United Brachial Plexus Network, Inc.

I have six children. I have a history of large babies and shoulder dystocia, but thankfully, no injury to any of them as a result. I am pregnant with my 7th and my doctor is suggesting a c-section based on my history. My other children were delivered in military hospitals with the exception of my first and last. They always noted my history of SD, and asked if trauma resulted but never mentioned C-Section, but I was allowed to be induced at around 38 weeks after my 4th. My last was born in a civilian hospital and she too did not bring up c-section but induced at 39 weeks. After delivery and another SD she mentioned something about her partner being surprised that she didn't give me a c-section. My new doctor is now going to let me consult with a high risk OB to see what he suggests. She mentioned that we could check the baby's lungs at 37 weeks and possibly induce then, but she is favoring c-section. Given my history, she says I'm lucky that my children have not been injured. I want to do what is best for me and my baby. If not induced I ususally go over my due date and have had babies that were facing up during labor, so I feel that something should be done. Just wondering if inducing early or c-section would be better.

I can't really answer what would be best for you, but I thought I would give you my experiences.
My first son was born c-section due to a breech presentation. I tried a vaginal delivery with my 2nd baby, but after many hours of labor, they finally did a c-section. He was 9 lb 8 oz. I tried a vaginal delivery again with my 3rd and was successful. My water broke at 38 weeks and she was 7 lb. 12 oz. My 4th was another vaginal delivery and he was 9 lb. 1 oz., but didn't have too much problem with the delivery.

My 5th baby came 9 years after my 4th baby. The doctor was a little concerned about the baby being big, but he said we would induce at 38 weeks. I was induced, but the baby was 10 lb 9 oz. He suffered an injury to his left arm. He is now 5 and is doing really well, but is still in therapy and will never have completely "normal" function.

When I got pregnant with my 6th baby, they were really concerned about another big baby. The doctor offered a c-section and after much consideration, we decided that would be the best option for us. The c-section was performed at 37 1/2 weeks and the baby was 8 1b. 3 oz.

I do not regret my decision to have a c-section. Everything went smoothly. But this is such an individual decision. Good luck in deciding what is best for you and your baby. Hopefully you'll get a lot of information that you'll be able to use to make that decision.

Connie

Here are the risk factors for SD and BPIs.

suspected large baby - over 8 lbs. 14 oz. (fetal macrosomia)

maternal diabetes / gestational diabetes

maternal obesity

an overdue baby - gestation over 40 weeks

short maternal stature

contracted or flat (platypelloid) pelvis

maternal weight gain of more than 35 lbs.

protracted first stage of labor

prolonged second stage

breech birth (or other abnormal presentation) this is a risk factor for brachial plexus injury but not for shoulder dystocia

AND HERE IS A LIST OF RISK FACTORS WHEN THIS IS NOT YOUR 1ST DELIVERY.
a history of shoulder dystocia during a previous delivery

a history of giving birth to large babies

8 years or more have passed since your last birth

You missed out some of the risk factors that seem present in almost all injured babies births and are totally preventable unlike the mothers or babies size. They are;

Induced labour
Epidural
Lithotomy position (lying on back)
ARM (artificial rupture of membranes)
Fetal monitoring
Forceps delivery

Only around half of bpi babies are large, but almost all of them have one or more of the above interventions.
Your babies weren't injured not through luck, but because you had delivery staff who knew what they were doing. SD does not have to result in injury to mother or baby.
Best wishes with your choice.

What do the initials "SD" stand for? I've seen it used before but don't know where or what it is?

I was having a stupid moment. I do know what SD is. Duh!!!

Cindy.... LOL....don't you just love those duh moments!
I am OBPI and did not know what SD was until I found UBPN... I also discovered two of my children were SD births as I began to read more about it...

Kath

Like others have said, this is such a personal choice. Let me give you some tips though if you do decide to go way of vaginal delivery (I'm a L&D nurse and Mom to Amber with ROBPI).

As far as having delivered babies that were face up (OP)...Ouch first of all...next, you can do exercises to attempt to get your baby to turn face down (OA). These exercises include lying with your hips tipped up (try lying on your back on the floor with your butt angled up towards the ceiling supported by some large blankets/pillows). You need about a 30 degree angle. Start this at around 36-37 weeks I believe (I'm sorry, but I can't remember when the clinic staff usually tells patients to start this, but it is near the end of your pregnancy...check with your provider). You can also while in labor get on your hands and knees to help rotate the baby to an OA position if it is OP. You can also rock your hips in a figure 8 formation while in labor to help turn the baby.

What about stripping your membranes early rather than just doing a medicinal induction at the hospital. Get your membranes stripped (not ruptured) and this will help release hormones that help with labor. It's not a surefire way, but since you are a grand multip, this could work. After your membranes are stripped, I hate to say it, but go have fun with your husband (if you know what I mean) as that helps too sometimes. Once again, this isn't foolproof, but it's worth a try instead of pitocin!

If you do have an induction, ask about a telemetry monitor. Our unit has a fetal monitor that can be hooked up to the mom to monitor contractions and the baby's heartrate, but it hooks up to a small box that the mom carries (or her support person does) so she can be in any position she wants, including walking in the hallway. This is called a telemetry fetal monitor. It can get wet so it can go in the jacuzzi or shower, too. Get off your back for labor and delivery.

What position did you deliver in Tammy? Get off your back for delivery if you have a SD! Get on your hands and knees to allow more room for your baby!

I wish you the best with your decision. And for goodness sake, ask your provider what they would do if you experienced another SD? What manuevers would they do? How would they do them? Have they experienced SD before and what was the outcome? What happens if your doctor/midwife isn't the one there for delivery, but rather someone who is covering for them? What is their experience with SD?

Tanya in NY

My first baby vaginal RBPI at 37.5 weeks. She weighed 8.11. My second delivered c-section weighed in at 9.2 at 37.5 weeks. I am so happy that I had the c-section. It is a personal choice that only you can make. But if you just want feed back I would have a c-section again and again. I watch my 20 month old do things my poor daughter never could (and even some she still can't at age 5). I have so many regrets about my first delivery. So many what if's. This is a horrible thing to live with. And what the child goes through still kills me. Good luck.

My first child was a vaginal delivery and she is ROBPI. I chose to have a c section with my second daughter and it was OK....I appreciate that my second child was not injured and she would have been as she was a pound bigger than the first. Good luck with your decision....

Lenni