Shoulder Dystocia

What is Shoulder Dystocia?

Doctor Checking Baby's ArmShoulder dystocia is an obstetrical emergency during childbirth that occurs when a baby's anterior shoulder becomes stuck behind the mother's pelvic bone preventing the baby from continuing through the birth canal. Shoulder dystocia is a comparatively common type of obstetrical complication. Approximately 2 out of every 100 vaginal deliveries in the U.S. reported some level shoulder dystocia. Of course, the true incidence of shoulder dystocia is somewhat difficult to establish because there is a wide variation in diagnostic and reporting criteria among hospitals. Not surprisingly, shoulder dystocia is more common in male babies and it full term babies both of which tend to be comparatively larger. Shoulder dystocia is caused by a number of interrelated factors including the size of the baby (particularly the width of the baby's shoulders); the size of the mother and the birth canal, and the angle of the baby in the birth canal.

How is Shoulder Dystocia Handled?

When shoulder dystocia occurs it immediately threatens the safety of both mother and baby and is treated as an obstetrical emergency. If shoulder dystocia is not properly identified and overcome, a baby can potentially die or suffer serious brain damage from oxygen deprivation. As a result, OB/GYNs have a very limited window of time to act in response to shoulder dystocia. Unfortunately, the response to shoulder dystocia by doctors can often be just as risky for the baby.

There are a variety of well-known manipulative techniques and obstetrical procedures that obstetricians can employ to overcome shoulder dystocia. The primary manipulative techniques commonly used by OB/GYNs when shoulder dystocia occurs include the Rubin, Jacquemier, and Woods techniques. The so-called McRoberts maneuver and the use of suprapubic pressure are other widely used procedures for handling shoulder dystocia. When shoulder dystocia is first encountered during delivery, the doctor's initial step is to accurately determine the actual orientation of the baby's anterior shoulder (i.e., angle, depth, etc.). Accurate assessment of shoulder position and orientation is critical because the specific orientation will dictate what obstetrical techniques and/or maneuvers will be most effective in dislodging the shoulder. Certain techniques are designed for use with specific orientations.

After the orientation of the shoulder has been fully assessed the doctor must decide on a strategy for responding to the situation, including which of the various techniques to employ. This is where things can get very tricky. It is very important to overcome the dystocia and deliver the baby as quickly as possible. At the same time, however, excessive haste, overly aggressive manipulation, hyperflexion of the baby's neck, or the use of excessive force will easily cause injury to the baby. A very high level of skill is required to overcome shoulder dystocia without injuring mother or baby. The problem is that shoulder dystocia simply does not occur often enough for most doctors to develop expertise or test out various methods. As a result, many OB/GYNs lack confidence in their skills which often causes them to panic and make rushed decisions.

Shoulder Dystocia and Birth Injuries

When shoulder dystocia occurs the risk of a birth injury automatically skyrockets. Anxiety and a lack of experience caused many doctors to employ excessive force in response to shoulder dystocia which routinely causes injury to the baby. Physical trauma injuries to the baby such as broken bones or facial damage are common. Other common birth injuries resulting from shoulder dystocia include:

  • Erb's Palsy: this is a birth injury caused by damage to the brachial plexus nerves in the shoulder/neck area. The brachial plexus nerves connect the brain to the arms and hands. When these nerves are damaged during childbirth it can result in Erb's palsy which is characterized by paralysis in the arm/hand.
  • Klumpke's Palsy: this is another type of nerve damage injury during childbirth which also results in paralysis of the baby's hands or lower arms caused by injury to a nerve channel in the lower spine.
  • Cerebral Palsy: mismanagement of shoulder dystocia can potentially result in a temporary loss of oxygen to the baby's brain. This can happen in a number of ways including prolonged pressure, compression of the umbilical cord and excessive trauma. Oxygen deprivation during childbirth can result in cerebral palsy - a condition which impairs the brain's ability to control movement of the body.