Shoulder dystocia is a type of obstruction during birth where the baby’s shoulders get caught after the head is delivered. Dystocia means “difficult birth.” Shoulder dystocia creates issues during the rest of labor, sometimes causing further health complications in the mother and the child.
While shoulder dystocia is considered an emergency and requires swift and immediate action to treat, it is very rare, occurring in fewer than 1% of all vaginal births.
Shoulder Dystocia Causes and Risk Factors
Shoulder dystocia is highly unpredictable, meaning it can’t be prevented. But there are several factors known to increase the risk of shoulder dystocia during birth. Certain factors can cause an increased risk for shoulder dystocia.
Common Risk Factors of Shoulder Dystocia
Although these factors can increase the risk of shoulder dystocia, this event can occur even when there are no risk factors. Many of these risk factors cannot be controlled, but maintaining a healthy weight during pregnancy and watching for signs of gestational diabetes can reduce your risk of experiencing complications when you go into labor.
Diagnosing and Handling Shoulder Dystocia
One of the first indications of shoulder dystocia is an event called “turtling.” This occurs when the child’s head, once delivered, reverses back towards the birth canal, resembling a turtle going into its shell. Another sign of shoulder dystocia is a baby with a red, puffy face, caused by the pressure the mother’s pelvis puts on his or her body.
Doctors officially diagnose shoulder dystocia if 60 seconds pass after the head is delivered without the body of the baby following. When the event has been diagnosed, they will tell the mother to avoid the four Ps: pulling, pushing, panicking, or pivoting. These movements could endanger both mother and baby.
The delivery room doctors will then adhere to the steps of ALARMER:
Ask for help: The hospital will have a system in place for this situation. Those in the delivery room will call for aid from additional doctors and nurses, and the ob-gyn will ask for help from the mother and others in the room to make the process go smoothly.
Lift and hyperflex the legs: This action alone often resolves the issue. In lifting and pulling the mother’s legs to her abdomen, the pelvic shift creates more room for the baby to move through. This is also called the McRoberts maneuver.
Anterior shoulder disimpaction: Doctors will put pressure on the abdomen to free the anterior (or frontward) shoulder of the baby. In 91% of cases, this tactic combined with lifting the legs will be successful. Another way to disimpact the anterior shoulder is by reaching into the vagina and moving the shoulder, called the Rubin maneuver.
Rotate the posterior shoulder of the baby: Called the Woods maneuver, doctors will reach inside the vagina and use fingers to rotate the lower shoulder.
Manually remove the posterior arm: The ob-gyn will move the baby’s arm over the chest and deliver it. This process can sometimes break the child’s arm, but this injury will not lead to long term neurological damage.
Episiotomy: An episiotomy is a cut between the vagina and the anus (the perineum) made to enlarge the vaginal opening during delivery. In some cases, an episiotomy is necessary to facilitate some of the above procedures when the child is stuck.
Roll over onto hands and knees: Moving into this position widens the pelvis and gives more room for the baby to be delivered.
If one of these procedures does not work, they will often be performed again until successful. New maneuvers are only tried after 30-60 seconds to give time for the baby to be delivered.
Complications of Shoulder Dystocia
After the baby is finally delivered, the medical team will assess both the child and the mother for any injuries or complications. For the mother, this issue can lead to tearing of the uterus, cervix, or vagina. Doctors will check for postpartum bleeding and treat any tears immediately.
Did you know?Klumpke’s palsy & Erb’s palsy
Shoulder dystocia can result in a number of birth injuries for the child. The biggest concerns are the impact on the nerves and on oxygen flow. In very severe cases, the obstruction during delivery can cause the pH levels of the umbilical cord to drop. This will start to happen after five minutes of shoulder dystocia, and will cut off oxygen to the brain, sometimes leading to death. This only occurs in extremely rare cases.
When the shoulders are stuck, a lot of pressure is put on the baby’s nerves. This can lead to stretching of a group of nerves called the brachial plexus, causing issues like Klumpke’s palsy or Erb’s palsy. These conditions result in problems with motor control of the hands and arms, but in many cases these issues resolve themselves after about six months. Cerebral palsy is also a possible complication, but less common.
Overall, shoulder dystocia is an uncommon delivery complication. If it does occur, it is important to stay calm and to follow the orders from your delivery team. They will do everything they can to protect you and your baby from harm.