Shoulder dystocia in second birth?

[okinawama]

I am 10 weeks pregnant with my second child.

Today I went in for my first OB appointment, you know, the one where they ask you a million questions have you pee in a cup and send you on your way. During the questions he asked how my last delivery had gone, and I told him that it was an amazing drug free labor, however, during the long (2+hrs) pushing phase my son had gotten stuck at the end and was basically "pressed" out of me by three nurses literally pressing on my stomach while the midwife pulled my little guy out. He was very blue, but after a minute had an apgar score of 8. Nobody mentioned a single thing about it to me, I assumed he was just in an awkward position and I was too exhausted after pushing for 2hrs to get him out on my own.

So fast forward to today, my doctor heard that he got "stuck" and asked if he had shoulder dystocia, nobody during the previous birth had ever mentioned it, so I just told him I didn't know (I gave birth in another hospital and I had forgotten to bring my prior medical records with me to today's appointment). The doc said that if that was the case that we'd probably be looking at a c-section due to the high likely hood of it happening again. So after the appointment I went home and read through the records and it does say my little guy had shoulder dystocia.

So, that brings me to my next question. If your first had shoulder dystocia, did your second? did you opt for a planned c-section. My last birth was drug free and pretty intervention free. If at all, I'd really like to keep it that way again, but not at the cost of anybody's safety. So, any BTDT stories?

[Katigre]

I would not automatically have a csection for a previous dystocia. I would be very careful to choose a care provider who had experience with it and would ask how they would handle it if it occurred again.

What position were you pushing in? Did your dr./nurses have you flip to another position?

I think there are a lot of variables in the situation and your dr.'s stance on it is not completely uncommon but not the only option.

[bostonsmama]

No BTDT, but our doula/CNM (who teaches our birthing class) doesn't think that's a reason at all for a C-section for 2nd pgs. Every baby is different! There are different positions you can push in, esp if you're having an unmedicated vaginal delivery, that will help get the shoulders out. Our doula has done many a homebirth with tired-out mamas who pushed for a long time, and she always got baby out safely, but she did have to flip a few of them over onto hands/knees.

How big was your first baby at birth (weight)? If baby was big, you can follow Dr. Bradley's nutritional guidelines for keeping down baby weight. If you just have a smaller pelvis, there are poses and exercises you can practice during pg that will help open you up prior to delivery.

I try not to be suspiciuos, but it sounds to me like he sees dollar signs walking out the door (no epidural, no meds...ergo C-section).

[SnuggleBuggles]

Shoulder dystocia was a concern my CNM had when we knew ds2 was on the big side. So, during labor she told me that if things got hairy I would have to do hands and knees position for delivery. It gives her more room to work and opens the pelvis up so much more than pushing on your back. Were you able to do a variety of positions the first time around? Even though ds2 was 9.5lbs we didn't need any tricks because he came out easily.

Beth

[karstmama]

shoulder dystocia is unpredictable. let me rephrase - YOU CANNOT PREDICT IT. the risk factors, including previous shoulder dystocia, previous babies above whatever weight, and gestational diabetes, are not predictive.

if your doctor suggests otherwise, ask him to show you the data - because it ain't there.

[kam]

I'm a firm believer in hospital/ob birth. I had no interventions, except for the epidural I requested, but am more comfortable with an OB and the availability of a high level NICU and an OR if things go south.

BUT

I wouldn't go with an OB who said from day ONE that shoulder dystocia -- delivered vaginally -- meant a C-section in my next birth. The next baby may not be as big, may be positioned differently, etc. Thus, this type of practice indicates to me that the OB is not as comfortable with his skills in helping moms manage their weight/blood sugar (sometimes a reason for bigger babies and SD), and in interpreting the size & health & position of the baby as I would like going into a vaginal birth. Moreover, he may simply prefer scheduling C-Sections to dealing with the unpredictability of birth.

I'd find a new OB in a different practice.

[american_mama]

>>> My last birth was drug free and pretty intervention free. If at all, I'd really like to keep it that way again.

Good luck getting that with your current ob. I'd find another provider. This one has clearly shown that his mind is made up, with scant information to boot.

As an aside, it seems wrong that your midwife didn't discuss with you what happened in your earlier birth. It sounds quite dramatic, and potentially very serious, and a de-briefing the next day would have been good for your peace of mind and plans for future births.

[okinawama]

thank you so much for all your helpful and encouraging words!

My first son wasn't that large, 8lbs2oz. I did lots of research, reading, and classes in preparation for my first natural birth, and I never thought I'd push on my back. However, that's what felt right. I tried different positions and I wasn't as effective, so I went back on my back. I wish my midwife would have encouraged me to push on all fours, because in hindsight I remember in InaMay Gaskins book she had a technique that was pushing on all fours.

I did come home right away yesterday and do some research, and you're right, there is no way to predict should dystocia, but from what I've read a woman who has never birthed a baby with shoulder dystocia has around a 1% chance of having a birth with it. However, having prior births with dystocia increases your risk to 11-15% on your subsequent births.

I do plan on calling the practice I'm being see at and asking to be seen by someone else.

[okinawama]

As an aside, it seems wrong that your midwife didn't discuss with you what happened in your earlier birth. It sounds quite dramatic, and potentially very serious, and a de-briefing the next day would have been good for your peace of mind and plans for future births.[/QUOTE]

I COMPLETELY agree! I had no idea until I read our file yesterday after my appointment. I do remember reading about shoulder dystocia in many of my labor books, but to be honest, I didn't even give it a second thought in my birth.

After doing research last night things could have ended entirely different and I can't believe nobody even mentioned the dystocia to me. I gave birth overseas in a military hospital last time, and while I had an awesome experience for the most part, things there just aren't quite like the civilian side.

[brittone2]

Sometimes midwives also differentiate between a "true" shoulder dystocia (which is considered by many to be fairly rare) and "sticky shoulders." Maybe talk with your former midwife about what she thinks happened. I think midwives don't consider it a true dystocia if positioning resolves it fairly easily.

I would also run from any doc making the statements that have already been made.

Ditto considering using the hands/knees method this time if appropriate for your situation.

[kam]

I do plan on calling the practice I'm being see at and asking to be seen by someone else.

Respectfully, this may not be enough. First, this OB could be the doc on call when you go into labor, and knowing his belief that you will "need" a c-section means that he may not be very supportive of other options.

Second, I find that beliefs within practices are consistent, so the other docs in the practice may agree with him.

So, if possible, I'd find another practice. If not, I'd be seeing another OB and clearly talking to them all along about this statement and your desires. Also, if you stay with the same practice, make sure they change your file so it shows that you are the new OB's patient, not his, so that when nurses look to standing orders/ call the doc with questions, they won't call him!

Good luck for a H&H 9 months!!!!

[BabbyO]

FWIW, if you like your OB it may be worth having a talk with him or her about your thoughts/feelings about a C-section. Not quite the same situation, but my OB scheduled the date for my induction at my first appt. Things were happening so quickly that I didn't really realize what was going on. After thinking about it, I wasn't sure why he'd schedule an induction 1 wk after my due date. My first was born exactly 1 week late, and I know he came right on time (for him). There were no complications or concerns.

At my second appt, I asked my OB about it. It was his preference for a variety of reasons, but he was willing to work with me and find a solution that suited us both should the occasion arise. He did tell me that if it came right down to it, it was my decision and I had the right to refuse being induced (he'd of course make me sign paper work to that effect, but it was my decision). It was never needed as my son came a few days early.

Sometimes just having a conversation with the doc is worth while. Present the research you've done. After that you can decide if it is best to find a different OB who's practice fits you better. Regardless, I recommend following your gut. They may have degrees, but we know our bodies!

Best of luck!

[SnuggleBuggles]

Respectfully, this may not be enough. First, this OB could be the doc on call when you go into labor, and knowing his belief that you will "need" a c-section means that he may not be very supportive of other options.

Second, I find that beliefs within practices are consistent, so the other docs in the practice may agree with him.

So, if possible, I'd find another practice. If not, I'd be seeing another OB and clearly talking to them all along about this statement and your desires. Also, if you stay with the same practice, make sure they change your file so it shows that you are the new OB's patient, not his, so that when nurses look to standing orders/ call the doc with questions, they won't call him!

Good luck for a H&H 9 months!!!!

Thanks for not making me type out the exact same reply. You took the words right out of my mouth!! :)

Beth