94: over preparedness

I'm sure most pregnant women have at one point or another picked up the book "What to Expect When You're Expecting", and have browsed through the various questions and topics of pregnancy and labour. Numerous people have told me to use it as more of a reference when you have questions then a cover to cover read, and for the most part I've observed that wisdom, but once in a while when I'm bored I'll read a little bit of labour and end up freaking myself out with some chance medical complication.

For instance the other day I was reading about Shoulder Dystocia. Did you know 5-9% of children weighing over 9lbs at birth have shoulder dystocia? Did you know that I weighed in at 8lbs 10oz at birth and my husband was over 10lbs? What is shoulder dystocia you ask?

The book describes it as follows:

Shoulder Dystocia During Pregnancy

What it is: Shoulder dystocia is a complication of labor and delivery in which one or both of the baby's shoulders get "stuck" behind the mother's pelvic bone as the baby descends into the birth canal.

How common is it? Only one percent of babies weighing six pounds have shoulder dystocia; five to nine percent of babies weighing more than nine pounds have shoulder dystocia.

Who is most at risk? Shoulder dystocia occurs most frequently in larger babies. Women who've previously delivered a baby with shoulder dystocia or those who have gestational diabetes are also at risk. The risk also rises if you go past your due date before delivering or need to be assisted by forceps or vacuum during childbirth. Still, many cases of shoulder dystocia occur during labors without any of these risk factors.

What are the symptoms? A stalled delivery after the baby's head emerges.

Should you be concerned? Both you and your baby are at risk for complications of shoulder dystocia, almost all of which come as a result of the maneuvers that might need to be taken to dislodge your baby from the birth canal. Fortunately, those complications (such as nerve injury or breaks and fractures in the collarbone or arms of the baby or hemorrhage, significant tearing of your perineum, uterine rupture, and other pelvic injuries for the mother) are rare.

What you can do: Keep your weight gain within the recommended range so your baby doesn't get too big to maneuver through the birth canal. Picking a labor position that allows your pelvis to open as wide as possible might give you the best chance of avoiding dystocia. If you do have shoulder dystocia during labor, your practitioner may try to change your position, ask you to hyperflex your knees up to the abdomen, or apply pressure to the top of your pelvis to help the baby be delivered.

I had to put the book down half way through and walk away because the thought of it was just too scary. I was still curious later and I looked it up online, and another article said that: "It becomes apparent within seconds after the delivery of the head. At that point the doctor or midwife has approximately five minutes to resolve this stuck shoulder before the risk of brain damage due to decreased oxygen flow to the baby's brain occurs."

Um, scary. And really, the things you can do to prevent it as described above really aren't that helpful. I'm having trouble gaining the weight I'm supposed to, but the baby is right on target in terms of growth and has been very 'robust' from early on, so she may very well be on the bigger side like her parents were. Additionally, aren't almost all birthing positions having you opening your pelvis as wide as possible?

Clearly it something I can do very little about before labour begins, and worrying about it now or during labour wouldn't help the situation at all, but it's difficult to un-think these kinds of things. We're just praying for a healthy happy baby and an easy, uneventful labour. Hopefully it happens, but if it doesn't I've got a great team of midwives and the OB's are at the hospital if an emergency arises.

I don't think I'll be picking up my copy of What to Expect for a little while!

Check out the other posts in this series!