vaginal birth after bpi

[admin]

i am considering having another baby and am not 100% comfortable with the thought of having a c-section... i've scrolled through the topics and have noticed that most mothers automatically opt for c-section after giving birth to bpi baby, but it also seems that a common thought is that one can deliver a baby that presents with shoulder dystocia and/or other complications without the doctor having to apply so much pressure that bpi occurs and that doctors are to blam to bpi... so is it a c-section we need or compotent doctors? also i would love to hear about anyone who has vaginally delivered a baby without bpi after having a bpi baby.. thank you!

[Tanya in NY]

Hello. I have not delivered vaginally after my daughter's RBPI, but I am a labor and delivery nurse. I would opt for another vaginal delivery if I was going to have more children. There are ways of preventing BPI.

First of all, talk with your doctor. Make sure they understand that delivering on your back is the WORST way to delivery. Try the side or better yet, hands and knees or squatting.

Understand that a previous BPI delivery doesn't mean you will deliver another baby with BPI, but the chances are greater if precautions are not taken.

Keep weight gain to the recommended weight gain, be checked for gestational diabetes, insist on alternative delivery positions, have the baby's estimated fetal weight watched closely. Remember, ultrasounds an be 1-2 lbs. off EITHER way, depending on the technician's skill level.

Good luck.

Tanya in NY

[Karen Hillyer]

Tanya makes some excellent points here - I would like to comment on one aspect of her response, in my own case I only gained 12lbs in weight during my pregnancy with my son Gavin (robpi) and he weighed in at 10lbs 13.5 ozs- so maternal weight gain may NOT always be an indication of the size of the baby - as I also gained 11 lbs with my first son who weighed
6 lbs at birth.
The deciding factor in MOST shoulder dystocia cases of whether or not a baby will have a BPI is the clinician who delivers the baby.
It is perfectly possible to have a SD delivery and have a baby without a bpi - depending on the maoeuvres used to deliver the baby.
Do remember though, that you are more prone to another shoulder dystocia after having one already.
Good luck

[tylergsmom]

Hi--I delivered vaginally after giving birth to my first son, who is ROBPI. I was monitored much closer and was put on a nutritional diet to help with the weight control. I was induced two weeks before my due date due to the size of my first baby (8lbs 15oz) and things went so smooth. I just couldn't believe the difference in having a good dr who knew what they were doing. I felt so lucky to have an OB who listened to me and knew how scared I was to deliver another BPI baby. My second one came out 8 lbs 5 oz and he nearly shot right out---it was just a great labor---well, as well as labor can be. My OB promised me that if it looked as if any problems were going to happen, she would do an emergency c-section---but luckily, no problems. It's really a personal choice and how comfortable you feel with your OB. Good luck!

[admin]

I think it has everything to do with having a competent doctor. I have been really looking into this and if I have another baby I will give birth vaginally, unless there are concerns or labor does not progress the way it should.

It saddens me that many of us have so much fear and lack of information that we feel we must have a c-section to protect our babies, but this is certainly often not the case at all. Once again it has more to do with incompetent doctors and a medical system that is set up for the convenience of the doctors and not for working with the mothers natural, innate ability to give birth. Most shoulder dystocias don't end up with any injuries at all because fortunately there are many doctors that know how to easily resolve them.

Many shoulder dystocias or sticky shoulders, would not even occur in the first place if we delivered like our ancestors did. The only way I would deliver vaginally is in a birthing position that opens my birthing canal, not closes it. Get off your back and have a doctor or midwife who knows how to do the Woodscrew just in case, and everything will be just fine.

Don't forget to research the risks associated with c-sections. Doctors often don't give you the full scoop on that one either. There is just a lot to consider for your safety and your baby's, but in the end we have to do what we feel will be the best. I just hope that mothers take the time to educate and inform themselves, and find competent doctors versus jumping into surgery. I was CONVINCED I had to have a c-section, but now I am CONVINCED I do not need one.

Tanya, I so enjoyed meeting you. It was so nice to converse and not to feel alone in my crazy thoughts .

Posting as guest for legal reasons (which hopefully will be wrapping up soon).

[admin]

I agree with the need for more competent doctors. I did have a planned c-section with my 2nd. It was not an automatic decision, it was months in the making with my new drs, husband, and my gut. In the end, I felt I was more willing to take the c-section risks than the vaginal risks. I looked at not just the physical implications, but the emotional implications for me and my husband as well (as with most on the board, our delivery was horrific). I feel I did make the right decision at the time. Now that more time has passed, and now that I've learned even more, I would still struggle with the decision if I got pregnant again.

I do think that it comes down to competent doctors and more natural birthing situations. However, finding those competent doctors are really hard, and then even if you do find them things could change.

My first delivery was through a very reputable practise. I met all the practioners, was very comfortable with the group. I knew their call schedules so that I'd know who I'd get when I went into labor. Well, the day I delivered there was a call schedule change and a new doctor to the practise was on call (whom I never met) and ended up delivering my child. With her management of SD my dd was in the hospital for 2 weeks solely from her birth injuries.

The next time around I thought I was being smart. I made the decision for the planned c-section and then picked the delivering dr after months of interviewing. We coordinated schedules, picked the day and time and when I got to the hospital...schedule change and another dr was going to do the delivery. I was devastated. In the end we worked it out and it was an amazing delivery and this dr. (whom I did meet but did not select because she was leaving the practise)was incredible.

What I learned is that you need flexibility in your birthing plan. You need to ask yourself when do you need to change gears, what are you willing to accept and not accept in the birthing management. If you plan for c-section, what are the scenarios when you'll be comfortable with trying vaginal. If trying vaginal play out the scenarios that may lead to c-section.

Also, I learned that July is a terrible time to have a baby . Both my kids were born in early July and I found out that July 1 is when residency programs generally start, so you have a lot of newbies around. A lot of Dr. contracts start with July 1 as well, so you have a lot of schedule changes too. I say this tongue and cheek, but also from experience. Grill your practioner on possible schedule changes, new hires, and departures as much as you can...any time of the year.

[admin]

Hi,
I just want to let you know that I have had three children that had bpi. My Dr. told me that once you have a baby with shoulder dystocia, the next one usually gets stuck worse. Yes, that did happen with each of mine. My third child is severally injurred and the other two healed up. I had several ultra sounds and was induced a week early and my baby was still over 10lbs. You have got to weigh out the options and risks. I would call up a doctor that deals with high risk pregnancies and get their oppinion. Most importantly trust your gut feeling. I asked for my third child to be a c-section and was told there was no need for it. I should of never listened to the Dr. I should of gone with my gut feeling and had a c-section. Do your research and get several oppinions. In the olden days moms also died more frequetly from having babies. It's just too bad that Some of us just are not built to deliver babies as well as most other women. Part of the delivery is how good your doctor is but also you have to concider how you're built. Do you have a small birth canal, making it hard for a baby to come through? This is a BIG decision to make good luck making the right one!

[admin]

I was told by the Texas Children's folks never to have another vaginal delivery, because once you have a BPI baby, you have a much higher statistical likelihood of having another BPI baby. So, I opted for a C-section with #3. There are some risks I am just not going to take.

[m&mmom]

Guest who stated getting off of your back -
I agree with you totally. I have two children with bpi, one who recovered and one who is still on the road to recovery. Should we have chosen to go for a 3rd, I would go back to the days of our ancestors as you put it.

If all else failed I would choose a c-section over back.

Cindy

[admin]

As well as avoiding back lying delivery, avoid continuous fetal monitoring (because it means you lie on your back) epidural (a huge risk factor for SD) and forceps/ventouse. Remember only about half of bpi babies are large, the size is not the big factor the medics make it out to be. They focus on it because its the only factor they can't be blamed for! Remember also that the vast majority of big babies are born absolutely normally with no problems.
Good luck in your decisions.