I'm pregnant with #2

[admin]

We are very excited but obviously very nervous at the same time. I have a visit with a new OB who I have seen once for an annual. Any suggestions on questions I should ask specifically in regards to BPI?

[Tanya in NY]

Hi, and congratulations on your pregnancy. Here's a few questions I would personally ask.

Have you ever dealth with a shoulder dystocia?

What did you do to alleviate it?

What was the outcome of this delivery?

What methods do you know of to alleviate shoulder dystocia (whether or not you've used them before)?

Have you ever injured a child before (may want to rephrase that one)?

What position do you typically deliver a patient in vaginally (ie. on your back, side lying, squatting, hands-knees)?

Would you recommend a cesarean section?

If you recommend a cesarean section, can you make the incision larger than your normal to prevent a BPI during the cesarean?

These are just a few I could think of off the top of my head. Good luck to you.

Tanya in NY

[dmom]

Congratulations! I had a third baby after my BPI child, and everything went well, so try not to worry too much!

I think Tanya's questions are all great. Here's my two cents, beyond just the issue of what questions to ask.

First of all, I wouldn't go to just any OB. I would make a point of going to a high-risk OB. (I don't know if yours is or isn't, but it's a good idea to have an OB who deals with risky pregnancies and deliveries) Secondly, I would make sure to have a C-section. After having a BPI baby, you're at a much higher risk now of having another baby with BPI. I know some mothers on here have had vaginals after the BPIs, but I was told emphatically - by many different doctors - to not do that. To each her own ... but I just wouldn't risk it.

I would also advise you that if the OB you choose is somewhat cavalier about the BPI issue (like he tells you, "Oh, yeah, BPI. That happens every now and then. I wouldn't worry about it happening again"), I would find a new doctor. You need an OB who understands the seriousness of the injury and the importance of guarding against another one. I'd tell him ALL about your child, about the delivery, about the injury, about the lingering effects of the BPI - make sure he knows you are SERIOUS about it NEVER happening again.

Hope that helped a little. Good luck to you! I am sure everything will work out fine!
Janet

[admin]

I also would recommend a c-section. My first born had bpi and my two children after that were scheduled c-sections at the Dr.s recommendation. Good Luck and keep us posted.

[admin]

Well we had our first visit. Basically he outlined two options for me, a c-section at 39 weeks or we could monitor the baby's growth through the pregnancy and make some late 3rd trimester measurements of baby's shoulder width, head size, etc. along with measurements of my pelvis and make a decision from there. It was clear that while he would do whatever we wanted, he really feels the c-section is safer. Says the risk of SD occuring again is low because it was spontaneous and I had no risk factors for it. He still felt that the risk is there however and we need to watch baby's growth carefully.

I didnt ask anything about SD relief. I really, truly am terrified of a c/s and almost mournful that I wont have another vaginal. Even though we had the result we did with our DD, giving birth was still an amazing process and I truly am sad that I may not experience it again. However I really feel in my gut that the c/s is the only sure thing. This just stinks.

[admin]

I just want to chime in that the only thing that I've seen written that scares me is that "a c-section is the only sure way" that your 2nd child won't be injured. I thought this, too, when I scheduled a C-section for my 2nd delivery after my first child had been injured at birth (shoulder dystocia situation)with a brachial plexus injury. However although no one picked up on it at the hospital, my husband and I noticed un-even movement between my second baby's two sides and he was diagnosed by x-ray with a broken clavicle that the OB, hospital pediatrician, and our own pediatrician missed. Monitoring how it healed, it was determined that movement did not return in the pattern of a simple clavicle break. My second son is now diagnosed with Erb's Palsy as well. I thought I was doing everythign possible for my child by going through a C-section but I left it in the OB's hands. I thought I did enough. Now I would become a control freak. I would ask what is the largest possible incision the OB could make and demand it. I wouldn't care that it would be a little more difficult recovery. It is AWFUL to hear that your second child is injured and you thought you did what you could to prevent it. Please know that up to 7% of all brachial plexus injuries are in fact caused by C-section births. It is not an automatic safe delivery. Most injuries are caused through emergency C-sections, but I hate to say it -- Any parent of a child with a brachial plexus injury needs to become a total control freak with the doctors to make sure their second child is born safely. I wish I had been more so.

[katep]

Hi Guest,

I know exactly how you feel about being "mournful" you won't have another vaginal birth. My first baby was LOPBI, he was full term in a home birth that was incredible and amazing and only marred by the horrible fact that he was injured. If I ever do get pregnant again, though, it will definitely have to be a c-section delivery.

Your doctor is incorrect about the risk of SD being low the next time. Some studies have shown that the risk of the second baby experiencing SD if the first did is 25%!! That is even with the chronic underreporting of SD that occurs in our hospitals. Every study shows that the most important and significant risk factor for SD is that you've had it before, and if you had it with your very first baby (as the risk of SD goes up with subsequent deliveries) then you are very high risk indeed.

Kate

[BarbH]

Congrats Guest,

I'm pregnant with my second too. Right at 5 months. I have already talked with my OBGYN and he says to have another vag birth would be to much risk for our baby. I never even thought about a larger cut for c-section. I didn't relize you could still have a BPI result with a c-section.
Thanks Tanya.

[admin]

Congratulations on your addition!! I, too, am pregnant with #2 after a first with a shoulder dystocia - 9 weeks. I have been told by everyone...Her specialist, Her Dr., Her pediatrician to have a c-section. Where I go to the OBGYN I saw the nurse mid-wife the first time just to give all the information, then a week later had the ultrasound. Next I finally get to see the OBGYN. I told the nurse mid-wife that I needed a c-section and all she said was "why" so I told her. I will find out what the OBGYN says soon...but I am going to be firm in my decision. Just too many people telling me I should go that way, with no one telling me it would be ok to go naturally. I feel the same fear that you are feeling. The surgury scares me so badly, so I am looking up all the information I can so I can be more prepared.
Congratulations Again!!!
Cathy

[admin]

first of all, congrats to the both of you! i had a c-section and there is no comparison between the two. my child with bp was a vbac and that was horrible. the c-section was a breeze, really. i had a bikini cut and was walking the next day and back to my regular duties, including being a new mom within the week. good luck to the both of you, you will be just fine!