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Shoulder dystocia
Why wasn't I told about it..?


9 replies to this topic

#1 MakesMeHappy

Posted 04 April 2012 - 11:11 PM

Hi, I'm wondering if anyone can tell me why I would not have been told that DS1 had shoulder dystocia at birth?

A little background and why I'm wondering about this now...

My first birth I was induced and he ended up being delivered by vacuum. When he came out he wasn't breathing and had to be resuscitated. They told me this was because he had a bit of a shock and a hard start to life. I accepted this answer. He was in the SCN for 2 nights. I wasn't overly concerned with any of this as the dr's and MW's didn't tell me I should be worried for any reason.

After I was discharged from hospital I read through the discharge summary and it all sounded a little more scary than I thought and it mentioned that he had shoulder dystocia at birth. But my little man was fine so I never asked anyone or really worried.

I am now pregnant again and had my first appointment with the hospital. The MW was asking my history. i ran off the details and I mentioned that I had read about the shoulder dystocia but no one had actually told me about it. I sort of got the impression that she thought I didn't know what I was talking about.

So I came home read through my birth summary again to confirm to myself I didn't make it up and then googled shoulder dystocia. To me it sounds like something I should have been told about at the time. Is it something I have to worry about in future births??

Sorry for the long winded post, I know no one can really answer me why I wouldn't have been told, but just thought I'd ask

I also hope I have put this in the right section....

Edited by MakesMeHappy, 12 December 2012 - 07:26 AM.


#2 popsuko

Posted 04 April 2012 - 11:27 PM

You definitely should have been told about that at the time!

I don't know a heap about it myself. I haven't had to deal with it personally, thank god. When I had DD 6 weeks ago, I'd been induced and they'd estimated her size as 4.8kg on an ultrasound the day before, so some of the staff were concerned this was mega-baby and that we'd have difficulty getting her out. She was actually 4.3kg and I pushed her out without any problems (apart from a 3rd degree tear...) I remember when I was just getting to the pushing stage that the midwife got all serious with me and said, if she asked me to change position whilst I was pushing it was very important I did as she asked and did I understand that and would I do it? And I was like, yes, of course. I'm sure she was preparing me in case this baby had shoulder dystocia and I had to get into a better position quickly to get her out.

Probably the best book I've ever read about birth, and the only reason I know what shoulder dystocia is, is 'Ina May's Guide to Childbirth' by Ina May Gaskin. She learnt a great technique for dealing with shoulder dystocia from midwives in tribes somewhere in South America. She took the technique back to the US and won an award for the good it's done there. I think it was essentially just getting onto all fours or something. I can't remember. But check it out. It might be reassuring about ways to deal with it if it does come up for you again. Good luck.

#3 veggiepatchfamily

Posted 05 April 2012 - 03:03 PM

How big was he born? Why and at what gestation were you induced?

When you were birthing your baby did they put you on all fours, or press down (rocking) on your public bone, or pull your legs up high towards your shoulder (if you were on your back)?
There are the most common ways to manage a SD.
However, it is not uncommon for a babe to be stunned at birth from the vacuum.
If it was a very mild SD that didn't require any intervention to resolve then unless your 2nd baby is bigger there shouldn't be a large risk factor.
Doctors take a SD very seriously and if they were concerned should do a check growth ultrasound closer to birthing and either would suggest an earlier induction (to prevent full growth) or a c-section if there is a large risk to mother and baby.

If you have had a previous SD you are at risk of another, unless risk factors have changed- ie 1st baby was large due to gestational diabetes, which is not occured 2nd time around etc).

If it is a risk again, learn about favorable labour and birthing position that maximize the pelvis size and structure.

Sorry if this is a little disjointed, my DS keeps getting me to come and roll playdough so I'm back and forth :-)


#4 IShallWearMidnight

Posted 05 April 2012 - 03:49 PM

subscribing

#5 Diamond~Sky~Lucy

Posted 05 April 2012 - 04:02 PM

Same happened to me.  Only found out about the shoulder dystocia with DD1 at 33 weeks pregnant with DD2, and I had to see a different ob as mine was away.  Can only assume this is because my ob is very laid back, and generally very calm and so he didn't mention it.  I was told that it was "mild" dystocia with DD1, however she was smallish (6pnd9) so  I was certainly concerned when I googled dystocia.  At the time, I remember the pushing went on forever, and eventually they told me DD! was distressed and she needed to come out straight away.  I was assisted from the floor to the bed, a second ob was called in and my partner too was asked to assist by holding one of my legs up against my shoulder.  We managed to get her out like this, and she was given some oxygen straight away, but everything thankfully was fine.

I suspect though it was considered at all times by my ob as my baby was predicted to be big, and ob was talking about possible early induction due to this.  At the time though, did not induce, went into spontaneous labour at 39+2, baby was an average size, and NO problems whatsoever.  I was told by the midwife that due to the history of shoulder dystocia (which I ensured she knew about) that when it came time to push that I would have to do so lying on my back on the bed, as opposed to however I found it easier.

Good luck.   I was really worried when I was told about the shoulder dystocia, and all I could really incorporate into my own management plan was to ensure that midwifes etc knew about it from the time I went into labour (ie every p/c to the hospital - as I laboured for a while at home - and as soon as I presented and was allocated a midwife) so that they knew that this may need to be managed again.

Edited by Diamond~Sky~Lucy, 05 April 2012 - 04:06 PM.


#6 Xiola

Posted 05 April 2012 - 04:10 PM

I was in the same boat as you.  I didn't realise how serious all of the things that happened were during DS2's birth until I became pregnant with DD and a blood loss/3 SPD manouveurs were mentioned.  I don't know why they don't tell you things....it seems strange to me as well.

#7 samshine

Posted 05 April 2012 - 04:16 PM

Hi OP

I would've thought it was something they may have discussed with your prior to discharge?

I had SD with my first.  I had an extremely long second stage and then shoulder dystocia.  It was treated with my legs being put in stirrups & staff pushing on my stomach (McRoberts procedure).  Like your baby, DD was removed by vaccuum and required resus.  

I had no idea what was going on at the time, or after.  I know it was explained briefly to me during my stay, however it was one of so many complications in her labour and birth that required discussion, so I didn't give it much thought until later.

I know more of an emphasis was placed on it when I was pregnant again.  My first was 3.66kg and my second 4.35kg.  After labouring until 10cm, DS showed a bit of resistance at progressing and due to his predicted size, the ob on duty (Iwas public) was not really happy to proceed so I had an emergency CS.  

I would definitely second PPs suggestion of researching positioning for birth. Also, as you are birthing at a different place, I would give them a copy of your previous discharge summary.  I found that a lack of continuity of care with my second (I had a different ob at every drs appt) meant one ob would be concerned about DS predicted big size and repeat SD and the next would brush it off.  I have just had my 3rd privately and she remarked that due to the discrepancy in size between my first and second  babies she would have managed my second pregnancy/birth a lot differently.  So having your caregiver informed and understanding is paramount in my opinion.  

I don't mean to scare you with the above.  But it is worth perhaps researching more.  Can you get copies of your notes from your first birth?  We did that prior to TTC this time so we had all the info available on how best to manage this time.

Good luck OP.

#8 Iwantitall

Posted 05 April 2012 - 04:59 PM

Maybe they didn't think it was severe enough to warrant saying anything?  Maybe the thought it was more to do with the position you were giving birth?

My last birth was severe shoulder dystocia.  I found out the next day why all hell broke loose. (codes being called, a million people in the room all of a sudden, looking over after DS was out and seeing the ped. doing chest compressions on my baby, not getting to hold him for a while) The OB had to get her hand up inside me beside DS3 and get him unstuck.  I was very very lucky that serious internal damage was not done (he was very stuck) He had a very traumatic birth and it took me a long time to recover (felt like my insides were falling out when I walked  ohmy.gif ) ohmy.gif

Now I am pregnant with # 4 and have been told I will have to have a c-section as they will not risk the baby or I with another birth like that (due to how severe it was)

They really should have discussed the birth at your first followup (the one you usually have while in hospital!)

Just wanted to add, I was labouring and pushing on all fours over the back of the bed, usually a great position, but it made no difference in my case.  He was a big boy with wide shoulders (and still is lol)

Edited by beljane, 05 April 2012 - 05:01 PM.


#9 spando

Posted 06 April 2012 - 02:44 PM

I had shoulder dystocia with DS1 he had to be revived apgars or 1and 4 so not well. After that birth I was pretty unhappy with my ob so for the next one I changed. In DS1 obs letter to my gp which he used to refer me on it was described as an uneventful birth (he was 5kgs). It wasn't until we requested my medical file that the midwives notes of shoulder dystocia were mentioned I was induced at 38weeks with dd1 due to DS shoulder dystocia and she was 4.5 kgs happy and healthy.
They happily offered me a c section but said they were happy for me to try natural but if at anytime they were concerned they would do an emergency c section.
Hope that helps.

#10 MakesMeHappy

Posted 07 April 2012 - 02:13 PM

Thank- you for all the replies. You have all made me realise this is something I need to find out more information about.
  
QUOTE (popsuko @ 05/04/2012, 12:27 AM)
14461153[/url]']

Probably the best book I've ever read about birth, and the only reason I know what shoulder dystocia is, is 'Ina May's Guide to Childbirth' by Ina May Gaskin.


Thank you for the book suggestion. I will get it and have a good read through.

QUOTE (veggiepatchfamily @ 05/04/2012, 04:03 PM)
14462671[/url]']
How big was he born? Why and at what gestation were you induced?

When you were birthing your baby did they put you on all fours, or press down (rocking) on your public bone, or pull your legs up high towards your shoulder (if you were on your back)?


I was induced at 40 weeks because of pre- eclamsia, he weighed 3.9kg.
I gave birth on my back and they didn't press down on me or anything like that, but I did have my knees quite close to my chest. But I thought that was my choice.


QUOTE (samshine @ 05/04/2012, 05:16 PM)
14462838[/url]']
Hi OP

I would've thought it was something they may have discussed with your prior to discharge?


Can you get copies of your notes from your first birth?


I though it was something they should of discussed with me to, but now when I think about it they didn't really discuss much with me. huh.gif

And yes the midwife that I saw at the hospital the other day sent away a request to get my birth notes. At least they will have all the information and I can ask them some more questions.

QUOTE (beljane @ 05/04/2012, 05:59 PM)
14462932[/url]']
Maybe they didn't think it was severe enough to warrant saying anything?  Maybe the thought it was more to do with the position you were giving birth?


Yes, this might have been the case my DS didn't have any problems afterwards so maybe it was just very mild so to them not worth mentioning. And I wasn't asking a lot of questions at the time either

I had to give birth on my back the whole time because I was induced I had to be constantly monitored.
QUOTE (spando @ 06/04/2012, 03:44 PM)
14464741[/url]']
I had shoulder dystocia with DS1 he had to be revived apgars or 1and 4 so not well.


My DS had low apgards too and was monitored in SCN, could this have had something to do with the shoulder dystocia? I don't even know what low apgars are?? I am starting to feel very stupid for not asking more questions at the time...    

Thank again, I have definatly learnt to ask more questions



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