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Alright ladies, lay it on me


I need to get some first hand accounts here. I am trying to find out what the true incidence of Shoulder dystocia is in homebirths if possible. I'm having a ton of trouble finding real statistics, because it's so badly under reported.

Does anyone know of any credible links to the definition of true dystocia? How do you define it in your practice? How many times have you seen it?
 

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I am only a student but I too am interested in this topic. I have a close friend who lost her son at a homebirth to shoulder dystoca and I have 3 other friends, (online) who lost their babies to shoulder dystocia. My last baby was 11 pounds and I noticed it was very, very difficult to push her out..which makes me worry about the dystocia issue. Before my friend lost her baby.. I naively thought..just have faith..follow your body, etc. but NOW.. well, these people did all the "right" things.. why didn't they have the good outcomes?? This is an issue I will always find near to my heart, for many reasons..
: I want to trust birth..but sometimes it is hard.
 

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I don't have tons of experience with it, I am interested to see what people say here...
:

But I will say it does not always happen b/c of the size of the baby, it is more the size and position of the baby in relationship to the mother's pelvis... for instance, the one true case of dystocia I encountered involved a baby whose head was almost fully out but kept backtracking (the "turtle") as if something inside the mom was keeping the body from emerging (the shoulders being stuck). Mom went on all 4's and the MW reached in to do a sort of corkscrew maneuver. It took time and several pushes, baby born very depressed and the head was dk blue purple but she revived.. she was 7 1/2 lbs. and the mother was not tiny, the baby just got a shoulder wedged behind that pubic bone as she descended and it was tough getting her past it. Conversely, when I was having my son an OB gave me the dystocia speech. He came flying out, very fast birth and he was 10 lbs 2 oz (I am 5'2" about 125 lbs). It saddens me when OB's suggest c sec b/c the baby is getting "big".
 

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I've seen someone have distocia - and it is very scary, I would agree. I think there are few situations I've been in that have shaken my faith in birth like being there for the distocia. Pretty wild.

In this case, baby was 9lb but Mom was more than able to push that size out - it was a case of positioning, Mother-position and emotional issues that held baby back. Baby was born with petikia (that purple/blue face) and required some oxygen, but was otherwise ok. The MW was worried she'd broken baby's clavicle getting baby's arm out (before rest of baby born), but she didn't (phew).

My boys have been 7.11, 8.8 and 9.12 - I will say that the hardest to push out was the 8.8 - he is still a very big kid and it had little to do with the fat on him them as it does now.
Our 9.12 was the fastest by FAR (5 minutes total from first push).

In my limited experience I would say that a skinny baby can have a large/wide head and shoulder breadth without being big... and I've seen more trouble with the births of babies that have quite a larger measurement of chest than they do circum. of head. But that's my limited exp. only (50 births?). Anyways...

Fruitful... I think you have to just trust that birth works on it's own 99% of the time, and we are there for the 1%. I wish no one would suffer that tragedy.
 

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:

My son got stuck on the way out. I ended up on all fours, pushing, and that still wasn't enough. The midwife had to put his (male midwife) hands inside me to turn and pull out DS. Mine was a birth center birth, not a homebirth. My friend (who attended the birth to support me) is an L&D nurse and said it looked like a moderate shoulder dystocia to her. I never asked the midwife though, as I processed the experience with my friend's help. My son was blue when he came out, but more a light blue. He needed a bit of oxygen, and had a nasty bruise down one arm, but otherwise was fine. He was 9lbs 9oz btw. My husband and I both have broad shoulders, and my son has inherited them, so I'm actually expecting another instance of shoulder dystocia with my baby due in March.
I'm still very curious about shoulder dystocia, and how it's defined by different people.
 

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I had a hard shoulder dystocia with my 4th baby. His clavicle did break, and you know, when I realized why it broke, I really didn't care.
As I was pushing him out, I had no idea that he was stuck. The midwife practically climbed into the tub and stuck her hand inside and twisted him out. My dh said she looked VERY serious, and he knew something wasn't quite right. I didn't realize the entire implications of the situation until much later, and I really feel that a broken clavicle is a small thing compared to what could have been.

Now, as an apprentice, I have seen one pretty tough dystocia with my preceptor, and a couple of sticky shoulders as a doula in the hospital. Fortunately, every one worked out fine.
 

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I've seen 2 true dystocias (in about 30 births as a doula and then an apprentice).

The first one was not too serious, baby retracted during first push to crown, midwife had her flip from semisquat to H&K and that resolved it with the next push a few minutes later, baby slid out. This was a second baby, and mom had a similar dystocia with her first, so midwife was aware, and mom felt intuitively that she should act if the baby seemed to be getting stuck.

The second one was in the water, thank goddess, because this was a looong second stage for a second baby (we were beginning to wonder what was up, since her first birth had been very quick and easy). All along mom c/o intense pain in her pubic symphysis. Baby finally at crown, but mom says he's stuck and won't come farther. The midwife felt for any obstructions, and felt shoulder were in a strange position. She tried to get under the arm and slip the shoulder under the pubic bone but it wouldn't budge, and ended up bringing the baby's head and shoulders up toward the pubic bone, then wiggled them down toward the perineum, got a hold of the arm that was just below the pubic bone, which had been trapped behind the baby's back folded at the elbow, and then corkscrewed him out. Time from crowning to baby out in the water was almost 8 minutes. Blessedly, he was just fine, and nursing 2 hours PP. I did a little bit of craniosacral on him, he did have crazy molding, and the chiro came to see him the next day.

Turns out the mom has a fused tailbone from her first, medically managed birth. During pushing the Dr. pulled her baby out, snapping her coccyx.

As a massage therapist, I now wonder how many shoulder dystocias are caused by trauma to the bones of the pelvis (and possibly the pelvic floor muscles and connective tissue) following traumic birth injuries to mothers (iatrogenic or otherwise), car accidents, or other traumas to the body

-lau.
 

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Discussion Starter · #8 ·
Quote:

Originally Posted by birthinglau View Post
I've seen 2 true dystocias (in about 30 births as a doula and then an apprentice).

The first one was not too serious, baby retracted during first push to crown, midwife had her flip from semisquat to H&K and that resolved it with the next push a few minutes later, baby slid out. This was a second baby, and mom had a similar dystocia with her first, so midwife was aware, and mom felt intuitively that she should act if the baby seemed to be getting stuck.

The second one was in the water, thank goddess, because this was a looong second stage for a second baby (we were beginning to wonder what was up, since her first birth had been very quick and easy). All along mom c/o intense pain in her pubic symphysis. Baby finally at crown, but mom says he's stuck and won't come farther. The midwife felt for any obstructions, and felt shoulder were in a strange position. She tried to get under the arm and slip the shoulder under the pubic bone but it wouldn't budge, and ended up bringing the baby's head and shoulders up toward the pubic bone, then wiggled them down toward the perineum, got a hold of the arm that was just below the pubic bone, which had been trapped behind the baby's back folded at the elbow, and then corkscrewed him out. Time from crowning to baby out in the water was almost 8 minutes. Blessedly, he was just fine, and nursing 2 hours PP. I did a little bit of craniosacral on him, he did have crazy molding, and the chiro came to see him the next day.

Turns out the mom has a fused tailbone from her first, medically managed birth. During pushing the Dr. pulled her baby out, snapping her coccyx.

As a massage therapist, I now wonder how many shoulder dystocias are caused by trauma to the bones of the pelvis (and possibly the pelvic floor muscles and connective tissue) following traumic birth injuries to mothers (iatrogenic or otherwise), car accidents, or other traumas to the body

-lau.
That is very interesting Lau. I've been searching and searching, but of course there is no studies on this...Also, I'm wondering why I never hear of anyone doing a hip press to resolve SD? I'm re-reading Ina May's Guide to Childbirth, and she talks about doing this for really difficult cases, but I never hear of it being used in practice, I was just curious.
 
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