I am currently 24 weeks pregnant. This is my second pregnancy. My first delivery was a planned induction and my water broken immediately after I arrived at the hospital. I was in labor 15 hrs and pushed for 2 hrs of that time before my daughter was born. She was 8 lbs 4 oz. She had a severe shoulder dystocia. She had 3 broken ribs, her arm was flaacid from the shoulder to the elbow, and she had a facial droop. The nerve damage was, as I was told, was related to brachial plexus damage. The damage reversed itself and she is now 4 1/2 and is fine. The doctor is telling me that the best way to avoid this problem is not to gain too much weight. I have gained 13 lbs so far. I am still extremely concerned about a normal vaginal delivery. The doctor says it is possible but he will be extremely cautious to note how the baby is moving down and how the labor is progressing. Should I be overly concerned from a lamaze standpoint or is it possible that the bony structure of my pelvis has changed enough to deliver an equally sized baby? Am I too concerned?

Also, I frequently have braxton-hicks contractions. They occur with even mild activity (such as walking to the car). They do resolve with rest. Should I be concerned about this? Is this a pre-cursor to premature labor since it occurs so readily? By: MyBabyJad

The best and safest way to avoid (or relieve) shoulder dystocia is to give birth on hands and knees, a technique often used by midwives, but few obs seem to know about it. If your ob is not willing to accomodate you in this, I strongly recommend finding a caregiver who will.

Bruner JP et al. All-fours maneuver for reducing shoulder dystocia during labor. J Reprod Med 1998;43(5):439-43.

Next, while it is possible to give birth on hands and knees with an epidural, you will be much better off if you avoid one in terms of mobility and your ability to push effectively.

You should also know that inducing labor for suspected big baby does not improve outcomes and increases the cesarean rate. Go to HenciGoer.com/resources and scroll down to "Labor Induction: When a Big Baby Is Expected." It sounds like your ob may suggest a cesarean either during labor or perhaps even a planned cesarean. I recommend you download What Every Pregnant Woman Needs to Know About Cesarean Section so that you make an informed decision based on knowledge of the potential risks of cesarean surgery as well as the potential benefits.

As for weight gain, if you are a high-weight woman, you will want to gain less weight than an average- or low-weight woman, but you do want to gain weight throughout the pregnancy on a sensible, nutritious diet. Regular exercise helps too, not to mention helping build stamina.

I also recommend hiring a doula. I think all women benefit from the practical advice and emotional support doulas provide, and their labor companions also benefit from support. However, in your case, I think it is especially important. Your daughter's birth must have been very distressing to you, so you are bound to be more than usually anxious in this labor and in need of a calming, soothing influence. And if you aren't going to use an epidural, you will want someone with you who is knowledgeable about comfort measures and other strategies and techniques for coping with labor pain.

Finally, I wouldn't be too concerned about Braxton-Hicks. Most women notice them more the second time around. Check with your care provider on this, but I believe that as long as contractions don't get longer, stronger, and closer together, they aren't a concern. Also, Braxton-Hicks feel like a tightening whereas labor contractions are crampy.

Oh, and by the way, I don't know if this is an issue, but you don't need an episiotomy. Shoulder dystocia isn't a soft tissue problem, so an episiotomy does nothing to make the birth easier.

-- Henci By: Henci Goer