Desire for a vaginal birth after cesarean (VBAC) in my semi-tolerant setting, history of diabetes, and Attendings concerned for a shoulder dystocia did not set my hopes high for the outcome of her labor. She was technically low risk other than their unfounded concerns and incredibly low risk of uterine rupture, so I was able to take care of her without much disagreement from the other providers.
During bedside rounds, after the OB team saw her and began discussing (laughing) over the mom’s physical size and their concern for a shoulder dystocia, I brought up recent research over the most risk for shoulder dystocia being founded in providers’ fears for a shoulder, rather than actual fetal-maternal factors. I said my take-away from the research review* was, “Be prepared, not scared.” They laughed again, and wished me luck with the delivery.
One of the new residents followed with me during her care, and while in a room checking in on another patient I saw her strip looking “pushy,” and walked in to find the Resident checking on her. The head was born moments later. I watched the anterior shoulder pop immediately afterward, and observed the Resident continue to guide the baby down. “Up, up, up!” I whispered to him. And then he and I went through what has become a familiar dance of helping him put the baby on her belly, holding the clamps away from him, putting his hand on the cord to feel the pulsing, talking with the mom and the baby, and waiting for spontaneous placenta birth, which came easily after clamping.
Beautiful baby, no tears, successful VBAC. A Resident with a bit more midwife experience.
*The evidence review of provider fear over a “big baby” and shoulder dystocia is available through Evidence Based Birth.