What is Shoulder Dystocia

Shoulder dystocia is when a baby’s shoulders get stuck on the mother’s pubic bone after the head is delivered during labor. Shoulder dystocia is a medical emergency. It can cause serious injury to both the baby and the mother.

Who is at risk for shoulder dystocia?

This condition is more likely to develop if:

• The mother has diabetes.
• The mother is obese.
• The mother has a history of shoulder dystocia during delivery.
• The baby weighs more than 8.8 lb (4 kg).
• The mother’s labor was induced.
• An instrument, such as forceps, was used to help deliver the baby.
• The mother is having multiple babies, such as twins.
• Labor is slow, long, or difficult.

What are the signs of shoulder dystocia?

Signs of shoulder dystocia include:

• Very slow movement of the baby down the birth canal.
• Movement of the baby’s head back into the opening of the vagina during contractions. This is called the “turtle sign.”
• The baby’s shoulders being vertical and appearing to be coming out at the same time. During a normal delivery, the baby’s shoulders are usually diagonal to the mother’s pelvis (oblique position) and come out one at a time.

What problems can be caused by shoulder dystocia?

In the baby, shoulder dystocia can cause:

• A break (fracture) in the collarbone (clavicle).
• A fracture in the upper arm (humerus).
• Nerve damage that results in paralysis or loss of muscle control in the shoulders, arms, hands, or fingers.
• Brain damage.
• Speech disability.
• Death.

In the mother, shoulder dystocia can cause:

• Severe tearing (laceration) of the vagina, rectum, or cervix.
• Heavy bleeding (hemorrhage).
• Infection.
• Damage to nerves that control a woman’s ability to hold and pass stool (fecal incontinence).

Most of the time, the problems that are caused by shoulder dystocia are not permanent.

How is shoulder dystocia treated?

A health care provider can try several techniques to deliver the baby safely. These techniques include:

• Repositioning the baby’s arms or rotating the baby.
• Pressing against the mother’s abdomen.
• Repositioning the mother. This may involve the mother flexing her thighs up toward her abdomen (McRoberts maneuver).
• Making an incision to widen the opening of the vagina (episiotomy).
• Pushing the baby back into the uterus and delivering the baby by cesarean delivery.

Summary

• Shoulder dystocia is when a baby’s shoulders get stuck on the mother’s pubic bone after the head is delivered during labor.
• Shoulder dystocia is a medical emergency that can cause serious injury to both the baby and the mother.
• This condition is more likely to develop in mothers who are obese, have diabetes, or have a history of shoulder dystocia.
• If shoulder dystocia happens during labor, the baby may be rotated or repositioned, the mother may be repositioned, an episiotomy may be done to widen the vagina, or a cesarean delivery may be performed.
• Most of the time, the problems that are caused by shoulder dystocia are not permanent.