Pregnant, having cesarean in just over 8 wks

[Karenw3]

Hi Bronwyn, my first child was born at 8lbs5oz with a lobpi . I switched drs and agreed with my 2nd dr. to have c-sections scheduled for my next 2 children. Both were born by c-section with no complications that were scheduled for a week to a week and 1/2 before my due date. My dr. was very careful to make sure that they were not delivered early and luckily everything went well. I was totally relieved to not have to worry about how I was going to give birth, whether I would have an epidural, whether I would be able to move around, change positions, etc. Instead, I was able to relax and focus on the miracle of having children w/o being scared to death that my child might be stuck/injured again. I know that bpi's are posssible during c-sections, however I felt much more confident with this decision than with a natural birth. Everybody has to make this decision based on what they truly feel is best. I knew that this was the best decision for my baby and myself. the C-section was a breeze compared to my first vaginal birth! Best wishes to you and your baby. I hope that everything will turn out the way you would like it to.

[KimW]

anyone on UPBN actually reading this?

I'm on the UBPN board and yes, we actively monitor the boards.

I totally understand your position Kate and respect and admire the time and efforts you have put into researching shoulder dystocia and birth injuries. That being said, we had a limited number of minutes of content for both pieces.

Does it cover anything and everything in regards to birth injuries, absolutely not and no one suggested that it would or does.

The MAIN goal of this piece is to bring a greater awareness and understanding to shoulder dystocia and brachial plexus injuries for the layman. There wasn't enough time to cover every maneuver a doctor should try. In addition, doctors are NOT our main audience for this piece. It is for pregnant mothers who have never heard of shoulder dystocia or brachial plexus injuries and may be at risk.

The entire UBPN board is extremely excited to finally, after seven-long years, let the public get a glimpse of what a brachial plexus injury is and how it happens. I'm sorry you feel it falls short. We certainly recognize that we were never going to make everyone happy but feel we have come a long way since we started this process and we are more than pleased with the result.

And as always, I encourage those that think UBPN should be headed in a different direction to volunteer. We are an entirely volunteer-run organization and extra hands are always needed to achieve our MUTUAL goals!

Best wishes!

P.S. Sorry Bronwyn that responses got sidetracked.

[richinma2005]

Yes the UBPN volunteers do read the boards , and work on these videos and PSA's for radio stations, and read articles, and communicate through email and phone calls, maintain website, update as needed the online material, organize camp, maintain facebook page and twitter, fill store orders and help design new items for awareness. We also petition our states for proclamations, help raise money to keep the organization running, since there is no paid staff we collected donations for all these projects, and computer software for our books, we have a volunteer who does our books, helps with banking, and filed our taxes. We also pay our own way to mandatory yearly meetings (although not required, many who can afford it feel the donation is worthwhile). Matter of factly we have put personal thousands over the years to bring UBPN to the community. We also work on Outreach, and bringing other opportunities to spread awareness to the community.

We hope these efforts have made finding information easier. 13 years ago when UBPN was just being born it was VERY difficult to find others, find info, centers and such.

Hope you have found the organization useful!


rich
president ubpn

[helefa]

Kate, I definitely appreciate the results of your research. I wish I had more info before i had my last baby (the one with BPI that didn't just go away like it did with my first)
I just found this great paper http://www.yeree.com/nw/004/index.php/a ... /2599.html I'd love to know why this one was so hard to find and why there isn't any follow up...

[katep]

The simulators are a huge step in educating doctors and - more importantly - given practitioners "hands on" experience with manuevers to alleviate shoulder dystocia. I can't imagine someone getting trained to do CPR, for instance, without ever actually practicing or at least doing simulated practice on a dummy. And yet our medical schools, at least until recently, graduated OB/GYNs in a continuous stream with almost all of them having no "hands on" experience with the extremely dangerous situation?!? That was just insane. But shoulder dystocia is rare enough that it is completely possible to get through an entire OB rotation without ever experiencing one. So the simulators are HUGE PROGRESS.

For the record, I totally agree with Gaskin's manuever. Sure wish my midwife had tried something rather than just McRoberts in the birthing tub and then pull. Changing positions to all fours or squatting has profound potential to alleviate shoulder dystocia. And if that doesn't work, the mom can then easily move in to the "runner's stance" (one foot far forward, one foot back and crouched like starting a race) to allow room for "reach in" maneuvers. But Gaskin's maneuver is never going to be standard given the other ways we do birth in this country. Where I disagree with UBPN is it is so much more than just telling individual mothers to "stay off your back" as if that is a magic prescription for avoiding shoulder dystocia. In order to effectively stay off your back and be maneuverable, you can't be hooked up to wires all over the place, IVs and all that. You really need to have control of your body and your legs, so no epidural. And not be on a narrow gurney. And you need to have a practitioner who understands the different maternal positions, is used to them and PRACTICED with them so much they are second nature.

Shoulder dystocia is a life threatening emergency. Yes, that is obvious but it feels to me like that gets forgotten regularly on this forum. All our children are lucky to have survived without brain damage or CP. A doctor has to have the steps to resolve shoulder dystocia memorized by heart. There is no time to sit and ponder what you want to do next. I think the idea that they are going to have a different list of steps depending on the particular situation of each patient is just not reasonable and is actually asking for more trouble and confusion if this life-threatening situation arises. A practitioner's go-to maneuver has to be his/her go-to maneuver across the board - for ALL patients.

This is why midwives will put the Gaskin maneuver on the top of their list, but very few OB/GYNs. Because the midwife is dealing with mobile women who aren't drugged so as not to feel the lower half of their body. No IV for pitocin, no Epidural, no wires to get all tangled up and cause potential disaster... FlipFlop (starting with Gasin) can be their go-to set of maneuvers because it will apply to all their patients. There is no way in hell I would want to be a practitioner trying to manipulate an overweight woman into an unfamiliar position (to both of us), who can't feel her legs and has wires going this way and that, trying to get her onto her knees on a narrow gurney all with a baby's head sticking out the back of her vagina! I mean, seriously... who are we kidding that pregnant mothers demanding this of just any doctor is not going to result in anything other than just a different set tragedies? I think the mere idea of that is just irresponsible. Find a doctor who is familiar with using these more effective maneuvers, who doesn't have patients routinely hooked up to everything under the sun, who supports and encourages not getting an epidural... who DOES IT THIS WAY all the time.

I saw a video of a birth at a symposium in 2005. The mother had insisted to the OB that the OB not touch or manipulate the baby's head. Well, the baby got stuck. And the OB obeyed the mother's directions. She pathetically and tentatively tried the different maneuvers that she had "learned" (but never practiced nor really knew how to implement). After SIX MINUTES of the baby being turtled on the perineum, the practitioner FINALLY managed to work her hand into the woman's vagina, turn the baby, and get it out. Sitting in a room full of OBs, I can tell you... people were near to having a heart attack by the time the baby came out. And what if the baby was even more stuck? I shudder to think what might have happened. So if you want to be able to flip over onto all fours, if you want a practitioner who knows how to reach in and unstick the baby if that becomes necessary, grit your teeth, suck it up, go without an epidural, and look for a practitioner for whom this is standard. And recognize that, after all is said and done, the practitioner STILL might need to just haul your baby out of there. Alive and injured is better than dead. But the message I get from UBPN is that you should demand different behavior from your existing doctor, and I could not disagree more with this approach. Getting your regular OB to just "go along with your request" is just plain asking for trouble.

It is the HEALTH CARE INDUSTRY that has to change. Yes, it is pathetic that our health care system routinely puts women in the position where it is not feasible to use the most effective maneuvers to get babies out safely. But pregnant women MUST take some responsibility for that. The lithotomy position is NOT done just because it is convenient for doctors. Most of the reason for the lithotomy position is all the extra "stuff" that comes along with a pregnant woman's own desire to have a pain-free birth. But there are hidden risks that women need to know about. An epidural not only doubles the time it takes the baby to descend, it deprives the baby of natural pain control (your own natural endorphins cross the placenta but the epidural "relief" that helps you does not aid the baby at all). An epidural requires additional monitoring that effectively rule out the doctor performing the most effective interventions for shoulder dystocia. And your lack of being able to be involved in the birth by changing positions or even feeling what is going on means ALL the responsibility is on the doctor to get the baby out safely. Under those circumstances, why on earth wouldn't a woman want the doctor to have the easiest position from which to do his or her job? She gave over complete responsibility to the doctor for a safe birth! And all for some temporary pain relief - which only helps her - to make the temporary birth process more endurable. And the ridiculous thing is, women who seek a drug-free birth are somehow seen as "alternative" or self-indulgent, somehow wanting to "prove themselves" or be "super mom" wanting a "wonderful birth experience". How about just trying to create the SAFEST birth experience? That might help shift this pattern of wired up, on-your-back birthing that leaves everything to the practitioner while the woman just lies there. That is the fundamental problem with birthing in our country... the lithotomy position is just a by-product.

Kate

[helefa]

Thank you UBPN ppl for reading the boards, I really do appreciate it. I've only come accross your site a few days ago and I'm loving it. After 2 erb palsy babies (which were 2 of 3 shoulder dystocias) I wish I could change the way doctors handle my births, especially since I've always gone natural. Instead they freak out and tell me to stay on my back since they don't feel confident that if there were any complications they would do the right thing within the right amt of time ...
Thank you for putting together this site and for all the great work you do. People definitely need to hear about you guys more!

[helefa]

Yes the UBPN volunteers do read the boards , and work on these videos and PSA's for radio stations, and read articles, and communicate through email and phone calls, maintain website, update as needed the online material, organize camp, maintain facebook page and twitter, fill store orders and help design new items for awareness. We also petition our states for proclamations, help raise money to keep the organization running, since there is no paid staff we collected donations for all these projects, and computer software for our books, we have a volunteer who does our books, helps with banking, and filed our taxes.

Wouldn't it be interesting to take this all to a TED conference? It might help spread the word even more...

[Carolyn J]

I can personally attest to the reality and truth that all members of the BOD's have put Thousands of $Dollars of their personal Funds over the years as well as an infinite amount of their time to do everything Kim W and Rich have posted "UBPN" does and "IS".
Carolyn J
LOBPI/72

[katep]

My concern over the message contained in this video has NOTHING TO DO with lack of appreciation over those who put in countless time and effort to keep UBPN going and growing. I have nothing but immense respect and admiration for people who give themselves so much for such a noble cause.

But that does not change the fact that I fundamentally disagree with the message in these videos. Am I to just keep quiet because they volunteered their time and I did not? Should I rather be polite and look the other way? I would, except that I feel the message is not only not scientifically proven but potentially dangerous

I can't be quiet about that. Women who have had severe, life-threatening, MAJOR shoulder dystocia are being led to believe that "If you are prepared to go without an epidural and don't give birth on your back you should be able to delivery vaginally" (I'm very sorry for the direct quote, Kim, but your statement is exactly what scares me so much about this segment). No matter my respect or feelings about UBPN and its volunteers, I simply cannot keep silent when I see that happening.

I understand that the spotlight on segment had to be necessarily brief. But in this case, I think oversimplification means demeaning the risk... and that is dangerous. Such oversimplification also - I believe - completely misses the point in how to prevent these birth injuries. It doesn't address the fundamental problem, and thus will not reduce injuries. The resulting confusion may even cause more injuries. Giving birth on your back is NOT the true problem. It is NOT proven that this "closes the birth canal by 30%". Being unable to move, being locked INTO an on-your-back position, THAT is the problem. Practitioners not knowing what to do other than just pull the baby out are the problem.

Being able to change positions is a huge part of managing shoulder dystocia WHEN IT HAPPENS. Your position doesn't necessarily keep it from happening. Practitioners need to know what to do to help a baby when - not if - shoulder dystocia happens. Simply insisting that you get to labor on your side or on all fours isn't going to prevent shoulder dystocia completely, and could just confuse the doctor in the event a dystocia occurs. Just insisting the doctor keep his "hands off the head" could have even worse consequences if he or she doesn't know what to do instead.

Fact: A large baby with even larger shoulders is not going to easily rotate in the birth canal. Fact: if those large shoulders end up in the wrong place as they descend, they are going to get stuck. I mean, let's be real here. A baby is born with an average head circumference of over 30cm, an average biparietal diameter of over 9cm. No woman's vagina fits something that size without a whole lot of dilating! Don't we all remember the "OMG, how on earth is it going to fit through THERE" moments in the months leading up to birth? The baby can fit because the baby's head creates the passage. The head baby's head dilates everything as it is forced down the birth canal through powerful uterine contractions. There is so much force applied during that dilation that the baby's head plates often overlap and the head molds from the pressure! In normal births, the ones where the baby just "falls out" on the next contraction after the head is born, that dilation creates a passage through which the shoulders easily follow, twisting and turning without restriction. As soon as the head is out, the baby just slips out on the next contraction. But if the baby's shoulders are larger than the head, they don't easily follow in that dilated path. If the shoulders are larger, they are going to have to dilate the path some more, experiencing resistance ("sticky" shoulders) or possibly getting downright stuck (shoulder dystocia). Gravity is irrelevant in that case! The forces of the uterus could still push a baby's head out if you gave birth standing on your head. Gravity has nothing to do with whether or not the shoulders can fit behind the path created by the head.

The head dilates the canal, and for most babies the head dilates everything enough that the shoulders just follow along, twisting and turning with ease. For some, they won't. They just WILL NOT. Some women have the tendency to produce children with large shoulders. They just DO. For UBPN to push the notion that if you just get off your back, you will not experience shoulder dystocia, is - I strongly believe - irresponsible and not even true. MAYBE it would reduce the rate of "sticky shoulders", but exactly how often are "sticky shoulders" the cause of the permanent BPIs we see? Sticky shoulders do not result in nurses jumping up and down on pregnant stomachs, doctors bracing both feet on the bed to pull that baby out! A tiny amount of extra room under the pubic symphysis WOULD NOT PREVENT those dystocias! To suggest so could result in even more and worse consequences as misguided women push their practitioners for a "solution" which will not even solve the problem. And because I believe that, I can't just sit quietly while pregnant women - especially women with significant risk factors for severe shoulder dystocia - are being told to just stay off their backs and everything will be fine.

Kate

[richinma2005]

UBPN is pleased to provide these open forums to talk about different opinions and perspectives. As always we encourage anyone with medical questions to ask their professionals and discuss options.

Individuals need to consult with trusted clinicians to determine the appropriateness of products or services for their specific needs.