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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Oct 10
    2008

    Cesarean advised for potential shoulder dystocia reccurence

    Archived User
    Hi!  This is my third pregnancy; I'm at 37 weeks, and the OB just now recommended that we schedule a Cesarean for 2 weeks from now because 1) my previous two births had shoulder dystocia issues and 2) the baby is now breech.  I'm working on getting the baby to turn around through various exercises, and the OB offered to try an external version on the 17th.  But, she seemed mainly concerned with another shoulder dystocia occurring.  My first baby got stuck (I'm not sure for how long) and needed chest compressions for 90 seconds before she started breathing.  She was 9.5 pounds.  My second baby didn't seem to get stuck, but we discovered a day later that his collarbone was broken during delivery. He was 10.5 pounds.  I didn't and don't have gestational diabetes.  From reading the posts on the forum, I think I'm supported in my decision to go ahead with trying another natural birth with the added maneuver of delivering in a hands and knees position.  I guess I'm just checking that this is still a good idea!  Thanks!
     
    Henci Goer

    Not being a doctor or a midwife, I cannot give you advice on what do do. I can say, though, that hands and knees has been shown to be a safe, effective way of resolving shoulder dystocia, although you get no guarantees. On the other hand, cesarean surgery isn't risk free either. If you decide on vaginal birth, discuss your plan to use hands and knees with your care provider. Most doctors have never heard of it. Here is a study if your doctor wants to know more:

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

    -- Henci

    P.S. I hope you can get that baby turned. I would do it sooner rather than later. And you may also want to look for a chiropractor who knows the Webster Technique. (This is a pelvic adjustment that makes more room for the baby to turn.) Care providers who will do vaginal breech births are as scarce as hens' teeth, and the fact that your babies are so big is not optimal for vaginal breech.

    Archived User
    The baby turned on her own!  We are so relieved!  Thank you for that study.  I am going to mention the study to my doctor and see what she says. We had asked her about the hands and knees position before, but she didn't seem to think it would be as effective as the McRoberts position.  Thank you so much for your thoughts! 
    Henci Goer

    Phew! That's great news!

    As for hands-and-knees as a birth position, if your doctor is not familiar with it, her saying that the McRoberts maneuver is better may just be human nature preferring the familiar to something unfamiliar. Were I in your position, I would politely insist that she get a copy of the study and go over it together with you. Start with the old sales technique of making a statement with which the person you want to convince cannot disagree. In this case it is, "I know that we both want the safest birth for this baby. I want to make sure that we have settled on the best option for a birth position given that I have had a problem before." 

    -- Henci


    All Times America/New_York

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