shoulder dystocia - Mothering Forums

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Old 07-31-2006, 04:10 PM - Thread Starter
 
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Hi everyone,

Just wanted to thank you all for the inspirational stories you shared here!

Here is my story:

We are expecting our 2nd baby (edd 02/09/07) after a C-section with our son on 04/17/04. He was a large baby (9lbs 10 oz) and the doctor tried to get him out with forceps after (what I think was) not enough pushing (I had an epidural, ctxs slowed down, oxytocin, then pushed for about 1.5 hr - I don't rememebr this timeline very well).

I just saw an OB and she thinks that I have a 50% of delivering vaginally
(which to me means 50% of having another C-section ). Her main reason is that I will be very likely to have another big baby and she thinks I am too small : She says that she has about 80% success rate with her VBACs, but I doubt it for the following reasons:
- she will not allow me to go even one more day past my EDD if she suspects a large baby.
- she thinks that epidurals do not affect the labor and she does not see a problem inducing a woman with pytocin.
- she does a measurement of the pelvis and measures the baby's head about 38 wks. If the ratio is not within her comfort level she will want me to have a C-section.

I am definitely considering choosing a different OB/mw, even though it looks like I will have to drive 1 hr to get there...

Here are my questions to all of you that had/heard births with shoulder dystocia.

Is there anything that I can do to prevent it (like a no-sugar diet), or is this more like a genetic thing? (My dh's family has a history of large babies, but I also ate quite a lot of ice cream during my last month of pgcy).

Are there positions that help deliver babies with large head/shoulders?

I apologize if my questions are answered somewhere around here, I just need a little bit of support after this appt.

Thank you, all and good luck to all of you!

Mom to DS (04) , DD ( 07) , DS ( 09)
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Old 07-31-2006, 04:13 PM
 
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I'm sure there is a lot of good info available to you for prenatal prevention, but the one thing I can tell you based on my last birth (2 weeks ago) with shoulder dystocia: Find a provider who will try a long list of position changes and movement to release any stuckness. My midwife and her assistant literally flipped me over and had my stuck baby out in seconds. If hands/knees hadn't worked, they had a list of several other things to try in succession before resorting to anything drastic.
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Old 07-31-2006, 04:22 PM
 
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Sorry to hear about your first birth experience. It sounds pretty traumatic.

If I were in your situation, I would definately be proactive about trying to grow a nice, compact baby this time. Did you get screened for gestational diabetes in your first pregnancy? In addition to the 1 hour glucose tolerance test, I would suggest that you do a few blood sugar tests 2 hours after a typical meal (this is called a 2-hour post-prandial). The 2-hour post-prandial can give you a good idea about how your body is processing the glucose in your normal diet.

The dietary changes to make are very simple: cut out the white stuff. That means white bread, white pasta, white rice, sugar, ice cream (sorry), cheese, lots of dairy etc. Focus on lots of fresh vegetables, fruits, legumes, lean meat (if you eat meat) and whole grains.

good luck. I hope you are able to find a provider you are comfortable with.

Jessi
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Old 07-31-2006, 05:32 PM
 
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Quote:
Originally Posted by dulce_mami
Are there positions that help deliver babies with large head/shoulders?
Anything is better than flat on your back, but hands & knees is prob best. Good luck!
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Old 07-31-2006, 06:02 PM
 
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A big baby does not automatically = sholder dystocia. As far as I know, true shoulder dystocia is very rare and what most OBs refer to as shoulder dystocia is just a slower delivery.

You definitely want someone who will encourage you to use a variety of positions during your next labor and birth. Upright, hands and knees, etc. are all preferable to being on your back.
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Old 07-31-2006, 06:02 PM - Thread Starter
 
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Thank you for your advice!

I have already been watching what I am eating, whole grains, almost no sugars, the only thing is that I do not like meat much, but I am trying to get more protein from beans. During my 1st pgcy I tested 129 (sugar levels), then they ordered the 3-hr. test and my sugar levels came out normal (actually, a little on the low side as the dr. put it). With this pgcy I started testing my sugar levels at home, but I never got more than 110 (mostly between 80 and 90), so it seems like I am ``normal".

Definitely I will ask the next OB/mw about a ``plan of attack" in case the baby is stuck, with the OB we saw today there seemed to be no reason, since she insisted that there is no way I can give birth to a baby over 9 lbs : I also started doing a yoga DVD that has a lot of squats and pelvic stretches, so I am hoping my chances of birthing naturally will be higher than fifty-fifty... Plus, I am more educated this time around, and I know that the way I think/feel is important for me and the baby (the first time I was very stressed out, finishing my phd, looking for a job, my dh had a job in the other part of the country, etc.). Part of me thought it was the baby's job to find his way out as long as I exercised, ate well -- which I did until my last month of pgcy ...

Thanks again for listening

Mom to DS (04) , DD ( 07) , DS ( 09)
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Old 07-31-2006, 08:09 PM
 
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with the OB we saw today there seemed to be no reason, since she insisted that there is no way I can give birth to a baby over 9 lbs
ARGH! I so wish for you that OBs weren't such idiots when it came to "big" babies - and I really do mean "big" as in supposedly big. I haven't had shoulder dystocia - then again I've never actually given birth. I have a wonderful 18 mo old ds, but haven't the foggiest idea what a contraction feels. I never went into labor b/c I was given the same spiel you are being given now about my "big" baby. I was coerced into a primary c/s (elective on my part according to my records, but that's a WHOLE nother can 'o worms).

Here's the deal...what you described from the birth of your first sounds nothing like "shoulder dystocia". It sounds more like OB dystocia in that their amt of patience as compared to the amt of time your body/baby needed to give birth was off.

Quote:
I just saw an OB and she thinks that I have a 50% of delivering vaginally
I'm amazed she even gave you a 50% chance. Most OBs wouldn't have even given you that much. She's giving you a very clear indication here. Even if she were to "let" you go into labor (and BTW, no one "lets" you do anything when it comes to the birth of your child - you let them!) you can probably already begin to hear the things that she is going to be telling you to undermine your ability to birth your baby. So...kudos to you!! You've read her right and are starting to look for another care provider. That's certainly your first step!

I think that eating right is a wonderful thing to strive for and very important for the health of you and your child, but please - don't go crazy! The fact of the matter is - your body (unless you have GD, which it doesn't sound like you do) won't grow a baby it can't birth! You are living testament to that! If our bodies were so flawed that we couldn't give birth safely w/out extensive medical intervention, none of us would be here even discussing this!

[QUOTE]- she will not allow me to go even one more day past my EDD if she suspects a large baby.[\QUOTE]

This, unfortunately, represents a very sinister undercurrent in our present birthing climate. It's beginning to represent a VERY large chunk of "elective" c/s. I would suggest that you familiarize yourself with the term "suspected fetal macrosomia" aka big baby. Do a search on any search engine for "fetal macrosomia" - it will be eye opening. One of many you will find is a 2001 study done by the AAFP. You can find it here: http://www.aafp.org/afp/20010115/302.html

Quote:
- she does a measurement of the pelvis and measures the baby's head about 38 wks. If the ratio is not within her comfort level she will want me to have a C-section.
This is another one of those crazy things that some OBs do that really provides NO USEFUL INFORMATION, other than it's a great way to scare someone in to doing what you want them to do. She can measure your pelvis all she wants, but that is NOT A RELIABLE indicator of whether or not a baby will "fit" through your pelvis! There is absolutely NO WAY she can predict how your labor will go based on this. Women's bodies are amazing in that they can stretch and change to accomodate a baby on it's way out to meet the world! Not only that, but the position you give birth in has an impact how much room a baby has to twist and turn its way out. It's amazing how something as simple as getting on your hands and knees or squatting can give the babe more room.

Pre-labor checks for dilation are another one of those things OBs like to do that provides NO USEFUL INFORMATION and is NOT A RELIABLE predictor!

And, last, but not least, RUN, don't walk your way over to www.ican-online.org. They have OODLES of info on their website that I'm certain you will find helpful - including some things to consider when choosing a care provider. They also have an email list that I am very confident you will find helpful. It'll be a little bit like drinking from a fire hose, but I know you'll find it worth the time and effort. Oh...and take a look to see if there is an ICAN chapter in your area. They'll be able to give you a better picture of the birthing climate in your area and maybe even give you some suggestions on providers.

HTH! Remember, YOU CAN BIRTH THIS BABY!
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Old 08-01-2006, 01:25 AM
 
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I'm not sure what can be done to prevent it, however, in Ina May's Guide To Childbirth (Pages 98-99 for those whoe ahve the book), she recommends a techinque named after her (she learned it from indigenous midwives in Guatemala). From what I gather, and in the stories she shares, the mother is simply moved to an on all fours position. This techinique, the "Gaskin Manuever", has proven very successful once it was adopted by the midwives at the Farm in TN.

Hope this helps!!
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Old 08-01-2006, 12:33 PM - Thread Starter
 
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Thank you for your replies! I really needed and enjoyed your passionate reply, pamered_mom! With our boy I was almost forced into an early induction of labor, but I was strong enough to refuse it (I went into labor on my own 3 days after my edd). However, when I was in labor and in quite a bit of pain (the epidural was not working at that time) and they told me I had no way to get the baby out (0 chance, the way she put it!), I had to concede. Also, my dh was pretty shaken after the forceps maneuvre, so he was very much for the C-section too.

ICAN is a great resource, there is no chapter in NE where we live, but I will get on their e-mail list.

The encouragements and the advice you all gave me mean a lot to me, I appreciate it!

Mom to DS (04) , DD ( 07) , DS ( 09)
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Old 08-02-2006, 11:40 AM
 
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I too was coerced into a primary c-section due to fetal macrosomia diagnosed by a late term U/S. I plan to VBAC next time (in a couple of years), and have found a midwife who isn't afraid of big babies. It seems to me that most doctors are afraid of big babies.
They said they suspected missed GD with me, and I plan to be extra viligent about diet and exercise next time, but sometimes I think that it can be genetic.
Keeping active in labor is key. A good book is "Active Birth"
There is also a website out there about Brachial plexus injuries that can be caused by shoulder dystocia (i can't find the link right now). Many of the parents are upset and think that their doctor should have had ordered a c-section for their big babies, however, if you look at the site's information for prevention it is all about positioning during birthing.
Good luck!
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Old 08-02-2006, 11:49 AM
 
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The organization i was thinking about was the United Brachial Plexus Network. If you are trying to Getate in Peace, I wouldn't read any of the message boards or parents testimonies, but I would look on the section on prevention, lots of good birth positions shown there if I remember correctly.
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Old 08-02-2006, 12:13 PM
 
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From my understanding, and I am not a doc or midwife, shoulder distochia is the result of the bones of babies shoulders being too big for the mama. It can happen at 6 pounds as easily as it can at 10 or more. It has to do with the frame of the baby, not the weight. Fat is squishy.
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Old 08-02-2006, 03:08 PM - Thread Starter
 
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I read more about macrosomia, and in one research article they said that shoulder dystocia happens happens in as many normal babies as it happens in large babies. The article was then saying that this should not be taken as a reason to not allow a woman to give birth naturally (even if it is a VBAC), since there can never be an accurate prediction of the weight of the baby or of shoulder dystocia until the baby is actually born. Apparently, if they were to do C-sections for all the babies they predict would not fit through the birth canal, there would not be enough resources for all the surgeries. They also did not recommend an early induction since that increases the chances for unnecessary C-sections. :

Another interesting thing I read is that only a small percentage of mothers have a second baby with shoulder dystocia and often is associated with diabetic moms. (they had data from two studies, both numbers were under 12%).

The authors also said that doctors should not fear the weight or the size of the baby, but rather avoid the brachial plexus injuries for which they suggested kind of a ``wait and see" apprach, rather than going through unnecessary interventions.

I was really attempted to e-mail this article to the OB I saw on Monday ...

Mom to DS (04) , DD ( 07) , DS ( 09)
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