Shoulder dystocia is a condition in which your infant’s shoulders are impacted by your pelvic bones during vaginal delivery. Depending on the severity of the impact, your infant may sustain an injury during birth, or the birth may require intervention techniques or a cesarean delivery.
Understanding Shoulder Dystocia
Even with medical advancements, shoulder dystocia is a major concern for babies and mothers. Doctors must think quickly to carefully dislodge your baby’s shoulders without causing additional damage.
If your baby is stuck in the birth canal too long, it may lead to a lack of oxygen. Another concern is that your baby’s brachial plexus nerves may be damaged because of the positioning. Most babies are delivered safely and without injury. Shoulder dystocia is ranked from stage one to stage four in severity.
Causes of Shoulder Dystocia
All cases of shoulder dystocia may not be predictable. However, some factors increase the likelihood of shoulder dystocia occurring during vaginal delivery. These include:
- You have diabetes
- You were diagnosed with gestational diabetes
- You are significantly overweight
- You have a small stature or small pelvic opening
- Your baby measures large on ultrasounds before birth
- You experienced shoulder dystocia while giving birth a previous time
Delivery Techniques For Shoulder Dystocia
Mild shoulder dystocia. Your doctor applies gentle pressure to your baby’s midline using their palm. This helps move the back shoulder down, dislodging it from the pelvic bone.
If this doesn’t work, your doctor may try to use a technique called the Woods' Screw Maneuver. Your doctor rotates your baby in a twisting motion while applying pressure to the front shoulder.
The Rubin Maneuver is a technique where the doctor shifts your baby gently from side to side by pushing on your abdomen from the outside. The doctor may apply gentle pressure to your baby from the vaginal canal to assist in this method.
If your doctor is concerned with harming your baby, they may choose to do an episiotomy instead. This is an incision along your perineum to widen the opening for your baby’s delivery.
Moderate shoulder dystocia. This requires a more aggressive technique. The Hibbard maneuver is used to push your baby back into the womb by the top of the head. After that, the baby is rotated into a more favorable position. This technique is controversial in the medical community because it puts your baby at a greater risk of injury.
Your doctor may instead conduct a posterior shoulder delivery. Your doctor attempts to deliver the front arm and shoulder first, using it to rotate your baby’s other shoulder out of your pelvic bone. While it is more widely accepted, it may put your baby at risk.
Severe shoulder dystocia. The McRoberts Maneuver is standard for even more severe cases. It requires the help of two assistants who remove your legs from the stirrups and flex them back against your abdomen. This repositions your pelvic bones, so the doctor has more room to maneuver your baby using one of the above techniques.
Undeliverable shoulder dystocia. If your baby is undeliverable, you may need an emergency c-section. Your doctor may perform a cephalic replacement to push and rotate your baby’s head back into your vagina. This encourages blood circulation through the umbilical cord so a c-section can be performed without a loss of oxygen to your baby.
Risks of Shoulder Dystocia
If your delivery is impacted by shoulder dystocia, both you and your baby are at risk for injury. If your baby goes without oxygen for too long, it can lead to brain damage. The impact to your baby’s shoulders may cause damage to their collarbone and arms. In a worst-case scenario, it may leave your baby paralyzed.
You may experience tearing or bruising around your cervix, rectum, and vagina from the force of the impact. In rare cases, you may experience severe bleeding that requires immediate medical attention.
Preventing Shoulder Dystocia
Should dystocia is not preventable. However, through careful monitoring, your medical team can identify shoulder dystocia at an earlier stage before the condition worsens. If you had a previous birth affected by shoulder dystocia, your doctor may talk to you about scheduling a c-section delivery. This ensures there are no negative health impacts to you or your baby.