United Brachial Plexus Network, Inc.

if you are worried about shoulder dystocia with a bpi outcome, what you have to do is find a practitioner who is an expert at resolving shoulder dystocia without injuring a child. There is a list of questions that I have on my site http://www.injurednewborn.com and also a list of risk factors. And you can research the maneuvers on http://www.shoulderdystocia.com. Coming up with very honest and frank questions will help you decide who you want attending your birth. Shoulder dystocia can happen to any woman, but a bpi doesn't always have to happen - the practitioner has to be very savvy and well versed in the maneuvers and be experienced at performing them to resolution without injury to the baby.

I have read that midwives do shoulder dystocia births really well but there are a lot of women on here that have had midwives injure them and their kids - including me - and knowing what I know now about midwifery in America, I would NEVER EVER choose a midwife. It may be different in Australia however.

Choosing positions that open the pelvis are probably preferable - forward positions like on hands and knees, etc.. Read the book by Janet Balaskas - "Active Labor" and it talks about this in a big way. Laying on one's back is the worst position. Of course having interventions like epidural, forceps, vacuum extraction, induction - they all add to the risk. C-section is risky too - no bones about it - but you see this is why it's in the hands of the practitioner - you just have to find the BEST person.

I once asked someone who is an expert witness for our trials "how do you find this person" and he replied - find out who is publishing the articles on shoulder dystocia, or writing the textbooks, etc. I would also find out who plaintiff's are using for expert witnesses - usually they are pretty high up there on the experience scale.

Anyway - good luck to you!
-francine

natural childbirth, no pain meds, etc.

in the hospital, position was laying on my back with knees slightly bent up, no other positions were tried.

I have heard on all four really helps.

I would be interested to know the common positions people were in and if any different ones were tried once sd occurred. I hope others respond.

KarleenI was lying on left side with legs on the midwives shoulder, no epidural.

HI!
I was lying on my back, legs in stir ups. I had a epidural. They did try side lying too. I gave birth lying on my back though after 2 1/2 hrs of pushing. Good luck keep us posted!!
Staci Madysmom

Does anyone know whether more injuries are caused by midwives or obs? I too thought that midwives were far less likely to create a high risk situation (lying on back, monitoring, epidural etc) and more likely to encourage active birth like all fours or squatting but I don't know for sure, does anyone?

About midwives versus doctors...

I look at it this way - either you know how to handle a shoulder dystocia birth or you don't. There are probably an equal amount of negligent practitioners in each category. Unfortunately in neither category is anybody made accountable for their deeds nor are they retrained in the correct methods.

A midwife has to be able to assess a situation, move her ego out of the way, and give it up to a high risk practitioner if things get out of hand. Some are not able to do that. And sometimes money gets in the way - who knows what happens with the insurance when one has to step out of the way and let another take over.

Epideral was stopped completely when it came time to push. It took almost 4 hours of pushing to deliver Michael. I was in every position emaginable for about 4 hours, but ultimately I delivered on my back with my legs held up. Michael was 9 pounds 10 and 1/2 ounces.

Patty

I guess I got one of Dr. Pape's lessons. She said that when you are planning goals - work backwards.... so in this conversation I was working backwards...

I felt that if you found someone expert at shoulder dystocia - then in essence you have found a person that is also excellent at preventing shoulder dystocia in the first place - because they have studied it, dealt with it and try to get a woman to a place where it won't happen.

If I were to find a perfect practitioner it would be a doctor who would spend time looking at risk factors and educating me on how to minimize each and every risk factor. This means he would educate me about diet and gestational diabetes. He would do the appropriate tests at the appropriate times in the appropriate ways. He would sit down with me and plan the what if's and strategies. And then at the end - close to birth we would go over all of that again and redetermine what might work and what might not work and why. He would educate me to the point where I would completely understand the risks of each intervention and my husband and I and he would be able to make conscious decisions about what to do when. And he would also be expert at the SD maneuvers and C-section births.

So... am I living in fantasy land????
YEP! This person doesn't seem to exist any more.

I'll tell you what - when my daughters become pregnant I'm going to go nuts. Am not going to think about that now though....

-francine

On back with legs being held up bent towards my body. Epidural also.

It looks like lying on your back is in itself a risk factor? Since this thread appeared I looked into this and it seems that is the worst possible way to be lying to have a baby. This should be added to the risk factors in the information pages maybe? I will NEVER give birth lying on my back again, thanks for your thoughts