C-Section with Second After First Suffered Shoulder Dystocia

Preconception & Pregnancy Pregnancy Complications
1

Hi, Mamas,

I'm looking for advice and encouragement in the face of a possible, scheduled c-section. Two years ago, I delivered a large but healthy baby boy (9 pounds 5 ounces) vaginally, but he suffered a shoulder dystocia (where the head comes out but the shoulder lodges behind the mother's pelvic bone) and was without oxygen for almost two minutes. Although he has no lasting damage from the delivery, his case was very severe and the risk of serious injury was high. In light of that history and the fact that my second baby is measuring large already, my doctor "can't recommend" a scheduled c-section but has advised me that "if it was me, I would opt for the surgery." At first, I was adamant that I did NOT want a c-section. I told myself that I had had a vaginal birth once and could do it again, and I did not want a scar or the long recovery—especially with my two-year-old at home. In short, I felt like I would have failed as a woman if I chose the surgery. BUT, the more I think about it and talk to my family about it, the more I realize I'm being selfish and that the section is the safest option for the baby. I don't want to risk a natural labor that goes wrong because I couldn't face surgery—anything bad would be my fault.

So, now I'm trying to prepare myself for the section and what my recovery will involve. Would you guys share your experiences with me? Have any of you had a c-section after a vaginal birth—how were they different? How were your emotions afterward—did you feel bonded to the baby? If I plan to breastfeed, how will my body know to produce milk without my having gone through a delivery? Will I be able to breastfeed while on pain medication? How long does the pain last and do you have any advice on how to cope with caring for an active little boy while recovering?

2

I am a midwife and just because you had one shoulder dystocia does not mean that you will have another one. Typically this is due to position of you and position of the baby. When your baby had the shoulder dystocia what did the doctor have you do? When we encounter this with our clients we immediatly have them change positions most of the time we will flip them over to a hands and knees position. This is usually enough to force the shoulder off of the pubic bone. I would for sure choose a vaginal birth again and not schedule a c-section. The risk to you and the baby is much greater with a c-section vs. the small chance that your baby might have a shoulder dystocia again.

Lisa

3

"I don't want to risk a natural labor that goes wrong because I couldn't face surgery—anything bad would be my fault."

Who's fault will it be if something goes wrong with the surgery? I would think the risk of major abdominal surgery would be a lot worse than natural childbirth.

I had a c-section and obviously survived. I would absolutely never repeat that on purpose. If I were you, I would look into what things you can do during pregnancy to help your baby get into optimal fetal positioning for labor.

You know your body can deliver a big baby. You can do this naturally. Don't let fear drive you to major surgery that even your doctor "can't recommend".

4

I haven't had a C-section, but technically speaking, if there was a problem delivering vaginally, couldn't they do an emergency C-section?

5

I had an emergency c-section with my first due to lack of progress. I have absolutely hated the way things turned out and after 2 years and staring in the face of getting pregnant again I am looking at having another c-section. The biggest factor was the what if something goes wrong scenario. I too couldn't live with if I could have had the c-section and something goes wrong.

As my doctor put it to me you not only have yourself but you have a family to think of now. I thought it was harsh but true. Ultimately you have to make your own decision. Hopefully someone will chime in on having a c-section after a vaginal delivery. The c-section was not that difficult to recover from. I had never had an hospital stay or surgery prior to mine.

Talk with your doctor about what he/she would do if this happens again. If you are on pain/epidural ask how that will influence things.

I hope you receive more input and you are confident with your decision.

6

I would opt for the C section. You know a 9#5oz baby does NOT fit through your pelvis. While each baby is different, the 2nd is usually bigger than the first. The Dr. can induce you early, though they are not usually inclined to do that.

I had a long discussion with my Dr when I pg with my 3rd. My first was 9 pounds and he had to have the vacuum on him. My 2nd was 6 weeks early and 6 pounds (very large for that gestation). My 3rd was induced a little over a week early and he was just shy of 9 pounds. I think if the Dr. had let me go to term, I would not have been able to deliver vaginally. He essentially told me that if he induced me early I had a higher chance of C-section and I countered that if he let me wait I had an almost 100% chance of c-section since the baby would be too big and I had trouble with the 1st. He sided with me and I delivered without c-section.

You do need to do what is best for the health of the baby. I do not see why the Dr. can't make the recommendation with your history. Talk with your Dr. some more and if you are a praying woman, pray about it.

Good Luck, and congrats.

7

I had the same situation, 1st baby 9.6oz. So, the doctor knowing this watched 2nd babies weight and took him 2 weeks early. He induced and I had vaginal delivery. Much more easier than the first because of the weight. I don't see any reason why you should have a C-section. There are a lot of advantages to the baby to come through the birth canal. Good luck!

8

Hi! April,
My son was 9 lbs, 4 oz and born vaginally. It was a tough delivery because he was so big. I felt bruised and mashed up for weeks and weeks. I had an episiotomy too. My daughter was born via C-Section ( I had had a very large fibroid tumor removed the year before with the same type of incision as a c-section) and it was a walk in the park compared to delivering that big ol' boy vaginally. I was on pain killers in the hospital and wasn't able to breastfeed her until I started taking a mild form of pain relief. I did pump and throw out the milk and they fed her with soy formula in a dropper.....NOT A BOTTLE WITH A NIPPLE. It took about 48 hrs and then she was nursing just fine. I nursed her until she was 2 1/2 years old. After you leave the hospital, you will need to some help with your little one, but you should all be just fine in a few days. Honestly, a c-section was so much easier than the vaginal birth. I had a much quicker recovery with the c-section. I wish you the best!
Kathy

9

Well, I do know women who had shoulder dystocia with a first baby and a larger vaginal delivery with the next. In fact, there's a great youtube video of women who had VBACs with larger babies after being diagnosed (falsely) with CPD.

I can also tell you that I have had 5 c-sections. They are very risky (especially if you plan to have more children.) The possible complications are wide. The risk is more to the mom then to the baby, but there is still a risk to the baby. I have a friend whose baby was recently cut in her c-section.

My first two were unable to nurse and the third never fully nursed (had to have formula in addition to breastmilk until she started solids at 6 months.) My milk didn't come in until a week or so post delivery. My babies were in the NICU or special care nursery, which is common for section babies (some of them were early, but even the full term babies were in special care for common c-section issues such as respiratory issues and blood sugar problems.)

I had problems with anesthesia as well. I woke up one night post delivery and was paralyzed from the neck down. another delivery I got a spinal migraine that lasted 6 weeks and I had to hire someone to care for my family because I was bedridden.

Infection rates are very high. The incision may split open fully or just have a hole. The rate of hysterectomies and blood transfusions (and then the subsequent rejection of blood as the body sometimes rejects an organ transplant) is much much higher in section moms.

I highly suggest 1) that you contact ICAN
and 2) you look into various pushing positions suitable or large babies. If you are lying in bed pushing you are going against gravity and squashing your pelvis. If you squat or get on your hands and knees then your pelvis opens up and allows more room for the baby to come.

As for induction- induction only works if your body is ready to deliver. There's a high rate of c-sections among those induced. However, it may be better then going straight for the c-section.

If you do decide to have a c-section

1) see if you can have someone come in the room with you when your husband leaves with the baby. Or two in the OR, one who goes with the baby and one who stays

2) ask if they have the warm air gown. You can stay warmer waiting for the c-section and keep your top half warm while they are doing the surgery. It may help you keep from getting sick and improve healing later.

3) ask if you can have soothing music play in the OR, and if your husband can cut the chord (if he wants to do that. They can move the baby and the placenta to the bed and have him cut there.

4) ask if the baby can stay with you in the recovery room. Your husband can help you breastfeed and the soonest you can nurse the best. I was never allowed to do this but I know those who have and said it made a great difference in their breastfeeding. I had to wait 4 days to nurse my 36 weeker and 12 hours to nurse my 37 weeker.

Please feel free to PM me.

I wish you the best,
Sarah, mom to 4 on Earth, 5 in Heaven, and 1 being knit in the womb.

10

I like Lisa K's response! I do not think you should rule out a c-section entirely, but I do not think you should go with a c-section just because you are worried about the labor being the same. My labor was COMPLETELY different for both of my children, and my 2nd, the one who was 9 lbs 4 oz was a completely natural vaginal while my 1st child was an 8 lb 1 oz c-section. Also, I want to make sure that I mention that my cousin was induced early because they were convinced that her baby was SO big, but he ended up being 6 lbs when he was born. (He is only 22 months old, so it is not like technology has changed much since he was born.) Doctors make mistakes. Labor and delivery is a natural thing and your body will know what to do. There are times when science can help, but I would not rule anything out. If it were me, I would be prepared for either option, but wait until the delivery. You can always get a c-section if things are not going well after pushing - that is what happened with my daughter. Whatever you decide - Best of luck!

11

After 20 hours of labor with my son, I had to have a c-section due to his size (10 lbs 24 in). I was not happy about it b/c I wanted a vaginal birth due to the same reasons you do. The c-section will be very different than your vaginal birth. First of all it goes a whole lot quicker. There's no building up to the moment like a vaginal birth. And with a planned c-section, they may have to postpone it a couple of hours or so due to other, dire deliveries. You will have a spinal tap which numbs you from the waist down (much like an epidural). This may cause you to become very cold (like hypothermic cold), but it'll wear off about an hour after surgery. The c-section itself is indescribable b/c you feel everything they do, but it's not painful in anyway. Directly afterwards they will show your baby to you and then take him/her away. And they usually keep them in the NICU for a few hours. Your husband will be able to go into the NICU and visit him, but you will not. I know a few hours seems like an eternity, but it won't be for you. You will probably be very groggy and kind of out of it, if not really out of it. So the few hours they have the baby will actually be good for you. When it comes to bonding, I wouldn't worry one bit. Once they bring the baby in and lay them on your chest you'll connect instantly (even if you are out of it). You can nurse then and nurse the entire time you and the baby are in the hospital. Even though you will be on some major pain medications you can still nurse and the baby will be fine. You will be in the hospital for at least 3 days and those are the worst days of pain. But medication helps a lot so don't be afraid to take it. Once you leave the hospital you won't be able to walk all that well and using your abs will be very limited for at least another week. Also, you will not be able to pick up your son for 2 weeks after the c-section. So, you'll absolutely need help 24/7 with your toddler. After about 2 weeks you'll be feeling fine. You'll be able to do pretty much everything you did before (even workout) and the pain will be all but gone by then. You may hear horror stories about c-sections, but people have horror stories about vaginal births too and they are usually rare. C-sections are not as big of a deal as people make them out to be. You'll really be fine and you'll be even more of a woman for putting your baby's safety and well-being above your own desires. I hope all goes well for you and you have a safe delivery.

12

April,
I had a c-section after a vaginal birth because my 2nd child went into distress while I was in labor. He ended up having heart problems, 5 surgeries at 2 yrs olds...but that is another story. You will definitely bond with the child and your body knows that you have given birth. You shouldn't have any problem producing milk to feed your little bundle of joy. Please don't let your anxiousness put your child in danger. You will need someone to help with an active 2 yr old for about 1 month. You won't be in pain the entire time, but you shouldn't pick up anything heavier than your newborn. hope this info helps you in making a decision.

13

First of all congratulations and I'm glad you made the unselfish decision to have a C-section. I as well had a vaginal birth and was placed in the position of deciding to have a C-section to avoid possible complications. It was a difficult one but overall it gave me peace of mind. As for what to expect, I had a difficult time recovering and my daughter was a big baby 10lbs4oz and 23in. I breast feed her and didn't have any trouble at all. I guess your body just knows what to do. I don't remember taking pain medication but if I did I guess you are able to breastfeed because I feed my daughter since the day she was born.

I know of people whose experience with a C-section was easier than a vaginal birth so I guess everyone is different. As for myself, I think the major issue was that I was very fit and my stomach muscles were very strong before the operation. The doctor had a diffcult time doing the incision so I guess if that's your case you will probably experience a more difficult time healing. I do suggest if you are an active person, begin exercise as soon as the doctor approves it. It will help you regain your middle section back sooner, don't over do it, but don't use it as an excuse.

Good luck and best wishes.

14

April:

You have some excellent advice. I've had two C-sections - one by emergency, one planned. BOTH were very easy recoveries. Even though you will feel groggy during and immediately after the surgery, you will still bond with your child, breastfeed and be mobile.

On my first one, I took the pain medication they offered once out of fear but realized I didn't need it. The second one I went without. Most scars will be in the bikini line so you don't have to worry about it being visible. Mine is a thin, white line now. One unpleasant side effect though, you will be gassy the first day... just expect it.

In terms of bonding, ask to see your baby immediately. On my first one, he was whisked away with my husband (of course, that was the emergency birth). On my second, my husband brought him to me first and held his face up to mine, which I loved. You will be tired and sleepy after the surgery but that is simply the drugs in your system wearing off.

The main piece of advice I share with EVERYONE that has a C-section is to bring a small throw pillow with you everywhere. Seatbelts and counter tops are all at incision level and this adds a nice layer of padding between you and whatever. It also helps if you have to sneeze, cough or laugh out loud in the initial days. And when my first son had hernia surgery years later, I gave him a pillow to use too.

Best wishes to you and congradulations on your new little miracle.

15

Don't fear the c-section! I wanted to have natural deliveries and it just didn't work out that way. Both kids were breech and flipping was unsuccessful. I was opposed to c-section primarily because of the recovery time, however, I was pleasantly surprised. It was strange going in for a surgery and knowing a baby was going to be the result, but it worked out great! The hospital staff was awesome, my husband was in the room and they even helped accomodate his inability to stand the sight of blood! The c-section was fast and painless. Its a little weird watching people work on you and not feeling whats going on. And then just as your mind drifts, there's the baby! Just because he wasn't delivered vaginally, doesn't mean I didn't have that immediate love for him, and he knew exactly who I was! It doesn't matter where they come out, you've been bonding with them for months - they know who you are! I didn't mind my husband running off with the baby, they're finishing up and it gave me a few minutes for some shut eye! I couldn't believe I fell asleep,I guess the excitement wore me out, but that warm air blanket sure did help with the sleepies! The recovery time was my biggest concern. I was walking around the same day as delivery and I quickly found that the more you move the better you feel. Be realistic though, you're moving around SLOWLY and kinda hunched over! But, they couldn't keep me in bed at the hospital! I got a belly band to hold everything nice and snug and would get in and out of bad as much as possible. The nurses said it was great to move or the muscles would tighten and make moving much more uncomfortable. I was home on day 3 and alone with just the baby by day 5. I was able to care for him and move around (slowly). I couldn't bend down and pick things up or lift things, so my hubs would run through the house in the morning and put everything on table so I wasn't bending. I successfully nursed him until he was 1. Despite having a c-section, he has grown into a healthy four year old handful! ;) Things were a little different with my daughter (3 years later). I fell down FACE FIRST 2 weeks before she was due and she made her appearance a little early right after the hurricane! The power was still off and on at the hospital!! :) I had scheduled a c-section with her, however after my fall, I had developed pre-eclampsia so my blood pressure was out of control. The c-section was more of an emergency c-section, so everything happened fast, but smooth. Because of the pre-eclampsia I developed an infection and was on some major antibiotics courtesy of the infectious disease team and a slew of other Drs. I spent 2 weeks in the ICU and couldn't nurse. I pumped and dumped and was able to nurse when we got home. I never hit maximum capacity for nursing, so we supplemented and have had no problems. I wasn't really able to handle her much in the ICU. I had to have someone with me to hold her and my husband was stuck taking care of our son who wasn't allowed into the icu. It didn't change the bonding one bit. She knew who I was, she took to the breast fine and has grown into a happy healthy one year old drama queen! Everyone has a scary story to tell. You have a scary vaginal story but that wouldn't stop someone from having a vaginal delivery would it? So don't let the scary c-section stories put you off! I decided how I delivered these kids wasn't really up to me. These kids were going to come no matter what. I needed to have them however was going to ensure that happened successfully and however was best for all of us. C-section just happened to be the way for us! Best of luck to you and your family!

16

I am not sure if you want a doctor's perspective, but I am an Ob/Gyn physician. I had a primary elective cesarean section because I had a very high risk pregnancy. I agree with your doctor. Having a cesarean section is the most safe way for your baby. You may not have another shoulder dystocia, but who knows. Your first baby does not have long term damage and that is great. You really want to avoid the possiblity of a having child with long term damage or even worse. In this day and age, cesarean sections are generally uncomplicated and safe. I cannot compare vaginal birth to cesarean section. However, I know that a scheduled cesarean section will cause must less post op pain, then for some one who labors first and then has to have a cesarean section. So, keep this in mind when comparing the outcome of other women. I had alot a pain/burning at my incision site which is commom complaint for women. Going from sitting to standing seems to cause the most discomfort. Pain meds are ok when breastfeeding. You will likely need more help from your family, especially to help care for your 2 year old. However, It will only be for a short period of time. Recovery time varies depending on your pain tolerance. Your milk will come in, especially if you breast feed with your first pregnancy. Once you are no longer pregnant, the hormones in your body change which stimulates milk production. Each day your pain level decreases. As long as your ceserean section is straight forward, you will likely only need to take narcotics for 3-7 days. From there, usually Ibuprofen is enough. I know my response is a little scattered, but I hope this helps.

17

Hey April,

Take a deep breath girl! Listen, I had a c-section the second time around and it was fine, I didn't have to take pain medication or anything. My milk came in actually sooner than my first and yes, you do have to take it easy for a couple of weeks but for the SAFETY of your baby it will be well worth it.

God Bless,
Deb

18

I think you could go either way and be just fine. Trust your doctor. He or she is the expert. You still have a delivery with all the same hormone changes with a c-section as with a vaginal birth so your body knows to start producing milk. I choose a c-section with my son because he was so large and I didn't want to risk any complications. A long hard labor is difficult for you, but it is also very hard on the baby. A planned c-section is a very controlled environment. I'm a health care worker and have seen many vaginal births and c-sections. The risks and the recovery with a vaginal delivery can be just as severe as with a c-section. As far the scar, mine is below my bikini line and barely visible. I didn't feel the recovery was bad at all, but I don't have anything to compare it to. I breastfed my son for the first year. Saying all that, you may also be just fine with a vaginal delivery. Maybe they could induce early so the baby won't be as big. I really didn't want a c-section with my son either. I was sad about missing out on the labor and vaginal birth experience. But it is what I felt was best for my son. Talk it over with your OB and decide together. Either decision you make will be the right one for you and your son. Their are risks either way, but keep in mind that almost all deliveries come out just fine even with a history of problems in the past. Best of luck and congratulations on number 2!

19

April-

I can't compare a C-Section to a vaginal birth-- both my children were born by c-section, under different circumstances. And I don't feel I can give you advice on which method you should choose, but I wanted to give you some reassurances in case you go the c-section route.

Baby #1 was delivered by c-section after labor failed to progress. Recovery was difficult, and I attribute that to having been in labor for 14 hours prior to the surgery. (Although I just had a friend go through the same thing, and she's telling me it's not that bad for her-- maybe I'm just a wimp!) Anyway, I will tell you that the delivery itself was very traumatic-- and I attribute THAT to the relationship I had with the people in the room. My doctor at the time (obviously, I've switched) seemed to have the general attitude throughout my pregnancy that things would run a lot smoother if I'd just sit back and let her run things. The anesthesiologist (who you don't get a chance to meet until you're in the OR) seemed nice enough, but tied both of my arms down, which really freaked me out. It was just scary, but I felt helpless and didn't know I could do anything about it.

Now, hopefully I haven't scared you to death-- let me tell you about my second birth. I found a doctor that I really trusted. She doesn't do VBACs, but was willing to refer me to somebody if that's the way I wanted to go. Given my prior experience, I wasn't looking forward to a repeat C-section, but I felt so strongly about this doctor, I took a leap of faith and made the plan. The difference was night and day! Throughout the pregnancy, I built a good relationship with my doctor. Having been through it once, I was very clear with her about what I could deal with and what I did NOT want-- the arm restraints, for instance, were a dealbreaker. Since I once again wouldn't get to meet the anesthesiologist until right before the surgery, I made my husband and my doctor PROMISE to back me up on that issue. I swore I'd drag myself off the table if they tried to tie me down. :) When the day came, I was a little nervous, but I felt confident that I was enough in control of the situation, and I trusted the people who were in the room with me. I was calm but firm when filling the anesthesiologist in-- she explained that she preferred to restrain one arm, since monitoring is critical. I agreed, since she was TALKING to me instead of TAKING OVER. And it was fine. I was awake and joking with everyone the whole time. I told them this was the best c-section I'd ever had!

I feel like baby #2 came into the world in such a gentle, comfortable way-- despite the fact that it was surgical. And my bond with her was immediate. (I have been a bit ashamed to admit it, but it took a couple of days to feel that true motherly love with my first child. Some of that might have just been due to the trauma!) Please don't fear a scheduled c-section, if it's what's best for you and your baby. Just make sure you TRUST the people who will be with you, and try to be clear about what you want.

I didn't get to nurse either of my children right after birth. It was something I'd wanted to do, and had been told it was possible after the planned c-section, but it didn't happen. That was difficult, but it didn't affect anything in the long run. I've been nursing baby #2 for almost 2 years now. (I nursed her older brother over 2 years, too.) I was taking Vocodin for several days after both births, and both babies were fine with the milk. My scar is mostly hidden under the hairline-- I'm not self-conscious about it. Oh, and to help you get around better after the surgery, ask your doctor about a belly band (they sell them in stores, but the one I got from my doctor was better, firmer)-- it velcros around your abdomen to help support your injured muscles while you recover, and it helped me a lot. You won't be able to lift your toddler for a while after surgery, and he'll have to be a little careful climbing onto your lap, but it's manageable.

Whichever way you go, I wish you a safe delivery and a healthy baby. Good luck!

Kim

20

April,
I think that you need to take a deep breath and put it all in perspective. You will live with the child for the rest of your life. Do what is in his best interests. It has nothing to do with your abilities as a mom or as a woman. I give you points just for signing up for this job.
RE: experience. I had 2 vaginal births and 1 C section. The c-section was an emergency due to bleeding. I bonded with the baby (now 36) and was at the pta meeting of the oldest 10 days post op. Every first birth is more traumatic than any subsequent ones, just because it is first. My body bounced back from the Csection faster than from the first vaginal delivery. I was not on any pain meds by day 3.
This is a short period of time for you but will have lasting repercussions for him. No matter which way you go, line up some helpers who can take him out and run him into exhaustion for the first few weeks. And trust your doctor or change docs. You need to be at peace by November.
Wishing you a happy, safe delivery.
Kathy

Talk to your doctor. You might want to keep asking questions until you are convinced of the right answer.