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| 02/28/2006 11:43 AM |
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I'm trying to research the medical evidence regarding the use of elective caesareans when a large baby and potential shoulder dysotica are suspected, and am hoping that you may be able to provide some resources and information.
Here is my situation: My daughter (now 21 mos) was born at home with a licensed midwife. She was 10lbs 10oz at birth and experienced mild shoulder dystocia - she was stuck for about 50 seconds. (Amazingly, I had no tearing and my perineum was completely intact.) While her Apgar scores (5 and 8 for 1 min and 5 min Apgars, respectively) were on the low side, her pediatrician examined her when she was 2 days old and found her to be perfectly healthy (and she has remained so ever since, thank goodness). We are trying to conceive our second child, and I recently went in to Kaiser Oakland to have my IUD removed. The OB/GYN who performed the removal told in me in no uncertain terms (after reading about the circumstances of my daughter's birth in my chart) that I should have a c-section for my second.
I've done some searching on the internet and have found some references to the medical literature, and there seems to be no substantial evidence indicating that someone in my situation should automatically have a c-section. There are general recommendations that, in order to "play it safe" and avoid potential litigation, a c-seciton should be performed. I was wondering if you could recommend any web sites or specific studies that might provide me with some additional resources.
As for now, I do plan to have my second at home as well, but will likely be receiving some level of concurrent care at Kaiser. (I haven't gotten pregnant yet, and have not yet discussed this situation with my midwife.) I would like to be well-armed with references from the medical literature when I have to explain why I'm attempting to have another home birth. Thank you for any information you can provide. By: Kara V. |
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| 03/02/2006 12:44 AM |
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| Hi. I just wanted to let you know that I had asked a similar question on 1/18/06 under shoulder dystocia and I thought the answer might be helpful to you. Hope that helps. By: MyBabyJad |
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| 03/03/2006 1:48 PM |
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I have a couple of references for you:
TextThe effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound which concludes: "For the 97% of pregnant women who are not diabetic, a policy of elective cesarean delivery for ultrasonographically diagnosed fetal macrosomia is medically and economically unsound." and Sandmire HF, Wooley RJ. Macrosomia: Can we prevent big problems with big babies? Birth 1998;25(4):263-7, which concludes: "Little doubt exists that macrosomic [big bodied] infants face higher rates of morbidity and mortality than their normal-weight peers. The evidence that this excess morbidity and mortality can be significantly reduced by a policy of routine cesarean section is meager, however, and is contradicted by a substantial and growing body of evidence that doing so would require an unacceptable number of cesarean sections, with their attendant significant maternal morbidity and mortality. . . . [W]e cannot recommend cesarean section for the sole indication of macrosomia." (I didn't link you to PubMed for an abstract of this study because there isn't one.)
However, you don't quite fall in the category of planned c/sec for suspected macrosomia because you have already had one big baby and experienced mild shoulder dystocia. This puts you at greater risk to have this problem repeat with a subsequent baby. On the other hand, this ob appears to have presented only one side of the story: the risks of labor, and to have omitted the other side: the risks of cesarean surgery. To be fully informed, I suggest you download What Every Pregnant Woman Needs to Know About Cesarean Section (click on the icon of the booklet cover) or read through the pages of the consumer topic.
Finally, there are strategies that can minimize the chance of your having problems at your next birth. My response to "My Baby Jad's" post has some suggestions. (Use the search feature of this Forum and search on "shoulder dystocia" to get there. Since you say that you are not currently pregnant, one I would add is that if you are a high-weight woman, lose weight sensibly before getting pregnant again. The strongest correlation with the baby's birth weight is the mother's weight before pregnancy. Plain English version: big mothers tend to have big babies.
-- Henci By: Henci Goer |
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| 03/03/2006 2:16 PM |
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| Thank you. Since I'm 5'11" and currently weigh 185 lbs (yes, I'm overweight, but I'm also quite muscular and have a large frame), I'm not sure that there's too much I can do to avoid having a large baby. It does seem possible that, with careful weight management and losing some weight before I'm pregnant, I can prevent the second from being much larger than the first, and, I hope, a bit smaller. I also found a book called The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia by Penny Simkin and Ruth Ancheta that I think should be helpful. By: Kara V. |
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| 03/12/2006 1:58 PM |
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Given your height and bone structure, you are right in that you probably don't have a lot of wiggle room in modifying the baby's birthweight in a future pregnancy. The Labor Progress Handbook is a wonderful resource. I would say to any doula, midwife, or labor & delivery nurse, "Don't leave home without it!"
-- Henci By: Henci Goer |
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