DH want me to opt for an elective c-section after first birth

[okinawama]

During my first birth my husband was down on the "business end" of things when my son experienced shoulder dystocia and was stuck for about 2 minutes ( that labor was epidural free, I was given the option to push anyway I wanted, but chose my back, my son wasn't all that large 8lbs 2oz).

I am seeing a midwife, who is completely positive/supportive of a natural delivery for me ( the only risk factor I have is a prior dystocia) and up until recently, I was pretty positive that I was going that route. However, I have had to see 2 different OB's in the practice because the MW was unavailable for my appointment, and rather than cancel I saw whoever was available. Of course, after reading over my chart, they both asked me to strongly consider a C-section to avoid another dystocia.

After those appointments, my husband has expressed that he feels that the risks outweigh the benefits of going for a natural delivery and he feels that we should opt for an elective c-section.

I do see his point, after research, I realized that my chance for another dystocia goes up to 10-16 percent (instead of the .8-4% for women who've never had dystocia issues) and while there is no way to predict if it will happen again a prior dystocia is one of the largest indicators. He also worries that the stakes are high, if something does happen, the results can be terrible.

So, he is clearly worried ( a bit traumatized even) and would like us to go the c-section route. I am now on the fence, I still feel very confident in my body and midwife, but feel like I need to consider/respect how my husband feels as well. Would you go along with a C-section in this situation?

[fedoragirl]

I can't advise you either way because for me, the choice was taken out of my hands. The OB suspects DD had shoulder dystocia and it may have cracked her bone. She was crowning but we had to stop and get into a C-section. She was just not coming out no matter how much I pushed, and the OB said it was best to do a C/S. I was very upset about it and am still learning to let it go. The recovery from the C/S was very fast and almost painless for me but everyone is different.
Looking back, I am glad I didn't sacrifice DD's shoulder to my absolute need of wanting a natural delivery. Also, DD was almost 10 lbs. so in hindsight, a C/S was better. I still wouldn't want it and am looking for VBAC this time. However, if they told me that it was the same problem in labor, then I'd go that route again.
ETA: While I would respect DH's feelings, I wouldn't make a decision about MY body based on his trauma. After all, he just had to see it, not experience everything. It's hard on men but I think women are tough and if you feel confident, then go for what you want. He can opt to sit at the head of the bed this time. :D Also, you can compromise and go for a natural birth and if baby has dystocia, then let OB/Midwife know that you'd like to get a C/S.

[wellyes]

If I were you, I'd definitely strongly consider it. If my husband were having a medical procedure with a 10%-16% chance of serious complication, I would hope he'd take my opinion and feelings very seriously. And of course there is also a risk to the child which is probably making him doubly upset. It's your body and your choice but in your shoes, I'd partner with my husband and make a decision jointly.

[Hawkeyewife]

I guess my first question would be, how many more children are you planning on having? I could see how the fear of SD could outweigh the fear of a first time cesarean if this is the LAST baby you are planning on having together. You both haven't experienced a cesarean yet and in this culture it is sort of advertised as the easy/painless way to birth. There are risks, you should fully discuss those and come up to a decision together. If you still feel that you desire a normal, vaginal birth and your husband is still against it, you may want to consider hiring a doula since his fear could effect the way you feel during this birth.

Best wishes on getting the birth you want!

[WolfpackMom]

If I were you, I'd definitely strongly consider it. If my husband were having a medical procedure with a 10%-16% chance of serious complication, I would hope he'd take my opinion and feelings very seriously. And of course there is also a risk to the child which is probably making him doubly upset. It's your body and your choice but in your shoes, I'd partner with my husband and make a decision jointly.

:yeahthat: I know many people have strong feelings about elective c-sections on this board. However, I really think your husband's experience with your last birth should be taken into account in your decision. As hard as it is for you to experience what happened, I imagine its also horrible to watch it happen to someone you love, or really two people. Not saying you should go with a c-section, just that I would have a good sit down with DH and your midwife and weigh your options and come to a decision that everyone is comfortable with.

[SnuggleBuggles]

I understand pp's point about considering dh's feelings but I don't know if I agree with the conclusion. I think that the best thing to do would be to really, really sit down with your care providers (maybe even both the mW and an OB at the same time so you can really hear both POVs and they have a chance to debate) and discuss the situation completely. Discuss risks and benefits of both options for this pregnancy, birth and possible future pregnancies and births. Are there things that can be done to improve the vaginal or c-section safety? It is hard to get past the emotional reaction and make a scientific informed decision with all the facts available. No one knows exactly what hand will get dealt to you in labor, birth and recovery. Think about as many what-ifs as you can and decide what you feel comfortable with.

As much as it is good to include your dh I'm not sure I'd let him have final say as you are the one delivering the baby. You need to go with your gut, whatever that is. Not an easy decision, I am sure.

Beth

[DebbieJ]

I would absolutely NOT choose a c-section. I had one with DS2. although not by choice. A c-section is major surgery!

I would talk with your midwife about the possibility of it happening again and research how to avoid it.

A skilled midwife knows how to deal with dystocia and doesn't view it as a major complication.

[secchick]

I would consider it and did have a C-section for DC2 and will have another for DC3 (last one). In my case, I pushed for 2 hours with my first before they realized she was facing the wrong way and ended up with a 4th degree episiotomy and forceps to deliver. I also experienced a number of issues post-delivery that required several months of physical therapy. Based on the advice of 2 OBs and the fact that my post delivery probles would likely reoccur, necessitating additional PT and likely reoccurrance and subsequent surgery as I aged, I elected for a C-section, and it was SO SO SO much better and my recovery was so much easier. It would not have been my first choice, as I am generally against medically unnecessary C-sections, but it was best for me given the circumstances. Fortunately, my doctors are the types that never schedule non-emergency C-sections before 39 weeks, and I had no post-surgery complications or difficulty nursing.

[ThreeofUs]

Honestly, you don't have to make this decision set in stone. You can plan for contingencies.

Small baby, easy birth, no complications = natural birth
Big baby, hard birth, complications = c-section
Somewhere in between? = your choice (natural, wait and see, etc.)

You could even have an epidural installed but not pumping anything just for the c-section contingency, if you wanted.

But don't let anyone make you feel bad about going either route. It's your choice and dystocia is not considered a major birth complication.

FWIW, after my first horrific birth experience - and I'm talking we almost lost both of us, with ICU for me and and NICU for DS1 - I told the OB to put in a zipper for the next one. There was NO way I was going through that again, and I had an easy, planned C for DS2. But that was just me.

[Edensmum]

Distocia can be scary, but a section is very scary and comes with way more risks and a vaginal birth. A lot more recovery and dangers not only to you and this baby but future pregnancies. I have had two. I likely have another this time and it really scares me. I can't recommend it. You need a midwife skilled in delivery, distocia is one of those things that many doctors aren't skilled in dealing with, they go right to surgery. Make sure you are seeing someone who is comfortable with this and knows what they are doing. Show dh the risks of sections.
I am currently 5 weeks pregnant and I am enjoying a lot of pain at the incision site, tearing sensations from the adhesions from surgery. I had those before pregnant too. Please don't make this decision lightly or out of fear. ICAN has a lot of good info, do your research and trust you gut.

[Katigre]

I'm very surprised that with a dystocia you were kept pushing on your back - everything I have read on the subject says that having the mom flip to hands-and-knees is incredibly important as it allows for additional maneuvering if work on the back doesn't get the baby out.

I would not necessarily schedule a csection for dystocia based on what you wrote (though there may be other mitigating factors that might push me in that direction).

Also, have you googled for the difference between 'sticky shoulders' and true shoulder dystocia? Which did your daughter have?

Here are a few links I found (disclaimer: these are all from pro-natural childbirth sites, I'm not necessarily agreeing with all of their information, but figured hearing from the other side might help since you're getting the 'pro-caesarian' side already):
http://www.theunnecesarean.com/blog/2009/8/26/misdiagnosis-of-shoulder-dystocia-bed-dystocia-and-snug-shou.html
http://www.midwiferytoday.com/enews/enews0416.asp#main (scroll down)
http://midwifethinking.com/2010/12/03/shoulder-dystocia-the-real-story/
http://www.midwifery.org.uk/index.php?option=com_content&view=article&id=229:birth-of-the-shoulders-&catid=91:hidden-archives&Itemid=110

[ashleybama24]

Would either OB deliver you if for some reason your midwife wasn't available? In that case of course they would recommend surgery...they are surgeons. Ask if either of them has had to deal with dystocia during a vaginal delivery and I bet they haven't.

I would sit down and talk with everyone, DH, OB, and midwife about how you are feeling...chances of it happening again...and your options. Then decide what is best for YOU. YOU are the one that has to deliver this baby and everyone else is just on board to support you along the way.

You can always elect to have a c-section in the middle of labor but you can't opt for natural labor in the middle of a c-section. I have a friend who just had her second c-section and she vows if she ever had a third she would never do it again. It's painful, sterile, and major surgery. Plus at her hospital they take the baby for a min of 4 hours after delivery and you can't even hold your child. A month later she can't even lift her stroller out of the car without pain.

[trcy]

Plus at her hospital they take the baby for a min of 4 hours after delivery and you can't even hold your child. A month later she can't even lift her stroller out of the car without pain.
My c-section delivery was totally different. DH got to hold DD the entire time while they were finishing the surgery and she stayed with us while in the recovery room. My recovery wasn't that bad either. DD was breach so she was a scheduled c-section and I think that made the recovery better than going through hours of labor and then surgery; just my opinion though. You have to be comfortable with your choice but I thought it may be helpful for you to hear from someone who had a good c-section experience.

[Green_Tea]

Plus at her hospital they take the baby for a min of 4 hours after delivery and you can't even hold your child. A month later she can't even lift her stroller out of the car without pain.


I had three c sections in two different hospitals and was never separated from my babies during delivery or in recovery. My DH held each one from almost the moment they were delivered, and they were right next time me the whole time.

There are lots of reasons to choose not to have a c/s, but don't let tales of babies being whisked away from their mothers be one of them until you find out what the specific policies are at the hospital where you'll deliver.

[SnuggleBuggles]

We knew ds2 was going to be big- every midwife in the practice could tell, as could I. The u/s the day before I gave birth guesstimated him at 9lb 2oz. During labor the midwife came to talk to me about how they would handle a dystocia if it became an issue. She told me that I would have to push in the hands and knees position She told me how she has successfully managed shoulder dystocia in other births and expressed her confidences in handling it if it became an issue in ds2's birth. It was really reassuring. I did push some time on my hands and knees but I finished on my side- his size and position were not a problem for my birth.

Another thing to consider is fetal positioning. What did they say about the baby's position during L&D with your first? Could it have been a factor?

Beth

[okinawama]

I initially thought the c-section was an all or nothing thing, but like someone previously mentioned, we can opt in the middle if things aren't going well. There are a couple warning signs that things aren't going well (a slowing of progress from 8-10cm, as well as a slow pushing phase...both of these were true with my first birth). If at any point this started happening again, I'd reevaluate and make a decision.

My little guy last time was Right Occiput Anterior. I don't think it played a significant roll, but I'm not sure. I labored completely upright or on all 4's, never laying (or even sitting down). the first time we obviously had no idea we were going to be dealing with a shoulder dystocia, so nobody encouraged me to get off my back for pushing, this time, I know they would.

My midwife seems very confident with delivering a shoulder dystocia baby, she's delivered 50, all without any permanent damage. My husband however feels there is always a first, and who knows, it could be us!

I am thrilled to hear some good stories of c-sections. I guess I always assume the worst, so it's great to hear some stories of women who are happy with their choice. I know it's not the end of the world if we go in that direction, ultimately what I'm looking for is the safest option for me and my son...I'm just not sure what that is.

Keep the advice and stories coming. You each have given me something to think about.

[vonfirmath]

My sister has had 3 C-sections --1 after laboring for about 24 hours and 2 scheduled. She told me that the recovery from her scheduled C-sections was MUCH easier than the one where she both labored and then had an emergency C-section when the baby never dropped into the birth canal.

[wellyes]

My sister has had 3 C-sections --1 after laboring for about 24 hours and 2 scheduled. She told me that the recovery from her scheduled C-sections was MUCH easier than the one where she both labored and then had an emergency C-section when the baby never dropped into the birth canal.

Yes, the c-section horror stories that I've heard are from people who had emergency c-sections, not scheduled ones. It's just so hard on the body to go through labor AND surgery. I'd personally not be comfortable thinking it was a likely option going into a natural birth... of course it's always a possibility, in any labor, but if it's pretty likely, then I'd just schedule.

I understand how profound that moment of delivery is. I'd mourn not being able to have it, if I were expecting but needed to schedule a surgery. Don't get me wrong, I don't enjoy labor . And pushing. But the moment of delivery is just amazing. You do not have an easy choice ahead :hug:

[essnce629]

I'm another one that finds it surprising that they let you continue pushing on your back with a dystocia. I can see that happening with an epidural, but the standard of care with midwives and a dystocia is to have mom push on her hands and knees. This usually takes care of a dystocia right away as it gets the pressure up off the perineum and allows the pelvis to open up fully. Homebirth midwives always deal with a dystocia this way. It's known as the Gaskin Manuever, made popular from the world renowed midwife Ina May Gaskin. Here's some good info on it that you can even show your midwife:

http://www.spinningbabies.com/spinning-babies-and/resolving-shoulder-dystocia

It's also a great way to push to keep from getting any tears. If it were me, I would NOT have a c-section as it is major adominal surgery with it's own risks, and if your chance of having another dystocia really is 10-15% (which I don't think it would be if you didn't push on your back) then that means your chance of NOT having another dystocia is 85-90% which is great. I'd start going to a chiropractor right away to make sure your pelvis is in perfect alignment so it can be in optimal position for labor and I'd make it a plan now to NOT push on your back once it's time. Push on your side, hands and knees, squatting using the squat bar, kneeling, on the toilet, etc, but stay off your back. It's a lot more painful being on your back too. I've had two natural homebirths and pushed both times on my knees for less than 5 minutes. Use gravity to your advantage. Plus, as a doula I've seen moms push for 2 hours for their first babies and then go on to push for 10 minutes or less with their seconds. I wouldn't worry about it and keep thinking positively. Start reading some positive birth stories to get rid of the fear and get yourself in the right mindset. This is a great book for that (have your husband read it too):

Journey into Motherhood: Inspirational Stories of Natural Birth
http://www.amazon.com/gp/offer-listing/0974785326/ref=dp_olp_used?ie=UTF8&condition=used

[okinawama]

I'm another one that finds it surprising that they let you continue pushing on your back with a dystocia.


They didn't realize he had shoulder dystocia until the very last second (the head is out and the shoulder is already stuck), and rather than use the Gaskin maneuver (all fours), they used the McRoberts maneuver ( applying pressure to my belly, legs up by my ears...which seems to be what is used initially and then Gaskins from the research I've done...even though Gaskins seems to have a higher success rate at preventing as well as solving the problem...). They know now about the possibility of dystocia, so all 4's from the beginning as well as if he gets stuck will be used.

[Katigre]

The baby's position can definitely play a role. Seconding the spinningbabies.com website - some of those techniques saved my labor with DD and repositioned her head.

[Pear]

I probably would not. A c-section is still major surgery. Some people bounce right back, others end up with a lifetime of problems.

[barkley1]

I won't say what I would choose b/c I've not had the experience of both of them, BUT, if it were me, I would feel obligated to take my husband's feelings into consideration...afterall, Yes, you're carrying the baby, but it's his child, too. He is (hopefully) just as invested in its health and well-being as you are.

[bubbaray]

I have a friend who just had her second c-section and she vows if she ever had a third she would never do it again. It's painful, sterile, and major surgery. Plus at her hospital they take the baby for a min of 4 hours after delivery and you can't even hold your child. A month later she can't even lift her stroller out of the car without pain.


Yes, and there are also parents who's babies die as a result of dystocia.

I've had 2 c/s and with both, I was holding the baby while in recovery. The recovery room nurses were awesome. One was working with the anesthetist to stabilize me and the other was holding DD#1 to latch her onto me. I was basically passed out, but there was skin to skin contact within a few minutes of the birth (15 or 20?? not sure, I was out of it). There are a lot of variables in a c/s birth, but I know a LOT of moms who have had great c/s experiences.

ETA: I've had 1 emergency c/s and one scheduled. The scheduled one was for medical reasons, not convenience (though it was that too).

OP, in your situation, I would get a second opinion.

[mctlaw]

OP, it is a hard decision to make and I am not sure what I would do. Your husband should definitely be involved but I feel the final decision shoud be up to the delivering mom. Also, it is not becessarily something that can be decided along the way, as the dystocia is often not discovered until baby is head out and then the shoulder will not deliver.

To shed some light for those who say they are surprised that the OB did not have OP labor on hands and knees, I believe the standard of care, at least where I learned it, is that OBs generally try the McWilliams maneuver folowed by the corkscrew maneuver (or vice-versa, depending on the position of the dystocia). I don't believe most of them are even trained in the hands and knees maneuver. I believe this is something used primarily by midwifes.

This is based on my past experience as a defense lawyer handling medmal dystocia cases. I had never even heard of the hands and knees maneuver until I was pregnant and researching such things.

[okinawama]

My hubby has moved some things around with work and will be coming with me to my next appointment. I am SO glad because then he'll be able to ask his own questions and hear what the midwife has to say.

I am strongly considering how he feels! Not just out of respect but because in order to get into the many different pushing positions I'll need to be epidural free, and in order to be epidural free, I'll need his complete support. If he goes in with fear and anxiety I don't think he'll be able to offer the kind of support that I need....

[ashleybama24]

Did you and your hubby ever decide whether or not you were going to schedule a c-section?