Having a baby after delivering one with OBPI...

[Erin in Colorado]

Hi Everyone!
I'm new to posting on this forum, but often read what others have written. I have a two year old daughter, named Adelyne (Adi), who was born with a pretty severe OBPI. She has had the mod quad with Dr. Nath and has made significant improvements over the past two years. She still has a long way to go and we still are in the process of deciding whether or not she will have the triangle tilt. We are very proud of her range of motion and ability to sit through a therapy session (especially as the terrible two's set in!).
Currently, I am eight months pregnant and am getting a lot of direction from my new OB/GYN to have a c-section. I can understand her wanting to avoid complications during delivery, but what we have found during our research in to what caused Adi's injury, is that all signs point to doctor error. With this pregnancy there no pre-existing conditions (diabetes, obesity, large baby, etc.) and the only reason that she can give me for needing a c-section is that the likelihood of an injury occuring is higher because it has happened before.
I want to do what is best for the baby, but I don't want to have an unnecessary surgery or commit myself to c-sections from here on out if I don't need to.
Has anyone else ever experienced this with a doctor, and more importantly, has anyone delivered two babies, both resulting in OBPI?
As I mentioned before, I am pretty far along (due March 12), so this is kind of a time sensitive issue. If anyone has any advice or experience to share, please do so as soon as possible.
Thanks in advance for any help out there!
Happy Super Bowl Sunday!
Erin

[Karenw3]

Erin, there have been several other postings related to this topic. Most BPI parents have gone on to have other children and there are many varying opinions on the decision concerning vaginal birth or c-section after BPI. In my case, the doctor used a vacumm and due to this along with other doctor errors, my baby received a lifelong injury. There was shoulder dystocia present in my case as well. Due to many unknown factors and risks associated with birth, I knew that I never wanted to put myself or my child in that position again. I chose to have a c-section rather than wrestle with the idea that another child of mine could be put in the position of having a lifelong disability that might require multiple surgeries, therapy, pain, etc. There was no way I was going to gamble with that possibility. However, each person must make this decision on their own and of course, there have been many mothers who went on to deliver healthy babies vaginally after a BPI. Good luck and best wishes for a wonderfully healthy delivery and baby!

[candjwarner]

Erin,

I am a mom who recently (almost 4 months ago) gave birth successfully after a delivery resulting in an OBPI. It is a hard decision and not one to be taken lightly. Each case is SO DIFFERENT. I really think it depends on exactly what caused the BPI. How bad was the shoulder dystocia? How big was the baby? What factors are different this time around? What factors are the same? If you want to e-mail, please feel free to do so . I am glad we went the "natural" route again, but that doesn't mean it's the wisest thing for everybody. It was wise in our situation, and I'm thankful we went that way. My e-mail is candjwarner@yahoo.com if you want to "chat" a bit! They are hard decisions to make!!!

Jamie
mom to Titus 2, LOBPI

[aurorasmom]

Hi there, congratulations on your pregnancy! My daughter Aurora has a LOBPI, she is eight months old. I had natural childbirth in a hospital setting. I knew that I didn't want to give birth on my back but when it was time to push the nurse said, "Llay back grab your feet and push. No, I said and preceded to squat above the hospital bed. What a spectacle it must have been, and what the doctor and nurse must have thought. The pain was exquisite, I at my most primal delivered my daughters head, but somehow ended up sitting on the bed...the doctor and nurse said, "You are doing great, I need to deliver the shoulders." Or something close to that...I feel certain that is why Aurora sustained her injury. If we are blessed with another baby, I would give birth on all fours, or in a side lying position. I don't think there is a circumstance that a woman should give birth on her back in a sitting or semi-setting position because it can reduce the mothers pelvis by 30%! It prevents the tailbone (saccrum?) from expanding. I think that is what happened to Aurora. Good Luck!

[Ken. Levine]

I read with interest your post about vaginal delivery after a birth complicated by shoulder dytocia and brachial plexus injury. I have had many cases where the parents had two deliveries with shoulder dystocia. The common senario is that the first baby has no injury or at most a transient injury leading the ob.gyn feel it is proper to attempt a vaginal delivery with next baby.In these cases the ob/gyn usually does not inform the parents of the risk for shoulder dystocia with the next delivery.Sometimes the second delivery is fine but if the second baby suffers a more serious injury the parents can feel misled that they were not provided with appropriate information about risk factors and not offered a cesearian section.

In your case your doctor does seem to have warned you about the risk of recurrent shoulder dystocia. A shoulder dystocia with the first baby can be a risk factor for recurrent shoulder dystocia, along with other factors that you mentioned. If you do decide to deliver the next baby vaginally, your ob.gyn will certainly want you to sign a consent form that confirms you were warned of the risk factors to avoid any liability issue if there is a shoulder dystocia again.

As I have dealt this issue quite alot, I would be pleased to speak with you directly about it.

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

[Jennifer P]

This is a very interesting topic which makes me think of another one...

How common is it for a mother with OBPI to give birth to a baby with OBPI?

[Jmarcellus]

I'm assuming you already had the baby - so congratulations and let us know how it turned out. I wish my OB/GYN had recommended c-section with my 3rd daughter. Her two older sisters deliveries were not easy and both were stuck. Fortunately, no nerve damage. On the 3rd however, the Dr pulled with a vacuum to get her out. I say err on the side of caution and do the C-section.
Regarding the consent form for VBAC, the consent form says you were notified of the risks to the mother, but it doesn't say you are notified of the risks to the baby, particularly nothing about the shoulder distocia. The hospital tried to shove that consent form on me during our malpractice suit and it really didn't apply.