Q regarding subsequent births

[ChefEsther]

I am searching for info regarding the safety of a vaginal birth after a previous obpi. We are expecting baby #4 - our youngest daughter was had a obpi 20 months ago, and we are expecting in August 09. I am looking specifically for research on whether c-section is necessary... any information would greatly appreciated. TIA

[marieke]

A lot has to do with the SIZE of the baby, as larger babies often don't have enough room to be delivered safely (meaning without being injured).

I am sure others will respond as well and fill you in some more.

Marieke 33, LOBPI

[sgesford]

I don't know about research, but I do have experience. Nikki was born LOBI at 1 1/2 weeks early in 1996 @ 8 lbs 4 ozs. When I became pregnant in 1999 with our second child, obviously, that was a concern. I spent a great deal of time discussing the issue with my OB/GYN. Since our second child was a boy, the odds were very high that he would be even bigger than Nikki. I did not want to have a C-Section, but obviously did not want the same thing to happen to him. We mostly dicussed inducing a few weeks prior to the due date. I guess God knew what we needed. Clayton was born 2 1/2 weeks early, but not because of his weight, my blood pressure became an issue. He weighed 8 lbs 1 oz and was in good shape. I hope you find all the information you need to make the right decision for you and the baby. We'll be praying for all of you. -Shannon

[sgesford]

Sorry, I left off my P in LOBPI, but you know what I meant.

[joseph]

When I became pregnant just 11 months after my last baby's birth, which ended in a severe lobpi and a pubic symphasis injury on my part, we were very concerned. First we didn't know if I could even carry the baby to term just because of my injury. Our OB left the decision up to us about how we wanted to deliver. My husband and I decided for c section but as my delivery date grew closer I had second thoughts. I kept goi g back and forth about it. Two weeks before my due date we had an ultrasound to determine size. It showed the baby to be 9 1/2 lbs. We opted c section. Baby boy number three was born a week early weighing 9 lbs 7 oz. I believe an ultrasound prior to the delivery of my second son could have saved him from injury. He was 10 lbs 11oz. I always mesured too big for my dates but the midwife felt no need for the ultrasound cuz I didn't "look" big.

[Ken. Levine]

There was a strong movement several years ago supported by Benjamin Sachs, M.D. at the Harvard Medical and ACOG for vaginal birth after a cesearian section. The feeling was that ob/gyn's should always try a VBAC. The literature did not specifically concern shoulder dystocia but it was included in the discussion. A few years ago Sachs, and then ACOG, came off that position. The research showed that the push for ACOG was causing alot of problems and injuries to babies and mothers that could have been avoided.

I can tell you that when we have a case come in where there was a prior shoulder dystocia and then a vaginal delivery with shoulder dystocia and brachial plexus injury there is no defense. If shoulder dystocia is present in a delivery for all subsequent deliveries the standard of care is that the ob/gyn must warn the mother that it could happen again, that the child could suffer a brachial plexus injury even if the maneuvers are done correctly and give the mother the option of cesearian section. If the csesearian section is not offered and the baby suffers a brachial plexus injury there is truly no defense.

So, to make a long story short, be safe, be careful and have a cesearian section.

Ken Levine
Klevine@Klevinelaw.com
www.Klevinelaw.com
617-566-2700

[mommieinneed]

I had my first daughter weighing 8.10 and came out with a pulled BPI her arm movement came back within hours.

I had my second child 22 months later and since there was no news readily available about BPI I didnt even question having my daughter natural even though I knew she was bigger. Maggie came out with a severe BPI, she weighed 10.6.

I had my third child 3 years later, it was a boy and I opted for a csection and the new ob (I had the same ob with both girls) even said we were going to do it early. Three weeks early my son was delivered by csection weighing 8.13.

I wish you and your family the best on your decision.

Ken, If there is record of my first having a bpi but it doesnt say anything about shoulder dystosia would there still be no defence in the case.

[claudia]

I probably shouldn't say anything, as I am not going to have anymore children. And Juliana, my fourth child, is LOBPI.

However, we have this discussion on a regular basis here.

My first child was shoulder dystocia. She was induced 5 weeks early as my membranes had ruptured 10 weeks prior to that (yes, do the math...at 25 weeks PROM). In order to keep the two of us healthy, she was induced. When the nurses whispered that she might be "an Erbs baby" I had no idea what that meant ("it means her arm doesn't work"), but I knew that we had bigger fish to fry with her...lack of kidney function, lack of liver function, minor brain bleed...Well, she surprized everyone. And, by the time she was about 10 months old, I was trying again. I got pregnant with twins, and delivered them both vaginally.

Three years later, I got pregnant with Juliana. I thought and wanted to just labor at home and get to the hospital just in time to deliver. I wanted no interventions, just to have my little girl and go home. Obviously, that is not what occurred.

I make big babies. My "preemie" weighed in at 6lbs 9oz. My twins:7lbs and 8lbs9oz. Juliana:9lbs 6oz. I am certain that any baby I would have now would easily top 10 lbs. That being said. I would give anything to have a beautiful birth. To know what that is like. To have Ina May Gaskin deliver my child...I can only dream. It would have put to rest all those feelings of "what if". I would really know how it feels to just have a baby. Not have a technological wonder.

There are risks to C-sections too. And they need to be carefully thought out. I think this is a conversation you have with yourself, your husband and your new ob. I would interview about 10 doctors before I decided on one, no matter what you decide.

good luck,
claudia

[Ken. Levine]

Mommieinneed,

If there is a record of the previous child having a bpi, even transient that recovered, there would be no real defense to a case involving the next child with a permanent bpi. The general defense used by the doctors to bpi cases in which we argue there has been excessive lateral traction is that shoulder dystocia is an unpredictable medical emergency and that even "in the best of hands" when the maneuvers (McRoberts, Woods, Posterior arm) are done correctly the child can still suffer a bpi. I do not believe that to be true with a permanent injury, but that is the doctors position. In a case where there has been a prior shoulder dystocia, or a prior recorded bpi (where there was most likely an unrecognized shoulder dystocia) we can use the doctors own argument against them. We can in those cases agree that injury can occur in the best of hands with all the maneuvers being done because if that is true, there is an absolute responsibility to warn the mother before the next delivery and explain the risks of shoulder dystocia, fetal death, hypoxia, brachial plexus injury, and give the mother the option of cesearian section. In my experience in cases where the mother has had a prior shoulder dystocia and has been offered a cesearian section, the mother has always had the cesearian section.

We do have cases where in that instance the doctors claim to have offered the section but it is not written in the record. I have to date never had a judge or jury doubt the mother. The judge or jury always believes that in cases of a prior shoulder dystocia, if the mother was properly informed of the risks and offered a cesearian section the mother would have had the ceseraian section. No judge or jury believes that a mother would knowingly out their child at risk.

That is my experience with the hundreds of bpi cases I have had and that is why I say that it is not defensable.

If you have any other questions, please post a note or contact me directly.

Ken Levine
Klevine@Klevnelaw.com
617-566-2700
www.Klevinelaw.com

[Josh'smom]

Ok, so here's my story...I had my daughter in 1993...my first, they induced me because I was 2 weeks late...they used vacuums and forceps and delivered her with a broken collar bone she was lodged there and they couldn't get her out...the doctor shouted...lets get this baby out!!!I was totally devastated with my first delivery experience...she weighted 9 pounds (big baby since I am only about 5 feet tall)Then 4 years later I plan a pregnancy, interview doctors and tell them of the aweful delivery I had...I find the doctor that said "will watch me" and take care of the situation...they assure me it will not happen this time....about 5 days before the delivery they do a sono and it shows the baby over 8 pounds and I am worried...they schedule an induction and tell me ALL is fine...nothing to worry about....I beg for a c section because I am afraid..they tell me you can do this, the doctor delivering the baby tells me he feels confident the baby isn't EVEN 8 pounds and if I delivered a 9 pound baby before I can do the 8 pound baby with ease...so my son is born with a broken collar bone and a brachial plexus injury to his left side...he weighed 9 pounds 2 ounces...then with with my third child...I was NOT willing to risk it AGAIN...I demanded a c-section and found a doctor that would do one....born 10 days early by c=section was another son and he weighed 7lbs 6 ounces AND NOT INJURED!!! I wish I could go back and INSIST my son be delivered by c-section---he wouldn't have to have gone threw a surgery at 3 years old, teasing at school, constant therapy and another surgery in his future....please really think about this....I have to tell you my section was CAKE compared to my two VERY difficult deliveries...with the first I actually couldn't walk for a few days and the second I had a ton of stitches so I couldn't sit for a few days...It's your decision to make, but I wanted to share my story....good luck in your decision. Email me if you need further information.


Message was edited by: Josh'smom