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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

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