Shoulder Dystocia

[rookie]

My OB brought this up today and I was wondering if anyone here had experience with this.

[smrtmama]

My OB brought this up today and I was wondering if anyone here had experience with this.

 

Uncommon where the mom has true unhindered movement. "Sticky shoulders" are more common, but a skilled care provider can release a stuck baby through the use of the Gaskin maneuver or others (McRoberts or the corkscrew Wood maneuver).

 

Commonly used as a scare tactic for "big babies."

[rookie]

Why would it be used as a scare tactic for big babies?

What does the OB have to gain?

What IS a big baby?

[smrtmama]

Why would it be used as a scare tactic for big babies?

What does the OB have to gain?

What IS a big baby?

 

OBs have a lot to gain by pressuring mothers into inductions or c-sections, despite the fact that neither has been shown to improve outcomes for a macrosomic ("big") baby. Macrosomic babies are those that weigh over 4000 grams (8lb 13oz), though some care providers have a broader definition -- I've had one OB label all three of my babies macrosomic, even though one was only 8lb 3oz.

 

OBs benefit from scheduled births financially and due to convenience. Of course, money and convenience are not the bottom line for many care providers, but they are a major consideration for others. Some doctors also have a fear of liability. Though babies of any size can have shoulder dystocia, if a large baby becomes stuck and sustains any injury, the OB could be at risk for litigation for NOT having intervened -- even though the evidence shows intervention doesn't improve outcome.

 

Have you ever read The Thinking Woman's Guide to Better Birth? It's by a clinical researcher, Henci Goer, and is the best evidence-based guide to obstetrical protocol and procedure that I've come across. She has another book, Obstetrical Myths vs Research Realities, that is being released in a new edition this year with the most up to date info on various birth issues.

[Dawn in OH]

What IS a big baby?

 

That's a good question.

 

I delivered one, vaginally, that was 9lbs 2 oz.

 

I've heard of other women being told their baby was "big" and having c-sections pushed on them for that reason, and their babies were smaller than mine.

 

I guess it depends on the doctor.

[scrappyhappymama]

Why would it be used as a scare tactic for big babies?

What does the OB have to gain?

What IS a big baby?

 

Some OBs prefer c-sections for convenience sake. So possibly big for dates baby--> increased chance of shoulder dystocia (debatable) --> "reason" for scheduling a c-section rather than allowing a trial of labor.

 

Big babies do not have to be an issue. Fat squishes. :D I've seen many tiny women deliver 10 lb + babies.

 

Shoulder Dystocia is an uncommon complication where the baby is not rotated well and the shoulder gets stuck under the pubic bone after the head has already emerged. It is more common in lithotomy position labors (lying on back with legs up), than in squatting positions because the pelvis is not as open in that position. Well-informed obs and most midwives are able to handle a shoulder dystocia. One common procedure in this situation is the Gaskin Maneuver, named for the midwife who discovered it.

[smrtmama]

That's a good question.

 

I delivered one, vaginally, that was 9lbs 2 oz.

 

I've heard of other women being told their baby was "big" and having c-sections pushed on them for that reason, and their babies were smaller than mine.

 

I guess it depends on the doctor.

 

Mine were 9lbs, 8lb 3oz, and 9lb 4oz. All three of my babies have been considered "big" by obstetricians. All three were born vaginally, number 2 and 3 at home, with no complications relating to size. Freedom of movement was definitely a factor in the easy of birth with my last baby. I changed position dozens of times and moved in all manner of contortions, which I know was my body's instinctive way of repositioning her.

[smrtmama]

It's also worth noting that most cases of shoulder dystocia happen in NON-macrosomic babies. As a previous commenter said, fat squishes. Babies' heads mold and the pelvis spreads. :)

[rookie]

Would it be a correct assumption then that if a woman has a separated pubis it would be easier for baby's shoulders to pass, thereby reducing the chance of shoulder dystocia?

[Heather in OK]

Not necessarily. It has to do with how the baby rotates.

[rookie]

Hmm. I was hoping there was some advantage to an otherwise thoroughly miserable experience. :001_smile:

 

So, is there something a mom can do to prevent dystocia?

[KellyinAr]

He was 8 lb.s 8 ozs. which was big for me since I have a narrow pelvis. He was stuck for about 10 minutes and nearly died. I'm not telling you this to scare you but it can and does happen. A C-section would have been a blessing that day but it was a home birth. My midwife performed everything imaginable to get him out, and at last she did. We were rushed to the hospital and my son spent the first three days of his life in the NICU. I would just say trust your heart and pray about it and talk more to your OB about your options.

[smrtmama]

Hmm. I was hoping there was some advantage to an otherwise thoroughly miserable experience. :001_smile:

 

So, is there something a mom can do to prevent dystocia?

 

Yes! Keep your baby in optimal positioning. Have you checked out the Spinning Babies website before? Also, no artificial rupture of membranes -- let your waters break naturally, as AROM can cause malpositioning! Freedom of movement is also important, so get up and move around as you feel necessary. Stay off your back and avoid interventions as much as possible -- things like Pitocin and epidurals can interfere with your body's ability to move the baby into the correct position.

 

As KellyinAR points out, sometimes legitimate shoulder dystocia happens. With a knowledgeable care provider, it typically doesn't have to be a crisis, so ask your provider if s/he is familiar with the Gaskin maneuver, as it is the safest and most effective method.

Edited June 17, 2010 by smrtmama

[rookie]

Yes! Keep your baby in optimal positioning. Have you checked out the Spinning Babies website before? Also, no artificial rupture of membranes -- let your waters break naturally, as AROM can cause malpositioning! Freedom of movement is also important, so get up and move around as you feel necessary. Stay off your back and avoid interventions as much as possible -- things like Pitocin and epidurals can interfere with your body's ability to move the baby into the correct position.

 

As KellyinAR points out, sometimes legitimate shoulder dystocia happens. With a knowledgeable care provider, it typically doesn't have to be a crisis, so ask your provider if s/he is familiar with the Gaskin maneuver, as it is the safest and most effective method.

 

 

Thanks for the info.

Unfortunately, I really CANNOT move around. I can barely take a couple of steps. SPD is very, very painful and makes movement a nightmare. I have been severely restricted in my movements (think bed to chair to loo to bed) for three months and they say it will get worse later.

I looked into alternative positions for delivery because of the SPD and according to OB, the side deliveries are only good for small babies (I tend over 9 lbs) and it is painful to stand or be on all fours, impossible to squat.

At least baby is head down! I am not looking for a c-section but I have never dilated without meds. I am talking about 12-18 hours of contraction and no dilation past 3. So, I may need meds again to help it along.

[smrtmama]

Thanks for the info.

Unfortunately, I really CANNOT move around. I can barely take a couple of steps. SPD is very, very painful and makes movement a nightmare. I have been severely restricted in my movements (think bed to chair to loo to bed) for three months and they say it will get worse later.

I looked into alternative positions for delivery because of the SPD and according to OB, the side deliveries are only good for small babies (I tend over 9 lbs) and it is painful to stand or be on all fours, impossible to squat.

At least baby is head down! I am not looking for a c-section but I have never dilated without meds. I am talking about 12-18 hours of contraction and no dilation past 3. So, I may need meds again to help it along.

 

Can you give birth in water? It would take the pressure off your pelvis AND help with positioning. Not to mention that it softens your perineal tissue and helps it stretch.

[ktog29]

I delivered my last baby in August...he was 11 lbs, 3 oz and I didn't even tear. ;) So it can be done (though I'd rather not deliver a baby THAT big again, LOL!).

 

Anyway, I have two books that I read before every birth...Spiritual Midwifery and Ina May's Guide to Childbirth (both by Ina May Gaskin...who invented the Gaskin maneuver to deliver a baby with shoulder dystocia). I recommend them both...you'll get lots of good information from these books. HTH.

[Lilymax]

I had a shoulder dystocia with my 2nd baby. He was 8 lbs. 14 oz with very broad shoulders (like his dad).

 

It was a totally "medicalized" delivery...hospital induction, pitocin, AROM. I was allowed to get up and move around the first twelve hours. It took that long to get to 4 cm. At that point, she broke my water and let me have an epidural.

 

While the epidural was being given, and I was sitting up hunched over, I could feel myself opening for his head. It was pain like I've never known--I was screaming that I had to push and the anesthesiologist kept asking if they'd checked me before he started and they're like, yes, she was only a 4.

 

But apparently I went from 4 to 10 cm in under half an hour, because when I laid back down, his head was right there.

 

I pushed and pushed and pushed...a nurse pushed down on top of me. His shoulder was compressing the cord and his heartrate kept diving into the 30's. It was awful. The OB had to break his collarbone to get him out, and he was limp and non-responsive at first. It was a very scary delivery. Thankfully, he's had no lasting problems from it.

 

I really think it was my sitting up while he was descending that wedged his shoulders funny, but maybe I'm wrong. I don't know.

 

With DS3, we scheduled a c-section. He ended up being 9.2 with those same broad shoulders and a big ol' head. LOL I don't regret it.

 

(edited to add that I often wonder if a midwife would've been able to maneuver him out. But of course if I'd had a natural birth, there would've been no epidural, and when I felt all that pressure I probably would've just pushed him out normally.)

[Classical Country Mama]

I delivered dd vaginally; she was 9'15 and did have shoulder dystocia. I was unrestricted movement for the majority of my long labor (27 hours of horrible back labor). After 3 hours of pushing, it was clear she was stuck somehow. My ob performed an episiotomy and used a vacuum to get her out.

 

That said--she was right as rain within a week or two and has suffered no long-term effects.

 

My second child, now 7 weeks old, weighed 10' even--labor was quick and a breeze. I pushed once or twice and out he popped, with no need for assistance and no ill effects of any kind.

 

Mind you, my first ob told me later if he'd known she was that big, he'd not have ALLOWED me a vaginal birth... :glare:

[gpsings]

My firstborn had shoulder distocia which I attributed to several things:

I went in to the hospital too early

Administered several doses of pitocin

was hooked to a fetal monitor (for no actual reason) and not allowed to move around.

Was given a high block epidural where I was unable to feel contractions

Told to just keep pushing as much / hard/ fast as possible without any feeling of contraction.

A dr was called in and he basically wrenched her out manually. It looked like he was breaking her neck...

My daughter weighed 7 pounds and I am 5'7 160 pounds...I was told my hips were too narrow. :eyeroll: I don't think in my case that it had anything to do with size.

Seriously, her apgar scores were 0 and 2 and she was airvacced to another hospital with a NICU.

I was never allowed to deliver naturally again.

She was stuck for a total of 6 and a half minutes. My whole family was in the room, and we have it on video. It's terrifying.

[smrtmama]

My firstborn had shoulder distocia which I attributed to several things:

I went in to the hospital too early

Administered several doses of pitocin

was hooked to a fetal monitor (for no actual reason) and not allowed to move around.

Was given a high block epidural where I was unable to feel contractions

Told to just keep pushing as much / hard/ fast as possible without any feeling of contraction.

A dr was called in and he basically wrenched her out manually. It looked like he was breaking her neck...

My daughter weighed 7 pounds and I am 5'7 160 pounds...I was told my hips were too narrow. :eyeroll: I don't think in my case that it had anything to do with size.

Seriously, her apgar scores were 0 and 2 and she was airvacced to another hospital with a NICU.

I was never allowed to deliver naturally again.

She was stuck for a total of 6 and a half minutes. My whole family was in the room, and we have it on video. It's terrifying.

 

How terrifying and how utterly negligent of those care providers!

[Jennifer in MI]

So, is there something a mom can do to prevent dystocia?

 

YES!!!!!!! Deliver on hands and knees.

 

My third had a dystocia. He was stuck for 5 minutes. It was scary and painful for me, but he was FINE!!!!

 

With my fourth, I was SOOOOO scared to deliver vaginally because I was so scared she'd get stuck. But, she was MUCH smaller. I actually refused to push with her and she was born without issue - and no pushing - at home!! (I was on my hands and knees!!). The weight difference was 10 pounds, 2 ounces with the third down to 8 pounds 10 ounces with the third.

 

So, it can be FINE!!! Allow labor to happen naturally. Get a chiropractor who knows about birth to attend to you. Deliver on hands and knees.

[Sara in AZ]

A close friend of mine experienced true shoulder dystocia with her 4th baby. It was a frightening experience. The baby was born at home (like all of her others) but was purple and not breathing. The midwife had to work on him for a good couple of minutes before he took a breath. Now he is a completely fine and happy 2 year old. I can't remember how big he was, probably 10 something, but getting stuck, obviously, has to do more with the shoulder width. Her first three were big, and she had worried about SD with the third but it didn't happen that time. I tell you not to frighten you, but I guess to say, "See if it can happen at home, where many people (not myself) would assume to be the most dangerous place to have a baby and work out ok, then how much less worried would you need to be in a hospital with an OB?"

 

Also, I've known plenty of women who delivered 9-11 pound babies vaginally with never a shoulder problem. It think it's not that common. Just my 2, probably unhelpful, cents. When it comes to birth you just never know.

[smrtmama]

It really isn't that common at all. Sticky shoulders (a brief hangup/delay at the shoulders) isn't unusual, but true dystocia is quite rare.

[chris's girl]

I've had 3 babies that were 9 lbs and had no problems delivering. However, my 5th baby was 10lbs, 10oz and would not come out, despite my pushing in every position possible for 2 hours with no epidural. We ended up with a c-section when it was discovered baby's head was still floating in the pelvis after all that. I do feel like her c-section was necessary, but have my doubts about my 6th who they took 10 days early via c-section because of "size" and "shoulder dystocia" concerns (these scare tactics were used to scare my husband into insisting I have a repeat c-section). It's not that at 9 lbs I do not believe she would have been at least 10 lbs at birth, I just resent the fact that they would not even let me try to have the baby on my own (being military we could have been cut loose from their practice, in which case we would have had to shoulder a big medical bill we could not afford). Now with this baby I have little choice but a repeat section. I do think drs make decisions out of convenience for them--hence the drs I have had want to "speed up" my labors because I was taking a little too long on a Friday night. They are not all like that, of course, but there are motivators for some, and they DO use scare tactics for stubborn or questioning moms.

[msrift]

My first had shoulder dystocia. He was 8'8, and 'came out like a line-backer' with his shoulders squared as opposed to curled inward, to quote the medical staff. My only red-flag was that I had been pushing for 2.5 hours. He wasn't stuck for long, but every moment was scary. Several maneuvers were tried and they eventually freed him with a broken clavicle. He was pretty blue, his apgars were 7 and 7, and he didn't give a good cry for a good 20 minutes. All is well now, but as a precaution, I was induced about a week early with my next two. No problems with them, both were out with two pushes, weighing 7'2 and 8'1.

 

My understanding is that true shoulder dystocia is hard to predict, which is what makes it so scary. Don't have any links right now, but most of the risk factors don't seem too highly correlated.

[jplain]

I tell you not to frighten you, but I guess to say, "See if it can happen at home, where many people (not myself) would assume to be the most dangerous place to have a baby and work out ok, then how much less worried would you need to be in a hospital with an OB?"

Not all OBs know how to handle SD without causing unnecessary injury to baby and/or mom. If SD was a real possibility, I'd choose to be at home with a midwife who knows how to handle SD, and I'd do a LOT of positioning work before labor.

 

As they say, birth is as safe as life gets.

[smrtmama]

Not all OBs know how to handle SD without causing unnecessary injury to baby and/or mom. If SD was a real possibility, I'd choose to be at home with a midwife who knows how to handle SD, and I'd do a LOT of positioning work before labor.

 

As they say, birth is as safe as life gets.

 

Agreed. I am happy that some medical schools and hospitals are starting to invite Ina May Gaskin in to teach their obstetrical students how to do the Gaskin Maneuver.

 

Birth will never be without risk. Life is risky! I believe in stacking the deck in my favor, though. Give that baby the best position possible, give that mama as much freedom to move as possible, and only get in the way if either of them really need it.

[4kids4me]

My SIL had it with her 8th baby (big baby, like 10lbs). She was stuck for five minutes or so before her collarbone broke naturally and she came out. They had to revive her, I believe and she spent some time in the NICU (mom wasn't induced and had a natural delivery). Her doc said that if the baby's collarbone didn't break he would have broken it to get her out.

 

My second had it (9lbs, 5oz). Fortunately I had midwives who didn't mind repositioning me (something regular doctors don't do much of where I live, I heard), so I went on my hands and knees and he finally came out. Natural delivery, no induction or drugs or anything.

[Catherine]

He was 9lbs, 2 oz, and I had an unmedicated, free-moving birth. It was brief-as soon as his head was born, it was clear the rest did not follow quickly as it should, and with a change in position, onto my hands and knees, she was able to pull hard enough to deliver his shoulders.

 

He cried hard. I think it hurt. But his clavicle wasn't broken.

[Jann in TX]

I my pelvis had separated... walking was nearly impossible--and moving was excruciating... rolling over in bed brought SCREAMS... I was in a wheelchair the last 6 weeks of the pregnancy...

 

I was nervous.. OB said baby and I would be fine..

 

I asked about a C-section... OB said natural would be best... (seems kinda backward to me...)

 

Because my pelvis had separated, baby was 'spinning' instead of engaging. Cord kept wrapping around neck...

 

I talked the Dr into inducing me at 38 weeks. A light dose of pictocin and I was ready to go...head crowned then...

 

Baby's shoulders presented square (dystocia)

 

Cord prolapsed

 

Cord around neck strangled Baby..

 

This was an UNMEDICATED birth... DH AND my 9 and 11 yr old dds were also in the room!

 

All I remember is extreme blinding PAIN then baby finally came out... count down clock had already gone off..

 

Baby was unresponsive--apgar of 1 (heart started back up with first massage)...breathing took a few minutes longer...

 

Baby was terribly bruised and ended up with severe jaundice due to bruising... light blanket therapy for several weeks...

 

Perfectly happy, healthy 8yr old girl today... we were lucky.

 

If I had another pregnancy with pelvic separation I would go with a C-section--no hesitation Too many things could go wrong.

 

OB regrets not listening to me... this is nothing to play around with... both baby and mom's lives are at risk

[smrtmama]

I my pelvis had separated... walking was nearly impossible--and moving was excruciating... rolling over in bed brought SCREAMS... I was in a wheelchair the last 6 weeks of the pregnancy...

 

I was nervous.. OB said baby and I would be fine..

 

I asked about a C-section... OB said natural would be best... (seems kinda backward to me...)

 

Because my pelvis had separated, baby was 'spinning' instead of engaging. Cord kept wrapping around neck...

 

I talked the Dr into inducing me at 38 weeks. A light dose of pictocin and I was ready to go...head crowned then...

 

Baby's shoulders presented square (dystocia)

 

Cord prolapsed

 

Cord around neck strangled Baby..

 

This was an UNMEDICATED birth... DH AND my 9 and 11 yr old dds were also in the room!

 

All I remember is extreme blinding PAIN then baby finally came out... count down clock had already gone off..

 

Baby was unresponsive--apgar of 1 (heart started back up with first massage)...breathing took a few minutes longer...

 

Baby was terribly bruised and ended up with severe jaundice due to bruising... light blanket therapy for several weeks...

 

Perfectly happy, healthy 8yr old girl today... we were lucky.

 

If I had another pregnancy with pelvic separation I would go with a C-section--no hesitation Too many things could go wrong.

 

OB regrets not listening to me... this is nothing to play around with... both baby and mom's lives are at risk

 

This sounds like it was related to the induction, not to the SPD.

[BearWallowSchool]

My first was born 10lb. 2oz. and she had it. It scared me b/c it was my first and I was young and the nurse hands me the baby and says, "Oh be careful w/ her, she has a broken shoulder." :confused: But looking back on it, it wasn't a big deal and it healed within a week. My midwife told me that it was normal and that the babies collarbone is designed to break in order for a big baby to be born.

[annandatje]

According to my highly experienced and capable homebirth midwife, my last infant presented with shoulder dystocia. She was a long thin wiry 10 lb 8 oz baby who was delivered without an episiotomy. I do not know if it was "true" shoulder dystocia, but the midwife and her attendants handled it with positioning and maneuvering. It's all a blur to me except that I had to work exceptionally hard to evict the babe. So hard, in fact, that I had to get up and walk around immediately after the delivery because I had a terrible case of restless legs.

 

If I recall correctly, the midwife had some work alongside The Farm midwives.

 

Thanks for the thread. I never knew until now how potentially serious a complication it could be.

[twoxcell]

My first was 9lbs 7oz he was posterior, but turned after 4hrs of pushing and came out naturally. My second was 10lbs 7oz, and her shoulders did get stuck. My CNM manuvered her while the nurses all started pushing on my abdomen. It was freaky at the time, but she's fine. My last two were induced early due to cholestasis and macrosomnia. They were both two weeks early and 8lbs 10oz, and 7lbs 9oz. I have never had an episiotomy in my life. I tore a little with my first three, but it was minor. dd that had shoulder distocia her head was 14.5 in and her chest was 15.5 in.

[KidsHappen]

My third baby was born at home with a very experienced midwife. She had true shoulder dystocia. The midwife tried a few different maneuvers without success at which point it was a choice of break the baby's arm or pushing with all my might and risking a severe tear and the choice had to be made quickly as we were running out of time. It was an easy choice to make though. I delived a perfectly healthy 10 lb. 7 oz. baby and suffered third degree lacerations. The water had broken and labor began naturally. The baby's head was engaged and she presently normally. I was also free to move around as I wished and we tried changing positions but it did not help. She just happened to have very broad shoulders and they came out squared like a line backers. I later gave birth to another baby of exactly the same size, completely naturally without any tearing at all.