Shoulder dystocia - Mothering Forums

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Old 07-31-2004, 09:29 PM - Thread Starter
 
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For you midwives, if you had a client with a previous shoulder dystocia, would you do anything different with the next pregnancy and delivery?
I have a mama who had a 9 lb baby the first time 2 1/2 years ago, with a significant shoulder dystocia. I hadn't done as much reading about shoulder dystocia at that time, so used McRoberts and suprapubic pressure, which eventually freed the shoulder. The baby had a brachial plexus palsy, which resolved over the first few weeks. I actually haven't had a significant shoulder since then, so although in principle I think I'd try hands and knees now, I haven't had the opportunity. I don't want to cause another bachial plexus palsy if I can avoid it! This mom is 5 wks only now, so I have plenty of time to think about it, not to mention perhaps the next baby will slide right out.
But just in case, any shoulder tips?
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Old 07-31-2004, 09:58 PM
 
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I think it's really important to keep a mom off her tailbone for this reason - the semi-sitting position is often thought of as really good, but it really reduces that pelvic outlet.

What about sidelying? Or her even squatting or standing or kneeling? Maybe offering her more info on vertical delivery - and being more upright when in transition, etc.

The only shoulder dystocia I've experienced was with a 13lb sugar baby - a friend/midwife told the mother it would be better for her to be on her back/semi-sit. Ugh. Took this five time mom nearly two hours to push out the baby. I feel like had she been left alone to choose on her own, it would have been better.
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Old 08-04-2004, 01:43 AM - Thread Starter
 
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I should remember not to mention complications I haven't had in a while out loud!
Had a mom this weekend who herself weighs nearly 400 lbs. She had very uncomfortable back labor for most of her labor. She eventually requested an epidural as she was exhausted, then she slept for a couple hours, then woke up in transition. For pushing, she greatly preferred hands and knees, and ended up pushing out her baby kneeling. I am sure this would have been a bad shoulder dystocia in a less vertical position. As it was, baby came very slowly after the head, and even after both shoulders were visible, baby was still stuck until finally one arm, then the other popped out (I swear it almost seemed like the baby shoved her hands out on purpose!) Baby was pale and floppy right at birth, but recovered quickly. I'm sure this baby would never have come out with mom on her back; as it was, it was kind of scary. Baby had no problems from her slow, slow entrance to the world, and mom managed to push out this 8 lb 11 oz first baby with no tears whatsoever.
Then, mom proceded to have a massive postpartum hemorrhage, which is another complication I haven't had in a long while.
I'm hoping I'm caught up on complications now, and I'm due for some lovely normal births!
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Old 08-04-2004, 03:20 AM
 
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Here's to some sweet, wonderful butter births for you!
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Old 08-04-2004, 04:32 PM
 
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I'm not a doctor, or a midwife, but after a client in March had SD I did some research on my own. What I have found and heard from care providers is that it's moving the mother during the pushing stage that helps prevent the shoulder from getting stuck; having her push for a few ctx in one position, then moving (at least 90 degrees) into another position really helps to get the baby down without getting stuck.

I hope that's helpful!

Kristina in Kitsap County, WA
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Old 08-04-2004, 04:51 PM
 
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I am not a midwife, just a mama who has given birth to two shoulder dystocia babies, both at home, one with a midwife and one UC. Both my babies were small, 6 lbs 8 oz and 7 lbs 4 oz, so babies' size had nothing to do with the dystocia. With my first sd baby, my midwife had me move to hands and knees position once it was clear she was stuck and performed the Gaskin maneuver and she slipped out with nuchal arm. With DS my UC baby, he was born in the caul, cord around his neck, I broke the sack and removed the cord (very loose so easy to do). I was in a squat but when I realized he wasn't moving down further, I moved to hands and knees tried pushing but still he wouldn't move, so my DH, who has absolutely no knowledge of obstetrics and who had a copy of "Emergency Childbirth" on his desk for 6 months, performed his own version of the Gaskin Maveuver and easily unstuck the baby's shoulder. Again out this baby cam with a nuchal arm! Neither of my SD babies suffered any ill effects with apagar scores of 9 and 10.

t
 
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Old 08-05-2004, 04:48 PM
 
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I've been thinking about this post. Jen I wouldn't worry about another SD. Keep in mind that SD is positional, a bad match between baby and mom at that angle and the shoulder gets stuck. Force doesn't help much to get baby out, changing mom's and or babies position to get a better fit works. Read all you can and be ready, let mom show her worries but don't show her yours Have mom imagine a smooth birth where baby comes out easily, perhaps in her hands and knees or in a squat, etc. If mom shows concern about size have her cut back on carbs the last month of pregnancy. Tell her what you have learned about positioning and that being upright or H and K will help and why Isn't it fun to have repeats!
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Old 08-09-2004, 10:30 AM - Thread Starter
 
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Hey Pam, thanks for the good vibes!
I'm heading to a water park today with my nurse practioner, and all 9 of our kids between the 2 of us. I have a fellow family doc covering for me today, but took my own call last night. Shortly after I fell asleep, labor and delivery called me. A forty year old, about to be 5 time mom (but first in 11 years) had walked in in labor. I immediately imagined hours of lost sleep and a miserable water park trip. However, I crawled out of bed, and headed out. They called me at 11:10. I arrived at 11:20. The baby arrived at 11:35! This mom had 4 older children, 3 of them born by forceps, but this baby flew right out. I did feel bad that apparently I hadn't made clear to her during her prenatal care that I just about never cut an episiotomy. She said several times while pushing "please don't cut me" and even though I kept assuring her I wouldn't, she still looked worried. She had just a tiny skid mark at the top of her old episiotomy scar, though, and no repair even remotely needed. I stayed to enjoy her introducing the baby to her teenagers, and helped her latch the baby to breast, and was still home by 12:45. Little dd was nice enough to wake up then and nurse, and the prolactin helped me relax and go back to sleep.
So now off to the water park!
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Old 08-09-2004, 07:03 PM
 
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You are wonderful!
I want to just tell you that you know what to do. There are all kinds of things that can be done for SD, positional, hand manuevers, etc. You do what you need to in order to get the baby born.
The only true SD I have seen was caused by the midwife - she believes in turning baby's head...bizarre. It scared the bejeezus outta' me and made me even more determined to keep my hands off and only assist if it's needed. It also taught me that I DO know what to do in an emergency and baby is truly stuck.

I am wondering what the "gaskin manuever" previous posters have mentioned is. From what I have read the Gaskin Manuever is simply putting mom in hands and knees...right?

Peace.
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Old 08-31-2004, 04:16 AM
 
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Hi! Just jumping on this old thread here. I'm neither midwife nor doctor, just a mama who had an SD with first birth at home. It was resolved in a minute or so (don't know where my birth records are, or I could tell you the exact maneuvers the midwife used). My midwife told me a couple years later that she could really have called it a "full body dystocia" as once the shoulder came free she had to wiggle all 9lbs 11 oz of baby outta there

with second baby I followed as closely as I could dietary restrictions for pregnancy diabetes (sorry, it's 2 a.m. and I can't remember words at all right now) in hopes of reducing my chances of a large baby again, even though I was showing no signs of diabetes, and in hopes of lowering my chances of another SD. I was so freaked about 6 weeks before my due date, worried I was headed for another major complication, that my midwives all gathered the day after Christmas to meet with me for 2 hours and talk through the last birth and go over every inch of everything with me. At the end of it my fears were gone and I had decided (not my midwives) that home was still the best plan. And, my midwives (with their 27 years of experience) reminded me that an SD happens when you least expect it, but that something else would probably happen.

Well, a week later my water had broken (possibly 34.5 weeks gestation, although at that point we began to wonder). 48 hours later I gave birth to an 8 lb 13 oz boy who was estimated to be at about 36.5 weeks and totally ready to go.

Anyway, thought I'd share this with you. Whatever happens, this client is getting you ready for the next SD, even if it's years from now......envious of your occupation, but also know from my first birth that I'll be a better doula than midwife or OB.....
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