Any Doulas or MWs with experience with Shoulder Dystocia?

[muming]

Hi,
I'm looking to find a private MW or Doula who has had experience delivering babies who've become stuck! The birth of my second baby was a forceps delivery which was pretty traumatic and resulted in a broken clavicle and horrible tears. Long story short, one side of my cervix swelled, head couldn't get past, heart rate dropped, OB called up, he pushed my cervix around her head, and ripped her out really bloody fast with the forceps! So not fun. I have been reading a lot lately and found the "Spinning Babies website". It has motivated me to find an experienced MW or Doula who has had experience with SD (so I feel better), who can help me with the delivery of my 3rd baby, due in June. I am in Melbourne.
I would also appreciate any stories of experiences where babies have been helped out safely from these situations.
TIA,
Ingrid

[Alan]

Hi Muming
I have had experience with shoulder dystocia, not in the homebirth setting but in hospitals. There are a number of tricks you can use way before considering using forceps and all of these tricks are far less traumatic that forceps. Just because you had this experience it does not mean that your next baby will also have problems with shoulder dysticia.
I am more than happy to talk more with you about this if you want to. Also, at the moment I have no bookings in June.

[muming]

Thanks Alan,
I was wondering if you could possibly tell me what happened in those cases? How did you help the mother(s) get the baby out?
Ing :-)

[Alan]

Hi muming
What is done depends a lot on the situation so it is a little difficult to say what I would have done for you. However here is a few things that we can try to help baby out

Position change:
Often just getting mum to change position will change the shape and size of your pelvic space and let that baby out. This would usually be my first choice.
Knees to chest
This also opens your pelvic space and again can help to give baby a little more room.
I could press on your tummy and try to push the baby's shoulder under your pubic bone.
I could put my fingers inside you and move the baby’s shoulder
I coul put my fingers inside you and pull the baby's arm out first this will help bring the shoulder out.

There are a couple of other things that could be done as a last resort, but these are a little vicious and perhaps best no discussed here.

[Lucy]

Ingrid, just wanted to pop in here and let you know......Olivia's birth was complicated by shoulder distocia. I was terrified the same would happen again with Charlie......but it didn't. I laboured and gave birth to him standing up (with Olivia I had been reclined on a bed).

[BellyBelly]

Also check out the Pink Kit here: The Pink Kit - Learn Birth Skills In Your Own Home

[hoobley]

The Gaskin Maneuvre is supposed to be effective in almost all cases - you turn onto your hands and knees and rock your hips. That's it, it usually frees the stuck shoulder because it open the pelvis more. Anything that gets your body weight off your sacrum makes a huge difference as it's like a little hinge and can move a good bit out of the way if you're not lying on it. Crawling around on the floor works too. THese are difficult things to contemplate when baby's head is out already but so much better if they allow you to avoid the trauma to you both of forceps.

The vast amjority of women who have forceps do not need them for their next baby, unless polio or rickets has actually physically deformed their pelvis to make it too narrow.

Bx

[smiley10P]

You could birth on all fours this allows more room for the baby to be birthed, no coached pushing. My son born in June last year was largish and once his head was birthed he was a very tight fit and 3 contractions later I pushed him into the world. I had been upright for most of the labour and instinctually moved into this all fours position when he became stuck. He was in fantastic condition at birth, we did a physiologic third stage and he was birthed in water too at home, no tears either he was my biggest bub at 9lb 6oz. I also did the pink kit too very helpful

[Trillian]

Shoulder dystocia is a positional problem so making sure that baby is in a great position for the birth greatly reduces the risk of it happening. You may not even have that problem this time round either. My last baby had shoulder dystocia due to being malpositioned and all that was done was to lay me on my back and push my legs up to my chest and they gently managed to get the shoulders to pop out one by one - no tear to me and no broken bones for bub. Not sure if they used hands or not as I couldn't exactly see what was going on down there at the time.

[Julie Doula]

Hi Ingrid, the Spinning Babies website is a great start. Another thought I had was, were in water for your first two births? A birth pool might be a good idea, it is easy to flip over onto hands and knees if necessary (making sure to keep your bottom under the water as you do so.) The Gaskin manouvre is simply going on hands and knees, and the motion of actually turning over can sometimes be all that is necessary to release sticky shoulders. Lying on your back with legs pulled right back is the "McRoberts" but because it does not allow the sacrum to be mobile, I would suggest the Gaskin hands & knees before the McRoberts. My mum is a midwife and I was picking her professional brains about this just the other day. Mum said she found that just by exerting a little pressure on the baby's shoulder to push it back in a bit, would often give the baby a bit of space to rotate and little more. Sometimes the midwife will try a cork-screw manouvre. When you are on your hands and knees, there's easy access to do this IF it is necessary.
I am available in June too if you're still in need of a doula. Also, I have previously attended a homebirth with Alan and I can warmly recommend him.

[muming]

I know I'm a bit late, but thank you all for your replies, and offers to be there.

I ended up booking a Doula to help support me through the labour, which I think will definitely help me mentally cope with the fear I am feeling. Unfortunately I have since had a couple of horrible OB appointments over the last week where I have been made to feel very uneasy about the birth. One wants me to have a CS and the other wants me to be induced at 38 weeks. I had a huge debate with the resident OB the other day. I was arguing that it wont necessarily happen again, about position of baby, methods to get out baby, why the last one got stuck in the first place etc. etc. In the end he basically said that I am irresponsible and will be endangering the life of my baby if I try natural delivery at term. Oh, and that if something was to go wrong, I might sue him! I don't trust any of the Ob's that might end up delivering my baby. I wish I had the support that I need.

I am going to see Christine Tippett next week for another opinion and advice.

Shoulder dystocia or any dystocia is such a hard thing to deal with regarding the next pregnancy, as you just don't know if it was just bad luck last time, or very likely to happen again. Also, because of all the concerns the Ob's have expressed I would never forgive myself if something did end up going horribly wrong.

But for now, I think I'll go to bed and try to forget about it!!!

Mumingx

[hoobley]

In the end he basically said that I am irresponsible and will be endangering the life of my baby if I try natural delivery at term.

Ok, take out "at term" and insert "at home" and you have EXACTLY what i was told by various obs, registrars, relatives, even midwives (or medwives as i secretly thought of them after i saw them kowtowing to the ob about another woman "needing" a section for her big baby - he came out 5lbs 10oz!). I'm sorry you don't trust your care providers - is there any way you can change? REALLY think about it - i know just how tough it is to have to face these horribly rigid attitudes and people in pregnancy but you will be totally unable to deal with them in labour and it will be so so hard for you.

I wish you all the best of luck in finding a supportive care provider!

Big hugs hun.

Bx

[Julie Doula]

I really get the feeling the 'real' fear is the fear of being sued - not the fear that your baby will have SD. May you be empowered to do what you truly feel is right and safe for YOU and YOUR baby - not what feels safe for these careproviders.

Just as a means of contrast, so you can find your parameters, it might be worth having a chat with an independent midwife - telling them your past history, and what your current cps are saying, then asking, "If I was your client, how would you manage my care and what would you be recommending?" It can create a different perspective and new confidence for you.

Take heart. Don't give up.

[smiley10P]

Hi muming,

this is standard dribble that Obs will tell you. I agree with Julie it is about fear of being sued. The shame and blame game or dead baby card is standard they must learn it at medical school if all else fails then resort to it !!! Sorry you find yourself in this vulnerable position. Not being able to trust your carers will not bode well for the birth. Please look at all your options, if you dont trust them then why arte you taking advise from them ???. Just because and Ob is a woman doesn't mean you will get woman centred care she is still an Ob and comes from the same background as all the male obs. I hope you find a solution your happy with

[muming]

Hi to all who have posted on this thread ages ago.
I just wanted to let you know how the birth went with my third. After all of the concerns and worrying I had an absolutely fantastic birth. I had the best midwife, she was an angel, and a very supportive doula too. I will go into detail in the birth stories section one day when I have time.
I am so proud that I went with what I felt was right. I gave birth naturally to a beautiful baby girl, 3330kg (7.4lbs) Meika Ruby. She came out on her own (the day before she was due to be induced 9 days early. It was a very healing birth. It confirmed what I felt went wrong with the second birth which ended in shoulder dystocia, as the same problem with the cervix started to happen again. However I had a fantastic midwife who new what she was doing and we managed the labor and overcame the problem. I am sure that if she had have been present at the second birth it definitely wouldn't have lead to SD.
Cheers to Alwyn my midwife, my Doula Relle, and me!! Yippee.

to the obs

[hoobley]

Oh wow hun, i'm so glad you went with your feeling and did this! Well done! What a wonderful experience for you all. Congratulations - FIND time to write that birth story, think of the women you could reassure/inspire!

Bx

[Lucy]

What a brilliant result! I have goosebumps now! Well done to your supportive team, and well done to you! CONGRATULATIONS! xx

[Trish]

That's fantastic news. So glad you had a much more positive experience this time around. Great to hear that your doula Relle and your midwife made a difference to you too

Just have to second how fantastic Relle is too!!