Homebirth after shoulder dystocia?

[AntoinetteCosway]

Anyone done this for no. 2?

I can't decide whether it's a) a brilliant idea, less chance of interventions, more calm, so less likely to have SD? etc or b) an idiotic idea, less chance of emergency help if required if SD happens again etc.

I was in hospital for no. 1. Waters broke on Sat, contracted all weekend, only got to 3cm. Eventually induced on Monday evening, given an epidural that didn't work, DD was born after a hair-raising delivery, blue, not breathing.

I don't know whether the SD was bad luck, because she was induced, or because of the shape of my pelvis. Apparently no one can tell me. She was 7lb 13oz so not massive, and I'm average weight too.

Argh. I am so anxious about this. We keep talking about having another baby but I can't do it if it might happen again. Spoke to GP and she said just have a C-section. I'm just as scared of those though, particularly as epidural apparently doesn't work on me.

[crunchingautumnleaves]

Inductions alter all kinds of stuff in labour/birth. And I'm guessing you having epidural meant you were giving birth on your back? This means the pelvis can't open to its fullest amount (as it can with upright forward positions) - it's a big difference, will try and fin the stats for you. Also you'd be working against gravity. I doubt it's as likely to happen with a homebirth compared to what you went through with DC1. But, there's info out there as to what you can do with shoulder dystocia to deliver the baby. And remember too that all midwives attending homebirths carry resuscitative equipment, enough for mum & baby, in case there's an emergency situation. Also, as birth gets nearer, the attending MW calls for a second backup MW. Was the cord clamped last time whilst they tried to resuscitate? The ideal is to delay cord clamping (whilst it's still pulsating your baby is still getting some oxygen). It's easier to do this if you've delivered on the floor (ok to do at home), cos baby can be kept attached, needs a flat surface for bag & mask, & if you've got a heater right nearby/on warm towels etc then that's ideal. Then as soon as baby is breathing, straight onto your chest - skin to skin with mummy is excellent at reviving babies, between the breasts is amazing (your body will adjust to the correct temperature needed for your little one) and hearing your heartbeat & breathing will be much needed familiar sounds for your baby. Will send you more when I've found the relevant links to give you more detailed information. But, in summary, definitely not mad to consider hb .

[AntoinetteCosway]

Thanks, that's really reassuring to know...I don't know whether the cord was clamped last time. There's a lot I don't know actually

I wish I could know for sure whether the SD happened because of my body, making it likely to happen again, or because of the interventions, epidural, induction roller coaster, in which case I can try and avoid it all.

I'm also just really aware of how far off plan things can go. Last time the plan was for a Hypnobirthing water birth but I wasn't allowed the water and they insisted on an epidural to 'let me sleep' as I'd been up for 3 days straight. Only for it not to work anyway!

[crunchingautumnleaves]

At what point did you go into hospital? It's easier to rest between contractions when you're home generally, even to get a little sleep. And at what point were you induced? Was it after you'd had been contracting some time or was it to get contractions started in first place?

I'm so sorry btw that you had such a rough time of it, especially seeing your baby go through that too. Was she ok in the end or did she have to go to SCBU? Have you had any real support or help dealing with how you felt after the labour and birth?

[AntoinetteCosway]

My water broke on Sat afternoon and then I contracted at home from Sat afternoon to Mon morning, which was the longest they'd let me stay at home after my waters broke. When we got to hospital they said I was only 3cm and needed to be induced. I convinced them to let me wait till the afternoon as I really wanted not to be induced; by about 5pm I was still only 3cm and they insisted on induction because it had been 48 hours since my waters broke.

I haven't really talked about it apart from on here. I feel so stupid as DD is 14mo now, but I think about it so much. I don't think I can get pregnant again with the risk of it happening again. The idea of a baby dying is just too awful to contemplate.

[crunchingautumnleaves]

Firstly, don't feel bad for feeling like this or thinking about it still. Even a 'normal' birth can leave a woman suffering - perhaps it was too quick/long/painful for her or she didn't get the privacy/respect/support she needed. What you went through was by all accounts a long & tough journey and your daughter not breathing would have only added to all this. We all react differently to what we experience and no way is 'right' - we just have to deal with how we are feeling, thinking etc

Secondly, remember that each labour and birth is different. I've had a couple of friends who had their waters broken for too long so then had induction. Both of them have since had a more straightforward birth with their second. So, hopefully this won't happen again for you.

I will try and get all the links I've mentioned to you soon (got to find them cos foolishly didn't save the links) but didn't want to leave you just unanswered.

Ultimately no birth is without risk, just like the rest of life, but shoulder dystocia really is more common when you're on your back, because there's not as much room as pelvis isn't fully open. And from what I understand, contractions that are powered by syntocin or similar (used for induction) are much stronger and often don't come in waves like naturally occurring contractions which doesn't give the baby as much chance to rest and move as they normally do, which probably had some impact too.

[AntoinetteCosway]

Thank you so much for talking about this with me. I'm a bit teary as I write this but I can't tell you how nice it is to talk about it!

I just wish there were some guarantees you know. I know there can't ever be though.

I was well read and well informed and prepared last time, and it still all went horribly wrong. I wanted to be upright, walking, using water, Hypnobirthing-but ended up flat on my back, induced and with an epidural! It's hard to separate that from the SD. But maybe it would have happened anyway? Who knows. I guess my big fear is that if I try and have the kind of birth I wanted last time, and it goes wrong again, then it will be all my fault. And it might not end happily a second time.

[Leafmould]

Hi a toilette.

If there is a lot you don't know about your previous delivery, you could consider getting a birth debrief? I have heard of people on here who had a traumatic birth get their notes and someone to talk them through with. This might help you feel better informed to make decisions about your next delivery.

Perhaps somebody on here knows what this debrief is actually called?

Good luck.

[cravingcake]

A birth debrief is called exactly that, sometimes is called birth reflections but its case of contacting your hospital and asking to go through your notes with someone so you can understand and find out exactly what happened (provided they took notes correctly). I did this with my DS. We had a very traumatic birth and SD.

I found it so helpful to read for myself what they did when the shoulder dystocia happened, for me McRoberts manevoure was all that was needed plus a bit of pushing of the top of my bump by then I didnt care, legs were in stirrups, epidural had worn off, consultant had yanked DS out as much as he could with forceps and I had 4th degree tear . But I was able to find out what they do if McRoberts didnt work, and then what they do next etc. I have since found out that Shoulder Dystocia is not able to be predicted at all and its about 1 in 200 births that have it, and there is a very very slightly higher chance of having it with any subsequent births. I really wish I could remember where I found this out but I dont sorry.

I was also reassured that every single midwife knows the McRoberts manevoure, and other methods and the order in which to use/try them so if that was the only complication then in theory it should be able to be sorted fairly quickly. And no specialist equipment is needed so the same things are done at home as they are in the hospital.

For me a home birth is out of the question, elcs all the way for me now but I can see your point and if I was in your situation then it could be considered.

[crunchingautumnleaves]

www.homebirth.org.uk/shoulders.htm has most of the info I was trying to find for you, some inspiring birth stories involving SD & further useful links. Hope it helps you lots more with thinking things through.

[MyLastDuchess]

A Canadian woman on another board I visit has recently had a successful homebirth after a very difficult first birth with SD. I don't think it's fair for me to post a link to her here but if you PM me I will give you the info :)

[AntoinetteCosway]

I'm sorry it's taken me so long to come back to this thread. To be honest I was kind of avoiding it because it was upsetting me to think about the SD-I know, ridiculous! I really appreciate your responses, links and advice. I don't think there's an easy answer to my real, internal question, which is 'do I risk having another baby?' and I think I'm going to give it some more time and do lots of reading and research while I wait to have an epiphany!

MyLastDuchess (great name!) I'll PM you.

[crunchingautumnleaves]

That sounds like a good plan. I hope all the reading & research is productive & helps you figure out what you really want to do.