United Brachial Plexus Network, Inc.

Hi,
I'm pregnant with my second child and because my son Kai was born large and suffered a ROBPI , my dr has said it would probably be safer to have a cesarean this time as the baby is already measuring large and could become stuck like last time.
Anyway, I was wondering if any other parents of children with bpi's have gone on to have a second child by cesarean section and also if they or anyone else has any info or questions I should give to my dr about bpi's during cesarean section. I used to speak to another lady and her child was born very premature by c-section and both arms were paralyzed so I'm not too sure what to speak to the dr about, in terms of ways of preventing a bpi during a c-section.
Any ideas would be appreciated =)

Congratulations on the upcoming birth of your baby. My first baby was born vaginally with an extremely severe BPI. His case is different from most because he has had 4 surgeries and has had no return of any functional use in his left arm. His arm still hangs limp with no muscle tone. I was very traumatized by the birth and must admit it took a long time to consider having another baby. Once we found out we were expecting we spoke to our new OB doctor about our experience, fears, and concerns. He was very patient and answered every question I had. I recommend making a complete list of questions and concerns you have. My second baby was delivered via c-section with no complications at 36 weeks. My third baby was born via c-section with no complications at 35 weeks. I think it definitely helped having confidence in my physician understanding my fears and concerns. I hope this has helped. Good luck to you and I will keep you in my thoughts and prayers.

hi, and congrats on your upcoming birth. I have had 4 children, 2 with erb's palsy, my first and last. Only 1 was not problematic. I've been told I need a C-section, but not knowing much about erb's, since my first child healed so quickly, I didn't realize how bad it was. Now my 4th month old is much more severely injured. He's going for physio and we're hoping he will recover. But it's a long journey as you well know.
C-section is probably the best way to go, but I was wondering, if I wanted to have a birth on all 4s, which is supposed to help with shoulder dystocia (my main problem), and the hospital won't allow it unless I take responsibility for the outcome, should I allow it? I got scared last time and just stayed on my back, and the baby was injured...

Watch this video http://ubpn.org/index.php?option=com_co ... Itemid=139

If you are prepared to go without an epidural and don't give birth on your back you should be able to delivery vaginally.

My daughter had a right bpi injury and I demanded my son be born via c-section six years later. However, if I knew then what I know now, I would have most definitely not had a c-section and instead labored naturally BUT NOT ON MY BACK!!!

Good luck with whatever you decide. Just remember -- OFF YOUR BACK during delivery!

Kim, I agree with what you've said, the issue I had is getting hospital staff to agree. Is there any "guarentee" so to speak that birthing on all 4th aka the Gaskin method will definitely work?
I've never taken any form of pain relief during labor/delivery, and was more than interested in giving birth off my back, but the hospital WOULDN'T allow it, unless I took responsibility. Which of course, freaked me out. Realistically, could anything have gone really bad if I was off my back? Now I regret the decision, but what can you do when the entire top hospital staff walks in on my birth and doesn't want to allow for a birth other than on my back as they are used to dealing with? My doula explained to me later that they're afraid of dealing with an unfamiliar position (to them) since if anything happened they would get mixed up. They're used to seeing women in a certain position, put her on all 4s and everything's backwards. They're worried they won't know how to react at crucial times. I feel that the drs there were good drs, but who lacked knowledge in this area. My baby was born over 8lbs and I have a history of babies getting stuck even when a bit smaller than that. never had gestational diabetes, but I always do gain a lot of weight during pregnancy.
I would like to educate the system at this hospital, so that they'll deal with others in my situation in a better fashion, but they'll just throw me out... Sorry, just venting my frustration.

Ummm... I side labored, squatted, moved around and was in and out of a birthing tub all through my first stage. During second stage I was in various positions in the birthing tub. No pressure on my tailbone, gravity assisted, no epidural. After I delivered I weighed the same as when I got pregnant. And my son still got stuck and the midwife injured him getting him out. While I think that laboring on your back cannot possibly help, I completely disagree with UBPNs stance that not laboring on your back is the magical answer to avoiding shoulder dystocia and BPI. It's NOT.

Kate

Kate --

There are exceptions in ALL cases. But laboring on your back closes your birth canal by 30% -- so that certainly is a factor.

The video also clearly states NO PULLING ON HEADS by obs. That is the most important!

Kim

KimW wrote:Kate --

There are exceptions in ALL cases. But laboring on your back closes your birth canal by 30% -- so that certainly is a factor.

The video also clearly states NO PULLING ON HEADS by obs. That is the most important!

Kim

The close your birth canal by as much as 30% is something that I've debated with Richard and others on UBPN hotly over the years. That claim has not been proven, as far as I know. In any case, putting pressure on your tailbone would close the OUTLET. But the babies shoulders get stuck on the INLET of the birth canal. If you look at the quotes these experts are making about pressure on the tailbone, they are referring to "snug" shoulders in which the teeny tiny bit of opening might allow the shoulders to slide out under the pubic symphysis if you open things up ever so slightly. This is not the completely-jammed-behind-the-pubic-symphysis haul on the baby's head, jump up and down on mom's stomach nightmare of shoulder dystocia that many here experienced because the baby's shoulder and chest were larger than his/her head. Those dystocias need to be resolved by somehow rotating the baby off-axis so the shoulders aren't directly behind the pubic bone and have more room THAT way. That's not a matter of the tailbone being in the way.

"No pulling on heads" is fine to say but doctors need to know WHAT to do in the event of an emergency, not just what NOT to do. Sitting there doing nothing can very well kill the mother and the child. If the shoulders are truly stuck, you have to be in a position to get that baby rotated so his/her shoulders can come through at a different angle where there is more space. Flipping onto all fours doesn't work because it opens the canal, it works (SOMETIMES) because it shifts the baby IN the canal into a position where the shoulders can pass. If you started in all fours and the baby got stuck, you'd still need to shift the baby somehow to let the shoulders pass. The singular emphasis on "not closing the birth canal" is utterly missing the point. The practitioner has to be ready and able to manipulate the mother, the baby, or both, to get the stuck shoulders into a position where they can fit.

So yes, don't do an epidural (because you can't move around). But get a doctor who is familiar with changing positions and manually rotating the baby if necessary through one of the screw-type manuevers. If you just insist to your average OB/GYN that they let you labor on all fours and that they not touch the baby's head, that is NOT going to be the miracle cure that is presented in these videos. The practitioner has to be comfortable enough with alternate positions to now what to do if the baby gets stuck (which could STILL HAPPEN). There was a video on YouTube recently (since taken down) showing a laboring woman who experienced shoulder dystocia. The practitioner had her get onto all fours and then applied traction to the baby's head IN THE WRONG DIRECTION. She pressed the infant's head down, as is traditional to help the anterior shoulder release, except that she didn't account for the woman being oriented 180 degrees from "normal". All she did was jam the baby MORE. That kind of thing is going to happen if moms just blindly start insisting on certain positions without the practitioner having any real experience or knowledge of those positions. It's just so much more complicated than "get off your back... don't pull on the head."

OB/GYNs and midwives need to learn a better way of delivering babies. I absolutely agree with. And frankly I think UBPNs focus should be on training and education of OB/GYNs and midwives - not pushing moms to insist on an overly simplistic solution with someone who has no experience in that direction. Until there is some changing standard of teaching and training, and a shift among PRACTITIONERS about shoulder dystocias and the best way to resolve them if they occur, I personally would not want my child to be some mother-insisted "on the job training" for someone's first try at delivering a shoulder dystocia without pulling and having them potentially not get my baby out at all, or have them wait too long to just haul them out... injured but alive.

Kate

thanks kate, I really feel you've addressed the issue. I've had 3 shoulder dystocia births, and my last one didn't respond to anything - not mc roberts, not supra-pubic pressure, not anything. baby forehead came out and then it was stuck, and baby started turning blue. I heard dr's follow a list of possible procedures, mc roberts, pressure, etc, the last one being TURNING THE WOMAN AROUND. That option should maybe have to be tried BEFORE trying to manually PULL the baby out. Why they don't try that first is beyond me. A simple maneuver to possibly dislodge the baby would be great if it worked, and if it doesn't, then pull the baby out.
The main issue is time though. There's about 5 minutes before the mother/baby can be severly damaged, and when faced with such an issue, no dr. wants to take his time to try something that is not proven to work.
Kate, out of interest, what kind of background do you have? Are you in the medical profession somehow? I'm trying to understand where you're coming from.
I totally agree that doctors need to be trained to deal with things better. It makes me feel better than at least I wasn't a total total jerk for agreeing to their terms. I know I can't have a home birth because of my history of complications, but I don't want to necessarily go for a c-section if it's not absolutely necessary.
anyone on UPBN actually reading this?

helefa,

I was in biomedical research between 1999 and 2009 but now I'm "just a mom" Obsessive research was my way of handling the stress of my son being injured in the early years. I haven't done so much in recent years, maybe that means I'm working through my trauma?? Actually, I think it is because I lost my UCLA medical library online access... I would actually have to work hard to see articles, now

Kate