United Brachial Plexus Network, Inc.

I had a baby 16 months ago and shoulder dystocia occured and I am due in 3 weeks and the baby is supposed to weight the same as my prior. Is there anything written that states that a 2nd baby within a 3yr time frame that weighs the same would be easier to deliver than a 1st? I have heard that it would be but I NEED to read something that is a published fact. C-sec is out of the question so please don't suggest it. I would be putting my life in danger. Please, I only want to read about my question so please lets not start a debate about me risking my babys life etc. I am feeling guilty enough.
patricia

If you had a shoulder dystocia birth last time, you are at high risk for another this time. However, you can greatly increase your pelvic outlet size by NOT giving birth on your back or semi-recumbent, try squatting or on all fours instead. Avoid epidural and constant monitoring of your baby/labour as both of these reduce your options for moving around during birth and the epidural means you are not able to push effectively. Avoid pitocin or other labour inducing/augmenting drugs, these too are dystocia risk factors. Ask your birth carer what he/she feels about SD and how he/she will deal with it if it occurs.

Above all, try not be be afraid (hard I know) and take care of yourself. All good wishes to you and yours

Hi Patricia,

Typically second babies are easier to deliver, but unfortunately this doesn't apply with shoulder dystocia. Typically, second babies are larger and descend faster - both risk factors for getting their shoulder stuck behind your pubic bone.

Most of the literature addressing shoulder dystocia says that previous SD is the single highest risk factor for subsequent SD - meaning, if you've already had one SD birth, you are much likely than average to have another. Here are two articles that try to quantify that increased risk:

http://www.ncbi.nlm.nih.gov/entrez/quer ... ds=7755040

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=11408863

It will be very important that your physician know about the various maneuvers that can be used to resolve SD. They should go into the labor assuming that the baby is going to be a tight fit, and act as preemptively as possible. Are they aware and comfortable with you laboring and pushing in a variety of positions? Motion might help the baby rotate appropriately to help them come through in the optimum position. Avoid the use of drugs that would accelerate labor and reduce the time the baby has to do its twisting and turning through the birth canal.

Ask your doctor what their protocol is for resolving a stuck baby, do they drill regularily, etc. Do they know that manipulating the infant's head is not an option (This isn't just about avoiding a brachial plexus injury - pulling on the head if the shoulder is impacted can make the baby get MORE stuck and put everyone further at risk.) If it were me, I would also make it clear to my doctor up front that I understood that the infant might need to have its collarbone or even arm broken if it gets stuck (bones heal! nerves and especially brains don't heal so well), so maybe they would be less reluctant if it became necessary. In the event of a real emergency, if a crash c-section would be life threatening, perhaps your doctor might know about (or find out about) cutting the pubic ligament - which also widens the canal and can unstick a baby - as a last resort instead.

Wow, I know this all sounds pretty scary. I hope you aren't completely freaked out by this! Remember it's still MUCH more likely than not that you will have a perfectly normal and fine delivery, and thats all YOU need to concentrate on. Your doctor should have a plan for shoulder dystocia and how to avoid it, and be armed with a contingency plan and prepared to head off problems before they start. Hopefully there won't be any problems, but if there are you both will be prepared to deal with them.

Good luck and I hope that you let us know how it goes. I will eventually be in the same boat as you!

Kate

A good friend of mine's first child is bpi. She had a normal delivery for her second child. Both babies were the same size.

Cindy

also, really think through the use of forceps or vacuums as these can really cause harm in shoulder dystocia situations.

Best wishes, I'm sure all of us on the board wish you the best of birthing vibes...The most important thing you can do is really drill your doctors on all the different scenarios, be open to options...especially the birthing positions....knowledge is your power,and knowledge helps to keep panic at bay (for everyone). You should also (or your partner) be sure the nurses go through the drills before things get to far, since the nurses tend to be the ones that spend more time with you. Is a doula an option for you?

Most importantly, because you are really thinking about your birth plan, you are doing everything in your power for a healthy and smooth delivery, and odds are it will be great.

Patricia
can you request that any staff delivering your baby are experienced in delivering a baby with a SD?

some care givers will be VERY experienced at delivering baby's suffering a SD and will have lots of experience in overcoming the SD without injuring the baby.

The real difference in whether or not your baby has a bpi is in the skill and expertise of the staff. Remember that only about 1 in 5 Shoulder dysoticas result in an injured baby - the other 4 out of 5 will be fine.

Think about your position during delivery - squatting or standing are better for the baby and you, than lying flat - gravity will be much better that way!

keep positive and try and stay calm
I wish you the best of luck
Karen

With my second child I did do a C-Section but my doctor said prior to my decision that she would want to induce labor early with my second. I don't know if this is an option for you. My second baby was delivered at 37.5 weeks.

Good responses. I just wanted to add that you should feel good about yourself that you are so educated about this and are doing so much already. Some of us had a history of SD, but didn't even know it.
I agree that the experience of the staff is important.
Good luck and please keep us posted.
Tina