shoulder dystocia

preckles12 · August 2014

Hi mammas

I am pregnant with my second and my doctor is pushing me to think about C-Section already! The issue is that I had a large (9.3lbs) baby the first time who had shoulder dystocia. After a panicky couple minutes in the delivery room, she was perfectly fine. I was trying to go for a natural birth and prepared with Bradley classes, but due to a super long labor and a baby that wouldnt descend because her head was in the wrong position, I wasnt able to have the natural birth that I wanted. I did narrowly escape having a c-section which I was SUPER happy about.

My doc is saying that if you have shoulder dystocia the first time then it is likely you will have it again and that my baby will most likely be even bigger this time. I obviously dont want to do anything to put my baby at risk but I really want to have the most natural birth possible which absolutely does not involve scheduling a c-section!

Just wondering if any of you have experience with shoulder dystocia? Did it happen the 1st time and not the 2nd? Thanks!

jennypolkadots · August 2014

When you were delivering your first, were you encouraged to get on all fours when pushing? This is the best method for delivering a baby with SD. If your doctor is already pushing c-section, I would consider a different doctor or trying to find a midwife. How does the doctor know this baby is bigger than the first?Sonogram measurements have a big range of inaccuracy when measuring weight. Just try to keep weight gain to a minimum and keep planning your natural birth.

barista411 · August 2014

According to the research that I have read you are ten times more likely to have another shoulder distocia because of your prior history. So I wouldn't discredit your OB purely because they are recommending a CS.

You do have some options though if you feel comfortable attempting a vaginal birth. I second trying different pushing positions. You may also want to look into OFP (optimal fetal position). spinningbabies.com is an excellent resource for exercise to help get the baby in the best position for birth. You could also request to have to have NICU on stand by and prepared in case another SD were to occur.

sschwege · August 2014

I can certainly understand why your doc is concerned, as he said you are more likely to have that happen again. That still doesn't mean you shouldn't get a second opinion, I would before making a decision.

DD had what my MW referred to as 'sticky shoulders'. In the time it took for my MW to say, "The shoulder is stuck" she was out with one turn by my MW. DD was 7lb15oz and my MWs think it was due to poor positioning. My second was out in two pushes, no problems and he was 8lb12oz. But obviously 'sticky shoulders' does not carry the same concerns as shoulder dystocia.

iris427 · August 2014

I had a shoulder dystocia with my baby that was born last month. I'm sure I don't need to tell you that it's a pretty scary scenario. We were lucky that it was resolved quickly with McRoberts and suprapubic pressure and everyone got through it healthy. My baby wasn't large and we had no risk factors, it just happened. Incidentally, I was on my hands and knees already when it happened, so no Gaskin maneuver for me.

Your doctor is not wrong to offer a cesarean and I think it's worth at least considering. I'm glad I'm not planning to have any more children because I don't know what I'd do for my next birth. Like PPs said, a history of SD puts you at significantly increased risk for another. I wouldn't want a cesarean either, but I'd feel terrible if I had another SD happen and the baby got hurt. I remember thinking after mine that a scheduled c/s would probably have been a more peaceful and positive birth experience for both baby and me, so maybe that's a plus in the c/s column. But I would definitely talk to your doctor about both options. What can they do to try and prevent another SD from occurring if you deliver vaginally? Can you wait until term and see if the baby appears to be measuring large or not and then decide? Etc. Good luck with your decision.

preckles12 · August 2014

Thanks ladies. I am definitely taking my OB's recommendations seriously. I was just very surprised because I hadnt realized that shoulder dystocia was something that I needed to be concerned about the second time around. I do plan on getting a second opinion and I wont make a decision until much closer to the due date. I am only 9 weeks so I was just taken off guard that she was talking section already. Obviously I will be happy with a healthy baby but its disappointing that I may not be able to even try for the natural birth that I was hoping for.

soulcupcake · August 2014

barista411 said:

According to the research that I have read you are ten times more likely to have another shoulder distocia because of your prior history. So I wouldn't discredit your OB purely because they are recommending a CS. You do have some options though if you feel comfortable attempting a vaginal birth. I second trying different pushing positions. You may also want to look into OFP (optimal fetal position). spinningbabies.com is an excellent resource for exercise to help get the baby in the best position for birth. You could also request to have to have NICU on stand by and prepared in case another SD were to occur.

Ahh, but the reasons for the dystocia play a much bigger role. And there's a difference between sticky shoulders and true shoulder dystocia. Shoulder dystocia is more common in average sized babies, 7-8 lbs, than bigger babies. 9 lbs really isn't "big" or at all concerning

Also, baby's position prior to the onset of labor and the second stage and mother's position have more to do with an optimal second stage than anything. OP, what position did you give birth in? Were you in the lithotomy position? How was your baby positioned? Dystocia occurs during baby's rotation through the birth canal, where the shoulder gets stuck behind the pubic bone. If both mom and baby are in optimal positions for birth, upright for mom and LOA for baby, this increases the chances of optimal/ideal rotation.

Chances are, OP, if you gave birth in the hospital, you weren't in the optimal position to facilitate proper rotation. Also, was your labor induced or augmented?

Shoulder dystocia is rare, but when it occurs in the hospital setting there are many factors, interventions, that play a significant role in a difficult second stage or complications.

MuchlyGen · August 2014

Read up on the "Gaskin maneuver". Ina May Gaskin has the distinguishment of being the only midwife in history to have an obstetrical maneuver named for her!

As others have said, the position you are in greatly affects the shape/size of your pelvic outlet.

The position of the baby can affect the probability of it occurring.

There are things that can be done (Gaskin maneuver!) to naturally help baby out.

If I were you, however, I would spend some time reading up on shoulder dystocia, reasons it happens, what can be done to help encourage baby to be in the best possible position, and maybe even specifically looking up birth stories where it has occurred..

MuchlyGen · August 2014

Oops! Hit enter too soon. I just wanted to add, for me, in my non-medical opinion, I wouldn't feel comfortable with a preventative C-section for something that has so many variables involved - but you absolutely have to make the choice you are comfortable with.

kindacrunchy · August 2014

Wow your first birth sounds almost identical to my second DD! She was 9lbs 3oz, was facing my hip so in a bad presentation. My labor was pretty long (27+hours after water breaking) and she had sticky shoulders complete with a nurse pushing on stomach. I was able to go all natural with no drugs but the end was pretty scary. She was perfectly fine though. Are you sure that it was a true dystocia and not just sticky? Mine was referred to as sticky but sounds exactly the same as what you described.

My midwife is fine with me delivering vaginally this time and hasn't mentioned a c section. We are keeping an eye on baby's size and I will likely push in a different position this time (I was on my back, it's what felt good). I also plan to check out spinning babies so hopefully baby will be in a better position. Good luck to you!

preckles12 · August 2014

My labor went on for 75 hours! The reason was that her head was on the wrong position and she would not drop. After 2 days of serious contractions (hours of 2 min apart) and only being dilated 3.5cm, I couldnt continue with the natural birth that I had prepared for. Even my midwife agreed that this baby wasnt coming without some type of intervention. I had an epidural and pitocin and was basically unable to move myself. So no, I was not in the optimal position. Also, I found out at 37 weeks that my DD was breach and had a successful external version, but I believe that because of this she never got in the right position.

aeonlux Thank you for the information. I was hoping to hear something like that. Logically, it makes sense that if this baby isnt breach and is in the right position before birth then I could very well be perfectly fine.

jennypolkadots · August 2014

@preckles12 - I had the same issue with tickers. There are 4 icons on the upper right side. Click the head and then "preferences". Then go to signature settings. Then click the html button that looks like a blank page with <> on it. Then enter the ticker url. Or I think you could click before your ticker and then click the html icon. That should do it!

preckles12 · August 2014

Yeah! I got it, thanks!

iris427 · August 2014

aeonlux said:

barista411 said:

According to the research that I have read you are ten times more likely to have another shoulder distocia because of your prior history. So I wouldn't discredit your OB purely because they are recommending a CS. You do have some options though if you feel comfortable attempting a vaginal birth. I second trying different pushing positions. You may also want to look into OFP (optimal fetal position). spinningbabies.com is an excellent resource for exercise to help get the baby in the best position for birth. You could also request to have to have NICU on stand by and prepared in case another SD were to occur.

Ahh, but the reasons for the dystocia play a much bigger role. And there's a difference between sticky shoulders and true shoulder dystocia. Shoulder dystocia is more common in average sized babies, 7-8 lbs, than bigger babies. 9 lbs really isn't "big" or at all concerning

Also, baby's position prior to the onset of labor and the second stage and mother's position have more to do with an optimal second stage than anything. OP, what position did you give birth in? Were you in the lithotomy position? How was your baby positioned? Dystocia occurs during baby's rotation through the birth canal, where the shoulder gets stuck behind the pubic bone. If both mom and baby are in optimal positions for birth, upright for mom and LOA for baby, this increases the chances of optimal/ideal rotation.

Chances are, OP, if you gave birth in the hospital, you weren't in the optimal position to facilitate proper rotation. Also, was your labor induced or augmented?

Shoulder dystocia is rare, but when it occurs in the hospital setting there are many factors, interventions, that play a significant role in a difficult second stage or complications.

Most babies with SD are average-sized, but that's because most babies are average-sized. Large/macrosomic babies are way more likely to have SD occur. 9 lbs is not small. The larger the baby, the more the risk of SD goes up.

SD may be rare overall (about 0.5% of births, or 1/200) but that is not what matters here. The OP's individual risk is what counts. With a history of SD, she has a significant risk of recurrence in her next delivery--12% according to some studies. That's a 1/8 chance of a serious emergency happening. 1/8 is not rare. Furthermore, a second SD is 4x more likely to result in injury to the baby than a primary SD. (link)

Is there any evidence that SD is more likely to occur in certain positions or in a hospital setting? I have not seen any. In fact, the lithotomy position is used to successfully resolve shoulder dystocia (McRoberts) in many cases.

And for anecdotes, I was delivering on my knees, upright, with no epidural or any obstetrical interventions, when my son's SD occurred. I've read some pretty horrifying SD home birth stories too.

iris427 · August 2014

MuchlyGen said:

Read up on the "Gaskin maneuver". Ina May Gaskin has the distinguishment of being the only midwife in history to have an obstetrical maneuver named for her!

As others have said, the position you are in greatly affects the shape/size of your pelvic outlet.
The position of the baby can affect the probability of it occurring.
There are things that can be done (Gaskin maneuver!) to naturally help baby out.

If I were you, however, I would spend some time reading up on shoulder dystocia, reasons it happens, what can be done to help encourage baby to be in the best possible position, and maybe even specifically looking up birth stories where it has occurred..

I'm not sure how you're defining "naturally" but most SD are resolved with low-tech maneuvers and position changes--McRoberts, suprapubic pressure, and internal maneuvers to rotate the fetal shoulders. The Gaskin maneuver may be a good option to resolve SD when the mom does not have an epidural, but it's no more or less natural than the other commonly used options.

iris427 · August 2014

preckles12 said:

My labor went on for 75 hours! The reason was that her head was on the wrong position and she would not drop. After 2 days of serious contractions (hours of 2 min apart) and only being dilated 3.5cm, I couldnt continue with the natural birth that I had prepared for. Even my midwife agreed that this baby wasnt coming without some type of intervention. I had an epidural and pitocin and was basically unable to move myself. So no, I was not in the optimal position. Also, I found out at 37 weeks that my DD was breach and had a successful external version, but I believe that because of this she never got in the right position.

aeonlux Thank you for the information. I was hoping to hear something like that. Logically, it makes sense that if this baby isnt breach and is in the right position before birth then I could very well be perfectly fine.

I don't think baby's position before labor really matters. Lots of babies start labor in a malposition (i.e. OP) and 95% of them will rotate on their own. Conversely, some babies start labor properly positioned and move into a malposition as labor progresses. What matters is how your baby engages in the pelvis and how the shoulders rotate after the head is born.

And yes, you may deliver vaginally and have everything go fine. If the recurrence of SD averages 12%, that means most women will not have a second SD. It's a matter of what level of risk you are comfortable with.

MuchlyGen · August 2014

I definitely didn't mean to imply that it was the /only/ maneuver to naturally help the baby out. It's the only one I'm familiar with on a first name basis, and I was just using it as an example of one of the ways that SD can sometimes be resolved without it coming to C-section.

soulcupcake · August 2014

iris427 said: aeonlux said: barista411 said: According to the research that I have read you are ten times more likely to have another shoulder distocia because of your prior history. So I wouldn't discredit your OB purely because they are recommending a CS. You do have some options though if you feel comfortable attempting a vaginal birth. I second trying different pushing positions. You may also want to look into OFP (optimal fetal position). spinningbabies.com is an excellent resource for exercise to help get the baby in the best position for birth. You could also request to have to have NICU on stand by and prepared in case another SD were to occur. Ahh, but the reasons for the dystocia play a much bigger role. And there's a difference between sticky shoulders and true shoulder dystocia. Shoulder dystocia is more common in average sized babies, 7-8 lbs, than bigger babies. 9 lbs really isn't "big" or at all concerning
Also, baby's position prior to the onset of labor and the second stage and mother's position have more to do with an optimal second stage than anything. OP, what position did you give birth in? Were you in the lithotomy position? How was your baby positioned? Dystocia occurs during baby's rotation through the birth canal, where the shoulder gets stuck behind the pubic bone. If both mom and baby are in optimal positions for birth, upright for mom and LOA for baby, this increases the chances of optimal/ideal rotation.
Chances are, OP, if you gave birth in the hospital, you weren't in the optimal position to facilitate proper rotation. Also, was your labor induced or augmented?
Shoulder dystocia is rare, but when it occurs in the hospital setting there are many factors, interventions, that play a significant role in a difficult second stage or complications. Most babies with SD are average-sized, but that's because most babies are average-sized. Large/macrosomic babies are way more likely to have SD occur. 9 lbs is not small. The larger the baby, the more the risk of SD goes up.
SD may be rare overall (about 0.5% of births, or 1/200) but that is not what matters here. The OP's individual risk is what counts. With a history of SD, she has a significant risk of recurrence in her next delivery--12% according to some studies. That's a 1/8 chance of a serious emergency happening. 1/8 is not rare. Furthermore, a second SD is 4x more likely to result in injury to the baby than a primary SD. (link)
Is there any evidence that SD is more likely to occur in certain positions or in a hospital setting? I have not seen any. In fact, the lithotomy position is used to successfully resolve shoulder dystocia (McRoberts) in many cases.
And for anecdotes, I was delivering on my knees, upright, with no epidural or any obstetrical interventions, when my son's SD occurred. I've read some pretty horrifying SD home birth stories too.

----- QUOTE FAIL----

I've read the literature. I'm quite familiar with what it states. I was not referring to being upright as a correction of SD. I was referring to lessening the chance of malpositioning in the second stage, and this is aided by the optimal positioning of both mother and baby prior to the baby's descent and rotation (e.g., the second stage).

*If* the OP was induced/augmented and the baby was not properly positioned or she was not in the proper position that facilitates proper rotation then it could increase the chances of sticky shoulders or true SD. I've also spoken with a number of midwives who have encountered sticky shoulders (more common) and true SD. Though either can and do happen in labors/births where there are little or no interventions, malpositioning, etc., a heavily managed birth is far more common in a hospital setting. (my midwife with my third baby had sticky shoulders with her fourth and true SD with her fifth. Both born at home).

This article discusses exactly what I am referring to. Like various complications that can arise during the first or second stage, there could and sometimes are interventions that contribute to complications or a difficult second stage.

preckles12 · August 2014

Thanks ladies. I appreciate your opinions. It looks like I definitely have some research to do, some second opinions to gather and many things to consider in the next several months!

LilTiger15 · September 2014

For my first birth, my son was born with shoulder dystocia. He was 9 lbs. 5 oz. I don't believe the reason for his SD was his size though, I think it was more due to the fact that he turned into a posterior position the day I went into labor. I used hypnobabies for the birth, so had no epi or pain medications. Due to his position, he did get stuck on my pelvis, which delayed coming out of the birth canal. I was at 10 cm at midnight. By 6am, I still felt no desire to push. The nurse decided I just needed to start trying to push on my own. After 2 hours and 15 minutes of pushing, my son was born. Not only was he in a posterior position, but his right arm was crossed over his chest with his hand up by his chin. This probably didn't help things. However, even with the diagnosis of SD, he was x-rayed and there were no problems. His arm was also fine.

After the birth, the OB did mention that I could choose to have an elective C-section for my next child since it looks like I have 'bigger babies.' That immediately annoyed me. He also said no matter what, induction would be best since I have big babies and my first came past my due date (41 weeks).

After finding out I was pregnant again, I actually decided homebirth would be my better option. I spoke to my midwife as well as a family physician who practices obstetrics and neither said they saw any reason why I would need to have an elective C-section or induction. My midwife has delivered 4 10+ lb. babies at home this year with the longest labor being 12 hours. This helped to relieve any possible concerns. I'm hoping for a water birth and also plan to be more mobile during labor and hopefully not in a lying down position, so I don't see why I'm any more at risk of having another SD baby than anyone else is. My midwife is more used to dealing with births in a non-traditional manner anyway.

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