Natural birth or C section after shoulder dystocia - Mothering Forums
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#1 of 3 Old 10-04-2012, 11:26 AM - Thread Starter
 
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Hi all,

 

I am not sure this is in the right place, so someone please alert me if I need to move it. Also, it is going to be long, sorry! 

 

I had my son in March 2011. He had a partial shoulder dystocia that has unfortunately resulted in Erb's palsy, requiring one surgery (so far), and many hours of PT. 

 

My birth was great, I labored at home until 5/6cm, then went into a hospital where I continued to labor without complications. My birth was attended by my midwife and a high risk OB, because of my mw being in a non-compete clause (she could not technically deliver, so she came as a nurse and the OB was delivering all of her patients at the time). 

 

During pushing, he became stuck. I am hazy on details bc at that point I was exhausted and focused on getting him out. It is my understanding that he was stuck and she rotated him, allowing him to finally come out. He had difficulty breathing, as well as temperature and blood sugar issues. I firmly believe that I was a case of undiagnosed GD, as he was also almost 3 weeks early, already 8lbs, and also suffered severe jaundice. My mw has agreed with this and we are already planning to treat me as GD this pregnancy (I am only 9.5 weeks so far). 

 

When my husband asked, my son's surgeon had told us that for our next child we would need to discuss options with our ob team. He said he has only rarely seen siblings both present with brachial plexus injuries. He also said he has seen them happen with C sections. So basically he had no opinion, but said to discuss further with my care providers.

 

My midwife says that she is not concerned with recurrence. She says that a) it was a matter of his positioning, b) likely the GD, and C) my pelvis is larger now after having one baby. 

 

I made the mistake of googling this issue, and came across some really scary info. One study claimed a 25% recurrence rate, with it even higher for SD resulting in injury. However, this is only with a sample size of 44. I also don't believe they included any incidence of the Gaskin method, which she claims reduced SD 82% when caught during labor. 

 

Basically, I am distraught. I worked hard last time and have a very strong believe in natural, no intervention birth. I have read a ton, taken classes, etc. I DO NOT want my baby cut out of me, but I also am not sure I can assume the risk associated with putting another baby through what my precious son has already endured at 18 months old. None of the literature I came across discussed GD in terms of controlled/not controlled, so I have no idea if controlling it this time will put me at a lower risk.

 

Any advice or input would be greatly appreciated. I have read a lot around here (including an older similar thread) and feel lucky to have found a place that seems to be full of smart women with similar values to my own.

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#2 of 3 Old 10-04-2012, 07:32 PM
 
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There are two things in your story that would make me strongly consider a c-section. 1. Your pelvis does not change size. 2. 8 lbs is an average size baby and there's no reason to think the next will be smaller. Good luck. 

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#3 of 3 Old 10-04-2012, 08:13 PM
 
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To be clear, your pelvic bones do not change size, but the ligaments and muscles that connect them have already gone through the stretch of childbirth.  This makes them easier to stretch with subsequent births (and also accounts for the extreme ligament loosening some women encounter).  A lot of people imagine the pelvic opening stretching in a single dimension, when in reality, there is a lot of stretching and movement in all three dimensions as the baby descends through the birth canal.  I have a friend who gave birth for the first time last year, with no hips to speak of, and she gave birth vaginally to an 11 pound baby.  And please remember, the weight of the baby is a poor determining factor for whether it will fit through your pelvis.  Humans are born with unfused cranial plates that allow the head to mold to the shape of the birth canal while protecting the brain.  This, combined with the natural loosening and stretching of the pelvic girdle allows us to birth much larger babies than if our pelvises maintained a static shape.

 

Also, the study you cited only studied 44 women who had births following a SD birth.  That small of a number, as you implied in your post, can hardly be used to determine anything statistically significant.  The Unnecesarean has a great post with that includes a meta-analysis (where multiple studies are reviewed and the data combined to preclude any bias that may have been inherent in the data of the individual studies) with over 2000 subjects.  The average rate from those is about 10%.  For some, that chance may be enough to encourage them to schedule a c-section, but, your particular case of SD could have been caused by something as simple as birth position.  If you delivered the baby flat on your back, the incidence of SD increases, whereas being mobile throughout labor, and assuming the position that feels best for you, generally insures the baby will descend without incident (as always, not 100% true for everyone, but there are plenty of things you can do to mitigate your chances, and it sounds like you're already doing a lot of them).  Given your history, I would recommend sticking with your midwife or an MD/OB, but I do not think having one SD guarantees another and should not be given as the reason to undergo a c-section.  The midwife thinking post below is also extremely informative about things we can do (and not do) during labor to help prevent SD.

 

Hope that helps, and here's hoping and praying that this pregnancy and birth goes well.

 

http://www.theunnecesarean.com/blog/2009/6/17/i-had-shoulder-dystocia-once-will-it-happen-again.html

http://midwifethinking.com/2010/12/03/shoulder-dystocia-the-real-story/

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