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kathleenmom
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| Posted: July 04 2006 at 10:33pm | IP Logged
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I'm not even sure if this is the right or best place to post this, but here goes. First of all, we're expecting baby #5 in February! The next part is we don't know where to have this baby. Let me elaborate: We have four beautiful children. The first dd was born in the hospital. The following 3 were born with different licensed midwives at home. We love love love homebirths. For our family, it is the perfect way to welcome a new member into the family.
Now, our three homebirths each produced healthy beautiful babies, but two of the births were rather tense. The two boys both presented with shoulder dystocia. For those of you who haven't heard of this, it is when the baby's head crowns but their shoulder gets hung up behind the pelvic bone. The two shoulder dystocias lasted for abut 4 minutes each and the boys were born blue and limp and not breathing after the midwife wrestled them out. Terrifying. Why did I do this? Well, the first one happened and the midwife who delivered him didn't elaborate much. We just sort of chalked the shoulder dystocia up to luck of the draw. The baby seemed to be wide chested. The next homebirth was DD2 and she didn't have a shoulder dystocia, but her shoulder was delayed. The midwife didn't have to do anything drastic to loose the baby's shoulder, but it was what is called a Sticky Shoulder instead of a dystocia. So, after dd's birth, I really wasn't all that concerned yet. Ds's scary shoulder dystocia was pretty far back and not looming all that large. This last baby was DS2. He was born with a tight nuchal cord first and then a shoulder dystocia. He was blue and limp and I was soooooo floored. I had literally NO idea that this would happen again. He pinked up after some rubbing and has no neurological damage. Neither does his brother, but my DH has certainly added more than a few gray hairs from his two sons births. That said, after the last homebirth I was feeling shocked and a bit culpable. In between baby #3 and #4 we lost a baby. I couldn't find a midwife who could deliver that baby at home so I went to see a group of nurse midwives who deliver at a local hospital. I remember during the initial exam/interview the midwife was downright incredulous that I had elected to have another homebirth after having a shoulder dystocia. I thought to myself "Hmmmm...how curious. She must just be a bit of an alarmist. Just because I've had one shoulder dystocia doesn't mean I'll have another." Well, since this last birth I've done a fair amount of googling and poking around in Medical Journals and my head is spinning with jargon and I don't know what good it has done me. However, one piece of information that comes to the fore is that the main risk factor for shoulder dystocia is previous shoulder dystocia. This really seems to be the only one that truly applies to my profile anyway. The two true shoulder dystocias were only 8 lbs. 5 oz. These are not huge babies.
Now, the advice I've received has run the gamut. Some say "You are definitely high risk. You should deliver your babies via elective C-Section" to "You are definitely high-risk, so you should definitely deliver at home."
From what I have read about shoulder dystocia stats, homebirthed babies have fewer incidents of injury...fewer brachial plexus injuries...major neuroroligical damage from being too forcibly removed essentially. Sooo, if I were going to attempt another traditional versus C-section type of birth I would probably rest easier if I did it at home with my midwife. In addition, I think most OBs would strongly encourage or requier the elective c-section route anyway.
Now, different midwives have successfully delivered two babies for me with dystocia. Should I just plan that this is an inevitability and proactively plan and do what we can to encourage the baby to come before 40 weeks...etc....pray and trust God? Or, do I take the ultra-conservative route and just plan for an elective C-Section. That is such a huge leap from where I've been. In thinking through the options, I keep thinking, that perhaps this baby wouldn't even have that problem and I would be signing myself up for major surgery for no reason. Plus, I think of the recovery and the hospital stay. My youngest will only be 21 months when this baby comes.
As you can probably deduce, my head is spinning. I guess I am asking if anyone has had an even remotely similar history and if so, what information did you get and what did you do? I also would just flat out like some prayers. I can't juggle all of this information and make sense of it myself. Please pray for God's will to be be made clear to us.
We love homebirths, but we don't do it because we're Mavericks or counter-cultural....well, okay maybe a little  , but because it is so gentle and beautiful a way to welcome a new baby to our home. If it is not safe and I need to have a C-Section, I will do it with a smile on my face and with bells on. I just can't figure out how to make the decision.
Thanks.
Kathleen
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Rebecca
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| Posted: July 04 2006 at 11:35pm | IP Logged
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Hi Kathleen,
Congratulations on your pregnancy! 
You certainly have some things to consider. I have no relevant advice or experience but I wanted to let you know that I am praying for you, your pregnancy and your birthing decision.
Love,
Rebecca
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momwise
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| Posted: July 05 2006 at 10:01am | IP Logged
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kathleenmom wrote:
| I just can't figure out how to make the decision. |
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How about a novena?......maybe toSaint Anne orSt. Gerard. I know how you feel about homebirths; this is going to be a really tough decision. I will be praying.
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Sarah
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| Posted: July 05 2006 at 1:10pm | IP Logged
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I don't know, Kathleen. This is so tough. I've had three beautiful homebirths and two in the hospital. DD2 was a planned hospital birth with a midwife, since there is no chance in our state for a home birth. Lucky for me because she was a crash crash c-section--like she was out in 60 seconds, no time for epidural (general aneth.), cut my lip and throat during intebation since it was done so quickly and I hemorraged everywhere. After going through that trama I view birth differently.
I can only say what I would do. Once I became "high risk" I knew I'd never again have a natural birth. Since I'd had beautiful ones I knew I could hold on to that in my memories. I'd experience the joy of birth, but I was okay to now play the hospital game and let them do their job, even if some policies were so stupid, and this was coming from a home birth nazi (me). Now, I wanted my babies alive, God-willing, and I was willing to go through the discomfort in order to do all we could for that.
In the end, I had a perinatologist who was willing to induce a VBAC and sit nervously by the monitor while I gave it a shot. It ended up to be a beautiful birth with every possible non-natural thing I could have  . Every type of monitor (even scalp electrode), and epidural, etc. He was born perfect and I'm glad I went that route. It taught me something about birth and that is that it doesn't have to be at home to be beautiful. It doesn't have to be natural to be a wonderful experience. I HAD to have an epidural in order to dilate since I was stuck on 5cm for 5 hours. Once I got the epidural I was complete in 1 hour! (obviously a mental hang-up--fear of some sort that I couldn't overcome).
In the end this decision is only yours. A C-section is not the end of the world. I bounced back. Yeah, its longer, and more painful, but it doesn't mean you've failed if you go that route. I'm not trying to talk you into it, though. Maybe seek out a very good Family Doc or OB and hear about your options.
I'll pray that God leads you. Listen very closely to your husband. I think they get special graces to lead us in this manner.
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aussieannie
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| Posted: July 05 2006 at 4:44pm | IP Logged
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Kathleen,
I have had two hospital births and three homebirths, and my belief is home is best, but hospital is the place to be if any serious medical emergency unfolds, (like anything in life).
I have had my last two babies (big boys 10.1 and 11pounds) both born blue and not breathing, one in hospital the other at home. I don't really know why both were like that, as the two girls at home were pink and rosy and the oldest a c/s.
If I seriously thought (through proper independent research) that bubs was going to be at significant risk I would not give it a second thought in having a ceasar but lots of prayer is obviously needed here and to have other people praying for you is also important.
Baby being alive and well (you also) is the only main factor in this decision. No birthing centres around? Or is natural birth, full stop, considered unsafe with this condition?
Do you know the stats on baby mortality from this condition with homebirths? That sounds like important info IF you can get it, looking a c/s stats is important too. I know that hospitals can hype up/exaggerate stats to mothers in order to get compliance (happened to me) so this is why if you can research this as independently as possible that is good.
I think, pray and trust God in bringing about the best outcome, once you and dh have done all the right investigation and the decision with that knowledge, has already been made. (Pray of course beforehand you make the right decision)
I feel uncomfortable expressing things on such important decisions like this because it sounds like no guarantee can be set in concrete for you, but I just want you to know that I am a home birthing mum and as you said, there is nothing quite like it! But there is nothing wrong in having ceasars if there is a very serious risk to consider.
I will pray for you right now through the intercession of the Miraculous Medal.
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Dawnie
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| Posted: July 05 2006 at 7:15pm | IP Logged
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kathleenmom wrote:
| Now, different midwives have successfully delivered two babies for me with dystocia. Should I just plan that this is an inevitability and proactively plan and do what we can to encourage the baby to come before 40 weeks...etc....pray and trust God? Or, do I take the ultra-conservative route and just plan for an elective C-Section. |
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Kathleen,
I was wondering if you are only considering the two options you mentioned: planned homebirth vs. elective c-section? Would a planned vaginal hospital birth be a possibility? That way, you could have the availability of technology IF it was needed, but you wouldn't be automatically signing yourself up for a C-section.
If I were in your position, here is what I would consider before making a decision:
What are the risks of an elective C-section?
What are the risks of neonatal mortality & injury for another shoulder dystocia?
Do the benefits of an elective C-section outweigh the risks of actual injury or death from shoulder dystocia?
You mentioned that the main risk factor for shoulder dystocia is previous shoulder dystocia. I would want to know how often shoulder dystocia actually results in injury or death.
You have lots of factors to weigh and a very tough decision to make. I've had two wonderful, totally uncomplicated homebirths myself, so I know how you feel about not wanting to go to the hospital unless it's truly neccessary.
Dawn
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Sarah
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| Posted: July 06 2006 at 8:25am | IP Logged
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Thinking more about it. . .
What about an hospital induction earlier? Although its nothing like a home birth, its still a vaginal.
My induction was high-tech, but not as high-tech as a c-cestion.
Perhaps babe would be smaller earlier.
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Six boys ages 16, 14, 11, 7, 5, 2 and one girl age 9
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aussieannie
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| Posted: July 07 2006 at 1:03am | IP Logged
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Sarah wrote:
Thinking more about it. . .
What about an hospital induction earlier? Although its nothing like a home birth, its still a vaginal.
My induction was high-tech, but not as high-tech as a c-cestion.
Perhaps babe would be smaller earlier. |
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I was thinking the same thing too......
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crazymamapajama
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| Posted: July 10 2006 at 4:26pm | IP Logged
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Kathleen,
I have been through something similar. I had a c-section with my first dd, 18 years ago, and immediately regretted that I didn't try harder to deliver vaginally. When I became pregnant with my next baby I was happy to learn that my doctor supported my choice to try for a VBAC. My oldest son's delivery went well, and we were confident that any future babies would be born vaginally. Baby #3, at only 8 lbs 6 oz, presented with shoulder dystocia, but fortunately the doctor was able to deliver her with no harm done. Once the moment had passed I didn't think much more about it. I didn't know to.
Baby #4 came along 4 years later and we weren't so lucky with her delivery. She weighed 9 lbs 8 oz and was stuck tight. Like your sons, she was also blue and not breathing at birth. Unlike your sons, she did suffer permanent neurological damage. She has a left brachial plexus injury, which left her arm totally limp for the first 22 months of her life. She had a nerve grafting surgery when she was 7 months old, and a muscle surgery at 20 months. About 2 months after the second surgery we saw her arm move for the first time. She is seven years old now and is able to use her arm pretty well, but it doesn't, nor will it ever, function as well as her uninjured arm. She can't fully straighten it, or raise it above her head. She is unable to turn her left hand into the palm up position and her left arm is shorter than the right one. Her left shoulder blade sticks out in a very strange way, and her left shoulder hangs lower than her right, making bathing suits and any other clothing with shoulder straps difficult to keep in place. She just recently, for the first time, has started having pains in her affected arm. On top of all of that, the lack of oxygen at birth, although slight, left my dd with lower than normal muscle tone which (I firmly believe) was a contributing factor to a serious fall she had 18 months ago that fractured her skull, and caused a blood clot (which required sugery to drain)to form in her brain. Brachial plexus injuries aren't all that common, but they can be very, very serious.
I'm absolutely NOT trying to talk you into having a c-section. In fact, I begged my doctor to let me try for a vaginal delivery with baby #7 (after having c-sections with numbers 5 (who weighed in at 10 lbs, 12 days early) and 6 (who was a measly 7 lbs 4 oz, three weeks early)) but it didn't happen. I'm now scheduled for my fifth c-section (8th baby) on July 26th. I can't say I'm happy about the idea of undergoing major surgery, especially since #7 is only 18 months old, but dealing with another brachial plexus injury (or worse) wouldn't make me very happy either. I think, if I were you, I'd go for an induced (2 or so weeks early) hospital delivery. In my case, by the time the doctor realized how serious my girl's shoulder dystocia was it was too late to perform a c-section, without causing other (just as serious) risks to the baby. But maybe it wouldn't be the same with you since everyone would be aware of the possibility of problems, and would be prepared to act quickly.
You have a really difficult decision to make. Learn all you can about your options, and keep praying. I will pray for you as well. If you'd like to chat more about it feel free to PM me.
Jodye
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4Real Forums : Tea and Conversation
Topic: homebirth or planned c-section
