Did you have more children after a complicated pregnancy? (possible TMI alert)

@Seek_Kolinahr I haven’t been through a complicated pregnancy, but as a CNM, I have lots of work experience in this area, so I’m going to try to answer some of your questions.

First, the long labor, big baby, vacuum delivery and shoulder dystocia set you up for PPH postpartum hemorrhage. Your uterus was as exhausted as you were, so didn’t contract properly to control the bleeding from the placental implantation site. Some women do have a tendency to hemorrhage after every baby, but when there’s a history like yours, we’re rady for it and intervene quickly with medications and uterine massage and can usually keep it from getting scary.

The big baby with shoulder dystocia is serious cause for concern and with anextt pregnany, your midwife or doctor should be talking with you about the option of elective C section. Second babies are usually a little bigger than the first, and shoulder dystocia is such a serious risk for the baby. At the least, they’ll be wanting to follow the baby’s growth with ultrasound near the due date. Sometimes if the mom gained a lot with the first baby, she can grow a more average size baby the second time by being really careful about nutriiton and weight gain. Also, if you had an epidural the first time, consider doing natural birth the second time so you can push more effectively and also get into more physiologic positions for labor and birth.

Second labors usually are much more efficient than some first ones, so it would probably be shorter. Nausea and fainting can be different from one pregnancy to the next. Or not. No way to predict.

I labored with my first for 8 hours before her heart rate dropped. I had to have an emergency c section. The cord was wrapped around her neck and chest. The major problem came after the surgery.
I got a horrible infection in my c section wound. I had to spend several weeks in the hospital. I had a surgery where they cut about 10lbs of dead tissue out of my abdomen. They left it totally open and packed it with bleachwater soaked gauze twice a day. When the gauze had dried enough they would rip it out and do it again. That was so the deep wound would stay fresh and heal from the inside out. It was horrifically painful. I was in the hospital on IV antibiotics for several weeks. After I finally got home I still had to have a healthcare worker come out twice a day to pack my wound.
I really wasn’t planning on having anymore after all that but we got a surprise! I knew a VBAC wasn’t an option at the small hospital I go to, so I was very worried about it. He was an emergency csection also because my water broke 3 weeks early. Everything was fine with him and I had no problems.

After reading that, I can see why you are hesitant.
Out of all of it, it sounds like the delivery is the biggest concern. I would talk to your ob/gyn about your past birth and I would most likely schedule a c-section. (And I’m totally all about vaginal birth, but if I wanted more children..in your case, I’d opt for the surgery.)

As for the pregnancy symptoms you had…there’s always Zofran for the nausea, eating healthy to try not to gain so much (I don’t have much room to talk, I’m gaining more this pregnancy than my last..and I tried eating better.) Not sure about the fainting..was it your BP?

What a horrible experience that must have been! In your case, I would also seriously consider a c-section for future children. Beyond that, symptoms during pregnancy vary a great deal so I wouldn’t worry about that part too much.

In my case, I had horrible pregnancies that were a constant threat to my health (I have kidney disease… not really compatible with pregnancy). I kept right on going until the doc literally told me if I kept it up my luck would run out and I’d leave my 3 children motherless. I stopped then.

I agree with @casheroo that the best thing to do is discuss it with your OBGYN and your SO. Then decide whether or not the risks are something you can live with. Does your doctor know what caused the complications? Is it something that can be controlled?

I didn’t have anything like your experience, but when my second baby was born I had a very unpleasant experience. I was given pitocin without anyone telling me how much more painful it would make labor. I had a bad reaction to the pain meds they gave me. My son weighed over 9 pounds and got “stuck.” The doctor thought he would have to dislocate the baby’s shoulder to get him out. The doctor on call when I delivered was rude, gruff, and made no attempt to be gentle or explain what he was doing. It was bad enough that when I found out I was pregnant again only 8 months later, I was torn between being happy and absolutely dreading it. The thought of going into labor again made me want to cry. However, my next baby was a more manageable 8 pounds, I had an epidural best invention ever and a much nicer doctor. The whole experience was calm, relaxed, and almost pain-free.

You just never know what you’re in for with pregnancy, labor, and delivery. The best you can do is discuss things with your doctor, take good care of yourself, and hope for the best.

There’s some talk about weight gain – I had none. Three days after I had my son, I weighed 14 lbs LESS than when I fell pregnant. The six months of morning sickness meant I was actually losing weight for a long time. I only went from 132 to 144 lbs through the whole shebang, then down to 118. He was just a really big baby. My midwife said the fainting could have been related to blood pressure. I also became anemic, if there weren’t enough fun things happening.

@Seek_Kolinahr Sorry, I thought when you said “I got so huge I couldn’t operate like a normal human being.” That you meant you gained a lot of weight! I didn’t mean to imply anything. I’m a gainer when pregnant, so I know how painful and difficult it is to have so much extra weight (considering I’m pretty small to begin with…usually 115lbs, and 5’6)

Oh. That’ll teach me to not read my posts before I hit “submit”.

My belly just got ginormous. Really, REALLY ginormous. I was looking at pictures the other day, and they are just cartoonish. You’d think they were photoshopped.

@Seek_Kolinahr were you screened for gestational diabetes during your pregnancy?
if you weren’t diabetic and lost weight throughout the pregnancy and still grew a 10½ pound baby, you just grow big babies because of factors outside your control. Probably genetics.

In your position, I too would opt for a planned C/S unless I felt confident as I got into the last month or so of pregnancy that I was carrying a smaller baby. Beleive it or not, shoulder dystocia can happen during a C/S too it can be difficult to deliver a very large baby through an average size uterine incision but it’s easier to deal with when your pelvic bones aren’t in the way.

@MagsRags

I was screened. I failed the first test (just barely), but passed the second with flying colours.

Yuck. For a midwifery client like me (the only reason I was induced in the hospital was because he was 2 weeks postdates… Florida law and all…) the phrase “caesarean section” just sounds like failure. ~sigh~

@Seek_Kolinahr I totally understand where you’re coming from. I gave birth to my daughter at home, and out of hospital birth was part of my midwifery practice for nearly the last 20 years or so. I deeply believe in normal birth. But severe shoulder dystocia is one of those birth complications that it’s better to avoid if you can see it coming. Once the baby’s head is out, you have about 8 minutes *estimated range 5–10 to deliver the rest of the baby before irreversible brain damage occurs.

A woman who has had shoulder dystocia has about 12% likelihood of another shoulder dystocia with the next baby. Did the doc deliver his head with the vacuum and then the shoulders got stuck? If the vacuum part of the delivery was pretty easy, I would wonder whether the vacuum brought his head down in such a way that the shoulders didn’t have a chance to rotate. It might be worthwhile scheduling an appointment with the midwife who was there for the delivery to go over the birth records and talk about what details she remembers and she what she thinks about the advisibility of trying for a vaginal birth for a baby of similar or slightly larger size. Midwives tend to remember those eventful births she may even have had a few bad dreams about yours and hopefully she’d give you a balanced and honest opinion.

The vacuum was really easy. I actually asked for it, after two hours of pushing. I think she only used it for 28 seconds total (three tries) or something like that. I was just absurdly tired, hungry, worn out, and had a plethora of hospital staff (none of which I knew – my midwife couldn’t even be there, as she didn’t have privileges at the hospital) threatening me with “emergency c-sections” since the beginning of the induction. I was determined not to have a c-section.

@Seek_Kolinahr My sons birth sounds so similar to yours. I wasn’t induced though, went into labor naturally..but my cervix wasn’t dilating. I had to get pain meds to make me less tense. And they kept badgering me about a c-section the entire time! Even cornered my husband and told him to convince me, but he told them to just ask me…he wasn’t getting in between that power struggle lol. I pushed for about 3 hours, they kept asking to use the vacuum but for me..there was NO need. My son wasn’t stuck, he was just slow coming down. His heartrate was perfectly fine the entire time, they kept trying to use scare tactics..it was awful. Oh and the cutoff of three hours of pushing or you get a c-section..so ridiculous! I read of women pushing for longer than 3 hours!

A few more details, please, @Seek_Kolinahr – do you know how many minutes passed between the baby’s head and delivery of the shoulders? If you don’t, request a copy of your hospital records so you can review the delivering doc’s dictation. After shoulder dystocia, the note will usually estimate the number of minutes along with a subjective assessment as to whether the dystocia was mild, moderate or severe. They’ll describe in sequence what they did to resolve the dystocia.

It’s useful to know is what manuevers and how many it took to get the baby out. If all they had to do was McRobert’s bringing your knees as close to your ears as possible to open up the pelvic bones a bit more and it took 1–2 minutes, that’s a mild dystocia. If they tried that first, then flipped you onto your hands and knees or had to reach inside to deliver the bottom shoulder first or had to do what’s called a Wood’s screw or tried to break the baby’s clavicle, it was a more severe dystocia. If the baby needed a lot of help to get started breathing after delivery, it was probably a more severe dystocia.

It’s really unfortunate that you didn’t have your midwife with you. It sounds like you were planning a home birth with a DEM direct entry midwife? I can tell you that in my community, most DEMs accompany their clients to the hospital as a doula/labor support person in the kind of situation you describe. Depending on the previous encounters between individual DEMs and the local docs, interactions can be tense or collaborative.

If you were coming into the CNM certified nurse midwife practice here in my community, they’d be getting records from your first birth. You would probably have at least one consultation appointment with one of the obstetricians to talk about your last birth and about pros and cons of different birth plans including scheduled C/S, or induction at term to try to keep the baby at a more reasonable size. You’d have an ultrasound about a month before the due date to get an estimated fetal weight and they’d be particularly interested in the ratio between the baby’s head and shoulders big shoulders increase risk of dystocia. If you decided to try for a vaginal birth, you’d have the CNM with you for labor and the OB on call would most likely come in for the delivery and be ready to step in and help if there was another dystocia. They would not want to do a vacuum or forceps to avoid a repeat of your last birth.

I hope this helps. I have seen women with a history of a shoulder dystocia have a normal vaginal birth next time around.

I had an okay pregnancy, a very difficult labor and a horrid postpartum period with terrible postpartum depression. I never thought twice about having more children though others assumed I’d never go through all that again. I had a miscarriage with my second pregnancy, another thing others think is a sign to ‘never do it again’. I didn’t care. 3 months later I was pregnant for the third time and had a good pregnancy and a much better labor because I stayed at home a lot longer and used anti depressants to prevent severe postpartum. I say you never know, just go for it if you want a large family.