What Is Shoulder Dystocia?

What is shoulder dystocia? For many parents, they may see and experience the condition without knowing the medical description. Shoulder dystocia occurs when the baby becomes trapped behind the mother’s pelvis. Due to the real possibility of the umbilical cord becoming compressed, shoulder dystocia is a delivery room emergency and must be treated as such. Doctors must use the maneuvers and techniques they are taught to help free the baby. In addition, because an emergency is created, doctors and nurses must have quick and accurate communication lines with each other.

Even though doctors cannot predict whether shoulder dystocia will be present during a delivery, doctors can pay attention to certain factors which increase the risk of a shoulder dystocia issue presenting during labor and delivery. As mentioned above, during a shoulder dystocia event, not only can the baby suffer injury to their arm, their hand, and shoulder (clavicle), but injury due to fetal hypoxia, or hypoxic ischemic encephalopathy, can also present itself.

What Are Some Of The Risk Factors For Shoulder Dystocia?

Although shoulder dystocia can pose some risk to mother, the greatest risk during this event is to the child. Because of cord compression, doctors must work timely to free the child. What can happen in some instances is that a reduced level of blood and oxygen gets to the child due to the compression. Doctors can look to some of the following to determine if there may be an increased risk of shoulder dystocia complications during delivery:

Increasing Fetal Weight: This can be seen as fetal macrosomia. Doctors should be on the lookout if the baby is greater than 4000g, or 8.8 lbs

Maternal Body Mass Index: Mothers who are obese present with an increased risk of shoulder dystocia. An increased fetal birth rate can be tied to a mother’s obesity in some cases.

Prolonged Second Stage Of Labor

Prior Shoulder Dystocia Delivery

Diabetes

Gestational Diabetes: Diabetes, and gestational diabetes pose an increased risk of shoulder dystocia because both conditions can increase the fetal weight.

Post-Term Pregnancy: A pregnancy more than 42 weeks

It is important for doctors to talk with their patients about certain risk factors which increase the chance of shoulder dystocia during delivery. As a matter of fact, the American College of Obstetricians and Gynecologists suggest that doctors take the following things as topics for discussion with mothers in determining whether a vaginal or C-Section delivery is appropriate:

Estimated Fetal Weight

Gestational Age

Maternal Glucose Intolerance

Severity Of Prior Neonatal Injury

In addition, doctors must be prepared for a shoulder dystocia situation, especially when certain risk factors are present. When doctors suspect that a mother may have a shoulder dystocia delivery, if the doctor is not “experienced” in this area, it is not unreasonable for the doctor is have a more senior doctor available for assistance.

How Do Doctors Manage Or Treat Shoulder Dystocia?

Doctors should be well versed in the management of shoulder dystocia, especially when certain risk factors are present. Since cord compression is a serious concern with shoulder dystocia, one focus must be to deliver the baby as soon as possible when the head appears. With that said, doctors cannot manipulate the baby in such a way as to invite injury. Therefore, it is suggested that the doctors use gentle attempts to guide the baby, along with maternal effort.

Shoulder Dystocia Treatment & Maneuvers

Suprapubic Pressure: As doctors use gentle attempts to guide the baby through the birth canal, they can use techniques to free the anterior shoulder from behind the pelvis. Suprapubic pressure is pressure applied to the heel of the hand to the stuck shoulder above and behind the symphysis. The stuck shoulder can then be depressed, rotated, or both, so that it can be freed.

McRoberts Maneuver: This maneuver consists of moving mother’s legs up into her abdomen. The McRoberts Maneuver in some cases can free the stuck shoulder and allow for delivery.

Delivery Of The Posterior Shoulder: Doctors can sweep the posterior arm across the baby’s chest, and then deliver the arm. This motion can then free the anterior shoulder, leading to the delivery of the baby.

Woods Corkscrew Maneuver: The corkscrew maneuver is performed just as the name suggests. The posterior shoulder is rotated in a 180-degree manner, thus freeing the anterior shoulder.

Rubin Maneuver: The Rubin Maneuver has two recommended maneuvers. The first consists of moving the baby’s shoulders from side to side using force on the mother’s abdomen. The second method is to use the pelvic hand and reach in for the easiest accessible shoulder and push it in towards the anterior surface of the chest.

What Are The Types Of Injuries Which Can Result From Shoulder Dystocia?

Shoulder dystocia can lead to injuries to the baby’s arm, hand, shoulder, and brain. The injury will depend on what area of the body is injured. Injuries to the limbs can occur due to a brachial plexus injury. The brachial plexus is a network of nerves leading from the neck into the upper part of the shoulder. These nerves can become injured due to the use of force freeing a baby during a shoulder dystocia injury. As mentioned above, injury to the brain can occur due to a compressed umbilical cord. Some of the typical shoulder dystocia injuries are as follows:

Erb’s Palsy: Usually children with Erb’s palsy will have paralysis of the arm.

Klumpke’s Palsy: Children suffering from Klumke’s Palsy will have paralysis in the forearm and hand.

Cerebral Palsy/Developmental Delays: Because there is a real risk of the umbilical cord being compressed, the baby can suffer from a reduced level of blood and oxygen. When this occurs, hypoxic ischemic encephalopathy may become an issue.

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