Shoulder dystocia is a medical emergency condition during the delivery in which the baby’s shoulder gets stuck inside the womb after its head passes through the vaginal canal. This is usually caused when the baby’s body is wider as compared to the mother’s vaginal opening during labor.
Following factors increase the risk of shoulder dystocia:
- History of shoulder dystocia in a prior vaginal delivery
- Head of the baby disproportionately larger than its body
- When the mother suffers from diabetes
- Excessive weight gain (>35 lb) during pregnancy
- Maternal obesity (body mass index >30 kg/m2)
- Post-dated pregnancy
- Instrument-assisted vaginal delivery (vacuum, forceps, or both)
- The short stature of the mother
Shoulder dystocia occurs in about three to seven out of every 100 women in the United States.
How is shoulder dystocia treated?
After doctors diagnose shoulder dystocia, they usually perform any of the techniques given below to allow for successful vaginal delivery:
- Episiotomy: A cut is made from the vagina extending towards the anus to increase the vaginal opening for an easier delivery.
- McRoberts maneuver: The mother is asked to bend the knee and pull the thighs over the stomach.
- Suprapubic pressure: Doctors manipulate your lower abdomen externally at the pubes and apply pressure over the shoulder of the baby in a downward direction to rotate the baby’s shoulder.
- Internal rotation: The doctors may first perform an episiotomy to gain entry into the vagina. They will then insert their two fingers of one hand into the vagina and rotate the baby’s shoulder internally. At the same time, the doctors may apply pressure over the abdomen with their other hand.
- Remove the other arm from the birth canal: The doctor removes one hand from the vaginal canal to facilitate the delivery.
- Roll the patient: You will be asked to roll to all fours-position (resembling the standing of an animal). This will allow the gravitational force to pull the baby in a way that helps free the baby’s stuck shoulders.
What are the complications of shoulder dystocia?
The mother and her baby may suffer from the complications of shoulder dystocia and the procedures to relieve it.
The possible risks in the baby include:
- Injury to the nerves (brachial plexus) that sends signals from your spinal cord to your shoulder, arm, and hand
- Collar-bone fracture
- Fracture of the long bone (humerus) in the arm
- Lack of oxygen (hypoxia) and brain damage to the baby
Possible risks in the mother are:
- Postpartum hemorrhage (excessive bleeding from the vagina, uterus, or cervix after delivery)
- Vaginal tears
- Injury to the bladder and rectum
Most of these complications, if they happen, are short-term, and doctors can minimize or treat them successfully.
Can shoulder dystocia be prevented?
In most instances, shoulder dystocia cannot be prevented because it is an unexpected complication of vaginal delivery. If you have diabetes or have developed diabetes during pregnancy, your doctor will recommend a planned cesarean delivery. This will reduce the risk of shoulder dystocia that happens only during vaginal delivery.
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Hill MG, Cohen WR. Shoulder dystocia: prediction and management. Womens Health (Lond). 2016;12(2):251-261.
Baxley EG, Gobbo RW. Shoulder dystocia. American Family Physician. 2004 Apr 1;69(7):1707-14.