United Brachial Plexus Network, Inc.

PLEASE--- this is NOT intended to be a debate!!! Reading other posts, I know most people on here have STRONG opinions on birthing, so please, please, please, if you don't have anything to say about the actual topic (having a vaginal birth after a BPI birth) DON'T POST!!!!!!!!!!!

Has anyone had a BPI child and then gone on to have another child vaginally with no complications? I am currently 5 months pregnant with child #4. Zadyn, my OBPI, was my third child. She was over 10 pounds at birth. My doctor, the same one who delivered Zadyn, said that if this new baby is around 8 pounds (where my first 2 where) he would let me deliver vaginally. But, if the baby is measuring bigger, he wants to do a C-section. I WILL NOT have a c-section. I know my body could handle it. So, does anyone have a successful story to share? Thanks,

Alisa, Mom to Zadyn, LOBPI, 2.5 years old

ps-- sorry the beginning is so harsh, I just don't think I can handle a bunch of people coming on to offer "advice" by telling me a c-section is the only way to go. My intentions were NOT to offend.

Just out of curiosity, how would you have the baby if it WERE to be over ten pounds?

I don't think people would tell you to have a C section because they were offended. I think they would just be concerned for you and the baby during another vaginal delivery, maybe you could ask to be induced early? I know that doesn't guarantee that your child won't be injured again but it's an option.
Just out of personal curiosity and please don't feel obligated to answer, but why are you so opposed to a c section?
Dawn, mom to Cassidy 22 months ROBPI

I am not in the situation you describe, so I don't have personal experience. But I ask you to consider one thing (not sure if you have yet, or not):

Even if you feel your body can handle it - and I absolutely support you in that belief - your doctor can still make or break the situation. A good doctor can get the baby out of trouble without injury, and a bad doctor can get the baby INTO trouble! From your description of your doctor, and the fact that he wants to do a c-section over being confronted with another possible shoulder dystocia... are you sure you want him managing this delivery?

If you are committed to a vaginal delivery, I would just make absolutely sure that your doctor is also strongly committed to that AND very practiced and knowledgeable at what to do - WITHOUT injuring the baby - if shoulder dystocia occurs or the baby is very large. You need a doctor who is comfortable and experienced with delivering large babies... not one who habitually takes the C-section route for large babies. He/she needs to know how to help the child out if the need arises, and this takes knowledge and experience. I don't believe there is an absolute way to avoid shoulder dystocia, but I do believe that a good practitioner can avoid injury IF one happens. I would just make very sure you have that practitioner if you go this route.

Best of luck and I wish I was in your shoes trying to make your decision...

Kate

PS... even though I've only birthed once, it was an all-natural birth, I did everything that you are supposed to do to avoid shoulder dystocia. I labored on side and all fours and in birthing tub, I was not on my tailbone during delivery, etc, but Joshua STILL got stuck. I would NOT assume that you will be able to avoid another BPI by avoiding a shoulder dystocia altogether. Take precautions definitely, but the biggest precaution is having a doctor who knows the right things to do IF shoulder dystocia occurs.


Message was edited by: katep

Boy, this is a tough situation that you are in, as many families in the future will also be in. I don't envy your situation at this time.

Let me just preface with this...it is well known that once you have had a shoulder dystocia and/or a delivery with a brachial plexus injury, there is an increased risk of it repeating in subsequent vaginal deliveries.

I have been witness to some vaginal deliveries that have occurred after there had been a previous BPI and/or shoulder dystocia delivery. I have to say that the common theme in that delivery for the family was one of fear. It has always been a very long, emotional labor because usually an induction of labor was utilized to prevent a large baby (induction of course takes longer than a natural labor progression), and the mother's psyche I believe slowed the process down. Mind over matter...fear took a seat at that table if you know what I mean.

It can be done of course, but it has to be the right circumstances. The right size baby, the right size pelvis, the baby in the right position, labor progression, and of course the doctor/midwife doing their part correctly. Kate made a very important point about the doctor/midwife. Just re-read her post and think about that part. Have a lengthy conversation with your practitioner about shoulder dystocia, along with what the nurse's experiences and drill practices are on the unit you'll deliver in. Some hospitals do not practice shoulder dystocia drills and when they happen all s**t hits the fan if you know what I mean. This will compromise your baby. Remember your last delivery and if the staff was calm or panicked.

What will you do if your baby is bigger than your doctor will allow you to deliver vaginally with? Will you refuse a cesarean and go against your doctor's advice? Will you switch to another doctor late in your pregnancy? Will you have a back-up plan? If your baby is 10 pounds again (as your last child with a BPI was), would you risk another injury, as this is a question you will have to ask yourself. If an injury occurs, will you be able to handle that knowing the choices you made, especially if you went against the advice of your doctor? Gosh, these are tough questions and decisions. You very well could experience the exact same scenario as your last delivery since it is the same body, same doctor, and could be a similar sized baby. Food for thought.

I am a huge proponent of vaginal birth! I work really hard with my patients (I am a labor and delivery nurse and mom to Amber who has a ROBPI) to help them to deliver vaginally. Sometimes, I have spoken up though and told them my personal opinion because I am not only an advocate for the mother, but I am an advocate for this beautiful unborn child. In the longrun, Moms and Dads just want healthy babies. The way they are brought into this world shouldn't be such a controversy, but alas it is.

Best wishes with your decision.

Tanya in NY
Amber's Mom, ROBPI, 5 years old

Just a reminder, induction is itself a risk factor for bpi.
Jen NZ

Everyone who posted so far did a fantastic job in writing great posts to you.

I used to be a birth doula before I had Maia. So the women who hired me wanted only natural, vaginal births adn we did everything we could to make that happen. But I spent a lot of time explaining to women that sometimes babies and moms have to have help and rather than looking at c-sections as a horrible, negative thing, to look at it as a medical tehnology that can help save lives.

I also stood in as support while women with the emergencies had c-sections and watched and after the baby was delivered I'd go talk to the baby and sing to the baby. I let the baby know that Mommy was getting helped by the doctor and that she'd be there to cuddle really soon. I helped the mom and baby meet that first time and breastfeed the first time. It was no different than with a vaginal birth. It was magical and wonderful.

Personally - I not a vagina activist nor am I a c-section activist but I'm truly a living mom and baby activist. Kate and Tonya gave you good advice.

The piece I want to add is that you need to get your partner/husband involved in this decision as well because you both need to make this decision together. You both need to decide how much risk you are willing to take for both of your lives.

I wish you the best and the greatest birth ever.... no matter how that baby comes out.
-francine

Everyone has added wonderful advice. I just want to stress a lot has to do with the doctor. My first daughter was 9 lbs. and was fine, my second child 7 lbs. 14 oz and has a severe OBPI. It had nothing to do with the size but with the doctor and his actions.

Thank you all for your thoughts. I have come up with just about everything you guys have brought up. I can not have a c-section with an epi. I am severly allergic to most types of anesthetic. If I did have a c-section, I would have to be put completely under and then probably have to deal with an extra two or three days in the hospital with seizures and constant supervision. So, bonding, nursing, etc., would be a HUGE issue. So, that is playing a major factor in my choice. Yes, I want a healthy baby, but I also want that baby to have a mother.

I have talked to the doctor multiple times, everytime I have an appointment in fact, and we agree that size isn't THE determining factor. I was induced with all three of my children, each two weeks early, to avoid the possibility of having an emergency c-section (again becuase of the anesthetic issues). I will most likely be induced with this one as well. Each of my labors were less than 4 hours, with Zadyn, my OBPI, being just under 3.

I know the risks involved with induction and with a possible repeat BPI. I also know what my body is able to do. I was hoping to hear that someone has had a successful experience. At this point, I don't know what I will do if this baby is over 9 pounds. I am trying to regulate the size of the baby by watching what I eat. We are doing more blood sugar checks and an ultrasound each month to watch the size more closely. I feel we are on top of things more so than when Zadyn was born.

Thank you all again for your encouragement and support. I will keep you all posted as it gets closer to let you know how it all turns out.

Alisa, Mom of Zadyn, LOBPI, 2.5 years old

HI Alisa,

Like I said, I'm not in your shoes, but... This is something I've thought a lot about lately (all my friends are having babies...). One thing I had thought of, if I ever managed to get pregnant and wanted to have a natural birth, is that I might ask the doctor to either pre-numb me for an episiotomy or pre-cut me.

Now, I know that episiotomies are NOT to make it easier for the child. And I know episiotomies are controversial even without BPI and shoulder dystocia thrown into the mix.

BUT here's my reasoning: I would want my doctor to absolutely apply NO TRACTION to the baby's head (they actually commonly apply quite a bit of traction) especially since there might be predisposing factors towards BPI that we don't even know about... so no reason to add further risk by applying ANY traction.

And a couple of years ago I saw a video of a birth where the doctor was also very careful not to apply traction to the baby's head. She tried manuever after manuever (not very effectively, it could be argued) and after a terrifying six minutes finally had to reach in and manually rotate the baby off-axis so it could come out.

LET ME TELL YOU it was obvioiusly VERY hard for her to get her hand in there and this is a woman with small hands!!! If the child's head is clamped against the perineum (which is the case for shoulder dystocia) it makes everything particularily tight for the doctor to get a hand up in there. And cutting an episiotomy in order to allow the room would be quite nervewracking with a turtlenecked baby sitting right there, I would think.

So all that is my long-winded way of saying I would ask the doctor to either pre-numb me OR pre-cut me in order that his hand could be there and waiting to help guide the child's shoulders through in the event they came down directly at 12-oclock and 6-oclock and thus got stuck. I strongly believe that shoulder dystocia is primarily a failure of the baby to rotate properly and so the most effective (and least risky to the plexus) solution is to manually rotate the baby to the oblique diameter so his/her shoulders have more space to come through. I would want my doctor completely prepared to make that happen if it didn't happen naturally by itself.

Anyway... food for thought.

Kate