United Brachial Plexus Network, Inc.

Hi I am about 9 weeks pregnant with my 2nd child. My daughter is 20 months old with a ROBPI. We are thankful that she has gained alot (but not all) of function back but am scared thinking about labor again. I meet with my NEW ob today and hope he is understanding of what we went through. From what I have read there is an increase risk of SD occurring again and would like to schedule a c-section. However many of my family and friends seem to think that it is silly for me to think it may happen again. They say with a new doctor and watching the pregnancy closer it should be fine. I don't understand how they can be so judgemental about this!!! Ideally I would love to deliver normally but I don't know if I can handle it. Any words of advice and encouragement would be GREATLY appreciated!

TIA

Hi Tia, my first daughter also has a ROBPI. Like you I was very worried about my second pregnancy , was unsure of whether it would happen again and could I live with it if it did? My OBGYN told me straight out that once a SD birth occurs the chances of it recurring with another birth increase not decrease. His exact words were this. I am not willing to let you go through that again, you will be anxious and fretful the entire labor and there is too much risk that a SD will occur. He did say however that he would send me to a high risk labor and delivery doctor if I wished to try for a vag birth. My husband and I decided there was too much to risk and opted for a c section. The risks of c sections are breathing for the newborn ( it's been a while so I can't remember them all ). I wanted to go into labor naturally and go all the way through with contractions ( I believe this is important for lungs in baby )then have my c section when the time came to push. This doctor agreed and all went beautifully. It was a relaxed, quick labor which I went into on my own with no drugs, and my daughter was born very healthy and screaming her lungs off before she was even all the way delivered. I can still hear the Doctors and nurses wowing at her large and healthy cry. She was 2 weeks early and weighed 8lbs 11 oz's, 1 pound bigger than her injured sister.

I would do it all over again the same way.

Don't let your family and friends sway your decision, they really do not understand the risks involved.

Lenni

My daughter's first child was born LOBPI. When she became pregnant with her second child she went to a new OB, who did not want her to have to go through that again either. She was scheduled for C-section, which went well. Afterwards, with delivery the Dr. indicated chances were high that the second baby would have gotten stuck also. We were all thankful she chose C-section.

Our first child was our bpi child. She weighed 9lbs 2 oz 2 days after the due date and had to be induced. I was very nervous about having another baby but knew it was absolutly the best thing we could do for her. Our son was born 2.5yrs later by c-section. He was 3 weeks early and weighed 7lbs 6oz. We had our 3rd child a daughter 7lbs 11oz and 3 weeks early by c-section last year and had the worse experience ever with the epidural. I had a spinal headache for 10 days after she was born and couldn't even raise my head to a sitting position. So needless to say I am scared to death about having a needle in my back again. We are expecting again come this March and this time around I felt led to try a v-bac. I am very nervous about it but I do feel this is what we should do of course I do have panic attacks just thinking about childbirth but if this one does come early and weighs about the same delivery should go smoothly. We are traveling 2.5 hrs away to a Dr I trust and have already discussed at length the plan, Shoulder dystocia prevention and maneuvers plus if spontaneous birth does not happen by 38-39 weeks we will do another c-section.
Hope this helps in some way

Jessica

Hi,
Congrats on your pregnancy.

When Melanie was just about a year old we found out I was pregnant. We were not ready for that news!! To make a long story short I was induced with Matthew. He was 10lb 6oz 2 weeks early. I found out afterwards I had undiagnosed diabetes which played a part in his size. He has a permanent injury. I do know people who have gone on to have uneventful vaginal births after bpi.

If I were to get preg again I would go for another vaginal delivery - however my diet would be monitored and I would not give birth on my back. I would have a very clear and specific birth plan and I would make every doc in the practice sign off on it.

Good luck with your decision, I know it's a difficult one.

Not saying that you should have a C Section, but if I were to become pregnant again, I would not think twice. I would have a C Section.
Also, to show you opposite of my thinking...there are moms here who did have a safe vaginal birth after an OBPI child. Maybe they can post or email you about their experience.
Good luck! Remember, do what you feel is right in your heart and things should be fine.
~Krista~

I am LOBPI. When I was first pregnant, I was terrified that My child would have the same problem. My Dr. assured me it wouldn't be a problem. Well, it turned out I had a c section and DS (8lbs 5 1/2 ozs) had no problems.

With our second I decided to do a V-BAC. I was doubly worried. He was born 9 lbs 8 ozs, and no problems.

By our 3rd, 4th, and 5th, no worries, and all V-BAC. (7 lbs 8 ozs, 7lbs 10 ozs, and 7 lbs 15 ozs respectivly)

As far as a V-BAC goes, I am VERY pro. It was soooo much better than a c-section. The recovery seemed instantanious comparitively. I would think that by keeping a close watch on the size of your little one would help enormously. Since a larger baby increases the risk, they might induce labor early is baby is getting too big, or even decide to do a c-section after all.

I do think that whatever works best for you, and makes you feel safest is what you should do.

I enjoy reading this thread. Another thing, as someone briefly mentioned, if you do end up chosing a vaginal delivery I would strongly suggest to speak (in great length and details) with your OBGYN about their experiences with shoulder dystocia. How many did they encounter? How did they handle it? Did injury(s) result? What type of maneuver(s) will they perform if shoulder dystocia is encountered? How about labor indications of a potential shoulder dystocia taking place? Will the doctor agree to take you into the operating room to do a C Section and not puch to have the birth accomplished vaginally? These are really important subjects to talk about ESPECIALLY when you already had a birth with shoulder dystocia present. Good luck with your decision.

First off, congratulations on your pregnancy. What a joy. Think of it only in that respect and don't let the question of vaginal versus cesarean mare that joy!

Next, what a tough position you have been placed in. I'm sorry you even have to deal with this issue, along with all the other families who may eventually have to deal with this same issue.

It is true that once you have had a shoulder dystocia, especially with a resulting BPI, the incidence of a repeat scenario is increased compared to someone who has never experienced either scenario. Here's statistics for repeat shoulder dystocia once you've already had one in the past:

*Baskett and Allen (1995) 1-2%
*Smith (1994) 12%
*Ginsburg (2001) 11%
*Gherman (2002) 11.9 and 16.7%

Remember that there are many risk factors involved with shoulder dystocia and BPI (diabetes, estimated fetal weights, position that mother LABORED AND DELIVERED IN, maternal weight (prior and gain in pregnanncy), position of baby at delivery (OP, breech), pelvic anatomy of mother, instrumental delivery (vacuum, forceps), experience of deliverer, anesthesia used (ie: epidural), prolonged second stage (pushing stage) of labor, induction of labor, and I feel like I am missing something here, but I can't think of it right now.

There are risks associated with a cesarean section as well. Babies that are born by c/s are at risk for TTN (transient tachypnea of the newborn) which is a temporary respiratory condition where the baby breathes faster than the normal and requires supplemental oxygen because amniotic fluid usually was not squeezed out of the lungs as with a vaginal delivery. This is also seen in vaginal deliveries where the baby was pushed out very quickly. The mother is at risk for infection (pneumonia, urinary tract infection from the foley catheter because you won't be able to get up to pee right away after your delivery probably and will have a catheter, etc.), bleeding, issues with her blood pressure, risk of DVT (blood clots), pain issues post-operatively, longer recovery period than with a vaginal delivery (although compared with some vaginal delivery experiences, it may seem easier), and others.

So, this being said, I just wanted to provide you with general information to take to the doctor's appointment with you. I don't know what you should do, just like you don't know what you should do just yet. It will come to you. You have plenty of time to decide. You may make one decision at one point in the pregnancy, and then things may change for one reason or another (you may become a gestational diabetic which may change your mind for example). Take your time, think about it, make the decision that is best for you. I am not having anymore babies as I had my tubes tied after Amber was born, which was planned prior to her delivery. I had a shoulder dystocia with our first child (no injury, but he did have seizures for hypoxia). I was induced with him for being 2 weeks overdue and he was 9lb. 12 oz. Then 7 1/2 years later Amber came along and I had another shoulder dystocia with a permanent injury. I was induced again for her, but this time 1 1/2 weeks early this time trying to "prevent" a shoulder dystocia on the advice of the midwife at the hospital I was then working at (I no longer work there). It sounded good at the time, but it didn't work in my situation. Amber only weighted 8lb. 3 1/2 oz. (1 1/2 lbs. less than our son, Casey!). I do trust in the birth process (I am a labor and delivery nurse), and I work with a wonderful group of nurses, midwives and ob's that I do believe would help me make the best choices. I don't have to make the choice you are making though. I hope you find a group of providers that you are comfortable with, answer your questions, and if you do decide to labor and deliver vaginally...I hope they encourage you to get up out of bed and deliver NOT LYING ON YOUR BACK!

Good luck.

Tanya in NY
Amber's Mom, ROBPI, 4 years old

Hi, Tia. You got some great info. here already. First of all, about the family advice, I'd just say "thank you" and then just file the info. away. They obviously just don't understand, but I'm sure they mean well and probably just want to comfort and assure you. I try not to let any advice / comments from family /friends upset me b/c I know that unless you're in a situation like this firsthand, there's just no way to comprehend it.

Anyway, there's no clear answer to this question of how to do the next delivery. We have a 7 1/2 y.o. daughter w/a LOBPI. When I got preg. again, my husband and I discussed everything at great lengths and my NEW OB and I did as well. I had actually met a few prospective OBs in b/w drs. (whenever I was due for an annual exam, I tried a different dr. for a few years until I found one who I was really confident with).

I think you really need to review what risk factors you had the first time around and see what risk factors you still have this time around, if any. Why did the BPI happen? Could it have been easily avoided with proper maneuvers? How would you feel if you were to deliver vaginally and have another baby born with a BPI? Could you be able to handle that possibility? For me, that was a big factor b/c I thought to myself, this time I know about the risks and a way to avoid the BPI and a c-s was recommended to me (although the dr. also said he'd be willing to discuss doing a vaginal delivery if I really wanted one). I think the guilt I would've had after had I had another baby w/a BPI would've been too much for me to handle. If you do decide to do a vaginal birth, really really question that dr. in advance. In hindsight, I feel that my new OB would've very likely delivered my 2nd baby normally with no problems. He was 8 1/2 lbs and my daughter with the BPI was 9 lbs, 12 oz. However, they did expect my son to be bigger than he ended up being.

Many women have posted about this on here and have said that their subsequent c-s birth / recovery was a breeze compared to their vaginal delivery. For me, that was definitely not the case. For one thing, I think that although my first delivery was difficult, it wasn't the extreme "horror story" that I've often read about here. Also, the recovery from my 2nd delivery (c-s) was quite difficult for me (I think that being overweight mdade it more difficult of a recovery). Anyway, there's a lot to consider and it might not be such an easy decision and you might change your mind a couple times before you definitely decide. Take your time, you don't need to finalize a birth plan just yet and try to relax and not get too stressed. Take care.

~Tina, bpmom@comcast.net mom to Nicole, 7 1/2 y.o. w/LOPBI) & Joshua (2 1/2 y.o. w/NOBPI, C-S)