual need to get up and MOVE.

MW was calm, and steady and so were my helpers.
Peaceful space and being a LIMBER lady helped me out.
This was my 2nd baby, she was 8#10 oz. My first was #8 2 oz. I am a small lady- 5'5 and 110#.


:hippie

[WriterMama]

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[KeysMama]

Originally posted by WriterMama
For that reason, I am re-thinking delivering in the water. The tub will be there for labor, but I feel that I'll have more movement options available if I'm outside of it.

Interesting point. My MW is one of the original pioneers of the international waterbirth movement. She even commented to me after the birth that it was wise I followed my instincts and got out of the water as delivery in the tub would have presented a bigger problem with the shoulders.
Water birth is awesome, but does limit mobility for sure.

[marymom]

oh that is definately interesting, the one birth I was attending with a dystocia was in the water, squatting.
I am so happy for you WM, I have a feeling youre goingto have a wonderful birth :)
birth blessing blossooms,
mary

[WriterMama]

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[marymom]

who is your MW? Are we allowed to ask about names on here? I will be down in DelRay on Saturday with Connie Mullen, LM, CPM, taking a class - if anyone is near there, I live up in FortPierce-

[WriterMama]

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[halah]

The manuveur that KeysMama mentioned sounds like the same move my doula calls it the "Stomp-stomp-squat" and it's when the mom stands up, stomps left and right in a wide stance and then squats down. A few births before my own, she and my midwife attended a woman with a 10 lb baby girl whose shoulders got stuck. They tried a few things like the Gaskin manuveur and when it wasn't working effectively enough, she had the mom do stomp-stomp-squat. Although arduous for the mom, it worked well and the baby was birthed, healthy and beautiful.

(Simultaneously to when this was going on, my coworker who was due at the same time as me was scared into doing an elective c-section by a doctor who told her he thought her baby was going to be huge and the shoulders would get stuck. She acquiesced and the doctor delivered a normal 8 lb. 14 oz girl, a big healthy size but no monster. They told her afterwards that the ultrasound they did to measure the baby had a "significant margin of error.") Now of course with the current anti-VBAC climate in Florida she will probably have to have repeat c-sections if she wants more kids.

[Kristina]

I feel moved to reply, and I respect you and any decision you feel comfortable with, however I had a sholder dystosia with my first baby. My son was still born. I don't want to scare you. But make sure you KNOW and are CONFIDENT with your midwife. My midwife did not have the experience and I should have asked ahead of time more things that I didn't even think of.
And while sd occurs in only 1 in 1000 births, think of how many babies are born every day. Sholder dystocia `occurs all the time. Every day.
I don't intend to scare you, but your fears are justifed. From where I stand, your fear of s.d. could mean a life. Just be sure you entrust your life and the life of your child to the most qualifed and experienced midwife you can find.

Lovingly,
Kristina