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Natural Birth
jaymiegerard
member
Anyone have home birth/shoulder dystocia experience?!!
jaymiegerard
member
I'm 18 weeks pregnant with my first...
My husband and I are currently working with a fabulous group of midwives who do all of their births in a progressive hospital. As great as they are, I recently realized that I want a home birth, not a hospital birth.
So, we found a pair of CPMs who have births hundreds of babies at home, and they work together, meaning the two of them will be at every prenatal visit AND the two of them will be at the home birth... We really like and trust them (yey!), and if we go the home birth route we will certainly work with them.
BUT, when we mentioned home birth to our hospital-birthing midwives they said, "We think it's great for your second, but we recommend hospital birth for your first. The big concern is a shoulder getting stuck."
I did some research on shoulder dystocia (stuck shoulders) and it seems to be a real concern (vs. an exaggerated medical sensationalistic concern), no matter where you birth.
My point and reason for posting - Has anyone here had a birth where baby had shoulder dystocia? How about a home birth where it happened?What did your dr/midwife do?
I have to admit that my current midwives kind of scared me, so I'm hoping to hear some real-life stories to help me make an informed decision.
Thanks!
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Re: Anyone have home birth/shoulder dystocia experience?!!
IMO if you ask a hospital-based practitioner where you should give birth, they are almost always going to say the hospital. Why wouldn't they? That is their belief system and they have a financial incentive for you to birth there. Talk to the home birth midwives about this too, see what they say and then decide what you are most comfortable with.
I don't think first time moms need to deliver in hospitals simply because of shoulder dystocia risk, and I think some typical hospital practices may actually increase the risk of shoulder dystocia (epidurals, pushing on your back, increased use of vacuum, etc.).
This. Deffinately talk to your home birth midwife about this.
Also, I am pregnant with my first so I don't have personal experience, but I have been doing a lot of reading up. There are a few positions that you can try while in labor to "release" the shoulder if it happens to get stuck. A really successful one is hands and knees with the leg on the side of the shoulder held up and out to the side. I can't think of another description but of a dog lifting his leg to pee, sorry, I know that sounds just lovely lol. Truthfully, most Dr.s have no idea about this stuff. There are still many Dr's that think staying mobile during labor is pointless, let alone ones who understand the benefits of different positions. GL!
I have no first hand experience with shoulder dystocia, but based on what I have read and heard, I am sooo much more comfortable being in the care of my homebirth midwife than being at a hospital if shoulder dystocia should occur. I talked with my midwives about what they do in cases of shoulder dystocia, and I am very comfortable that they would keep their heads and go through a research-based protocol of positions and other options if this came up, verses some random panicked OB intern yanking on my stuck baby and causing a birth injury.
Seriously, I feel like the risks of a birth injury due to ill-managed shoulder dystocia would be much higher at a hospital than with my homebirth midwives. Note that I'm sharing my specific comfort level of the risks, given the conversations I've had with my midwives. If I were you, I'd ask some questions of your potential homebirth midwives and then see where your comfort level is.
Here's a good midwife blog post about shoulder dystocia.
https://midwifethinking.com/2010/12/03/shoulder-dystocia-the-real-story/
I can't help with the first-hand experience thing either but shoulder dystocia is a concern for me because it happened to my mother, when she birthed my brother at home. I don't know what the midwife did but it took a while and was rather traumatizing for my mom, and she has passed her concerns on to me (yay!).
Ina May actually talks about it in her book. She said that the hands and knees position works most of the time because this position expands the pelvis and gravity helps to free the baby. I am keeping this in mind as I approach my labor, and telling my doula about it, in order to avoid any unnecessary hospital interventions. Ina May talks about birth philosophies too- it sounds to me like your current midwives have a hospital birth philosophy rather than a midwife birth philosophy (I forget the exact terms she used- basically, just because they are midwives doesn't mean their philosophy is any different than that of a doctor in a hospital). Find a midwife or a doctor who shares your philosophy about birth and your birth will most likely be exactly what you want it to be, whether you birth at home or in a hospital.
I didnt exactly experience a dystocia but I did have to change positions and have my midwife rotate him manually for his shoulders to be born.
Story- I was in a hands and knees squat, in the birth pool and his head was born. My pushing was not moving him ANY. So one midwife pulled me up into a high squat, while my other midwife reached in and rotated him so his shoulders would be born.
My midwife later called it a 'tight fit', not a dystocia so to speak but it was stuck shoulders. He didnt require any resucitation and cried within the minute. He was also my 2nd baby and was born at 8lbs 2 oz. My first child was 6lbs 12 oz. So he was much bigger than my first and I already had the 'proven pelvis'.
Had he needed rescuitation I have faith they couldve handled it. They had oxygen, face mask, suctioning, etc. My midwives were incredibly well prepared. Ill be homebirthing with them again when the time comes.
Why not ask your hospital-based midwives how THEY would handle a shoulder dystocia? Most of the maneuvers used to handle a shoulder dystocia can be performed just as easily at home vs. in the hospital.
The one exception is the Zavanelli maneuver (performing a c-section), which is rarely done even in the hospital because it carries the highest risk of severe complications, such as fetal death.
If you say, "Well, but at least in the hospital, I would have that option in the 1 in a million case where the Zavanelli maneuver would help," make sure to ask your midwives if there are anesthesiologists at the hospital 24/7. With shoulder dystocia, you have less than 10 minutes to free the shoulders before brain damage occurs. Even if you're in the hospital, you can't go from decision to incision in less than 10 minutes if the anesthesiologist has to be paged at home.
Also, ask your midwives about their epidural rate, because many of the maneuvers for resolving shoulder dystocia are difficult or impossible with a medicated mom. (But funny, no one mentions unresolved shoulder dystocia as a risk of having an epidural... only of having a homebirth.)
Then ask the same questions of the homebirth midwives you're considering, and decide for yourself what you feel comfortable with.
The blog link given above (from Midwife Thinking) is awesome, too.
Mommy to DD1 (June 2007), DS (January 2010), DD2 (July 2012), and The Next One (EDD 3/31/2015)
Thanks to all who responded so far!
You all brought me back to my original sense that home birth is safer in that I will have the freedom and ability to move the way my body needs to have the birth!
Yes, my current midwives are more medically-minded (honestly, NOT the impression they gave off during my interview with them). Slowly but surely I have been taking more tests, more "routine" interventions are being mentioned....
I will certainly talk to both my current midwives and the homebirth midwives about how they handle a situation like that. Most cases of shoulder dystocia seem to end positively - it just seems to be a little traumatic!
Best of luck to all :-)
My point and reason for posting - Has anyone here had a birth where baby had shoulder dystocia? How about a home birth where it happened?What did your dr/midwife do?
yes, that's what my MW called it though it may have just been sticky shoulders, she was "stuck" for about 3 min. I've done a lot of research since then and I'll talk to my mw when I get pregnant again and see what she remembers.
DD was my first. Head came out (this is as far as I remember) and she tried to breathe, m/w asked me to push to help her get out the rest of the way, pushed a few times- no go (I was squatting) so mw asked me to get on hands and knees/pushed- no go , so m/w asked me to put leg up into runner's position- pushed, no go. So she asked me to flip over on my back because she was going to help get her out.
When I flipped over her shoulder came unstuck and she came out. Her apgars were great.
Like I said looking back on it I'm not sure if it would have been a true dystocia, but it's the only one my m/w has had in her hundreds of HB's. All went well and I was happy with my birth.
If I had been in the hospital chances are good that she would have had a broken clavicle or would have been pushed back in for a c-section if the other manuever hadn't worked.
My CPM was great and calm and knew what to do.
If you have more questions let me know. Remember a TRUE shoulder dystocia occurs in only 1-2% of women and after you have one then you have a 10% chance. So still very low.
Some can LOOK like shoulder dystocia if you don't give baby enough time to turn after the head is born.
I really wouldn't worry about it. I'd ask them how they resolve it if they did see one and then make my decision.
I don't have first-hand experience with homebirth (yet), but your OP brought up an experience that I wanted to share. (I understand shoulder dystocia is the focus of your concern, but my take on your post is that it is a larger issue than this one specific risk.)
I had to visit the CNMs (my MW's backup, ironically) to get the hospital orders for my 20w u/s. Long story short, I was lectured by the MW and told that I would DIE (not exaggerating) giving birth at home because I would bleed to death due to my AMA (I was 37). I suspect there is always a reason to recommend against homebirth if you are against it.
Just wanted to share... good luck with your choice. No matter who you work with, know that everyone has a bias,... it's more a matter of finding someone you trust, who will listen to you, and with whom you can be honest when push comes to shove.
i'm sorry but your hospital mw's sound like they like to use scare tactics. that would be a red flag for me. the location of your birth does not increase or decrease the chance of a shoulder dystocia.
there are some good techniques to free up a stuck baby, i would ask your home birth mw's what their protocol is. here is mine...
Shoulder Dystocia Protocol I. What is Shoulder Dystocia 1. Definition: When the head has been delivered and the shoulders can not be born with usual mechanics. 2. "True Dystocia" is when the anterior shoulder is stuck at the superior pubic symphysis. II. What is the incidence rate 1. 0.15-2.1% of all births results in a shoulder dystocia. III. What are the potential complications to mom 1. Hemorrhage 2. Shock 3. Postpartum infection 4. Uterine rupture 5. Bladder injury 6. Broken coccyx 7. Separation of pubis 8. Emotional issues 9. Lacerations, possibly needing sutures. 10. Hematomas IIII. What are the potential complications to baby 1. Death 2. Injury 3. Brachial plexus injury 4. Paralysis 5. Brain damage 6. Intercranial hemorrhage, possible need for Vit. K injection or hospitalization. IV. What are the associated risk factors for a shoulder dystocia 1. Large baby (greater than 4000 grams) 2. Precipitous births 3. Prolonged first or second stage 4. Mom's birth weight 5. Mom's obesity 6. Extreme pelvic deformity 7. CPD 8. History of large babies 9. History of shoulder dystocia 10. Gestational Diabetes 11. Post dates 12. High parity 13. Excessive weight gain 14. Epidurals 15. Prolonged transition 16. Protracted labor 17. Arrested labor V. The following are the steps are taken during a shoulder dystocia. All steps will be taken until the baby has been delivered. If after three attempts or three minutes the baby has still not been born call 911. Assistant needs to call out in 30 second intervals once the head has been born until birth of the body. 1. Stay calm! 2. Clear respiratory track as normally done 3. Check for nuchal cord, try not to cut the cord, unless absolutely necessary 4. Apply gentle head traction first in the direction that best allows the posterior shoulder to be freed and then the anterior shoulder. 5. Put oxygen on the mother 6. Be prepared for resuscitation and or postpartum hemorrhage 7. Have the assistant apply suprapubic pressure and attempt traction again 8. Change position to hands and knees, if already in that position change to McRoberts. 9. Place hands inside mother and grasp baby with one hand on chest and the other hand on the back. Use the Woods' Corkscrew to loosen the baby. 10. Feel for the posterior shoulder. Attempt to move the shoulder forward. 11. Place hands inside the mother and feel for the posterior arm. If behind the baby move gently to the front. Follow down the arm to the inside of the elbow and bend the arm up toward the face, pull across the chest and up to deliver it. 12. Change positions to a full squat and repeat steps 9-11 13. Change positions to standing and repeat steps 9-11 14. Consider breaking the clavicle of the baby. 15. Keep repeating steps until the baby has been delivered VI. Immediate postpartum 1. Assess baby for any damage done during delivery 2. Assess mom for any postpartum hemorrhage 3. Transport mom and/or baby if indicated 4. Baby needs to see pediatrician, possible Vit. K injection or if baby has broken clavicle. 5. Follow up care and emotional debriefing for client during appointments Sources: 1. Heart & Hands, 4th ed., Elizabeth Davis, pp. 159-161, 2004 2. Varney?s Midwifery, 4th ed., Helen Varney, pp. 883-890, 2004 3. Williams Obstetrics, 21st ed., Cunningham et al., pp. 459-466, 2001This!!!
My DH had shoulder dystocia. Doctor broke his clavicle to get him out. born with apgars 2 and 3.
Definately suggest reading the chapter in Ina May's book where she talks about this. I believe she said she had 35 mothers where different positions were used (esp hands and knees) to "unstick" babies. I watch One born every minute, one of the first episodes had a birth with shoulder distocia. They never even attempted switching position in the scenerio aired.....
I don't think she could switch positions. Thank you, epidural.
Mommy to DD1 (June 2007), DS (January 2010), DD2 (July 2012), and The Next One (EDD 3/31/2015)