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 for 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.
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 has an assistant to apply gentle pressure to your baby's midline using their palm just above the mother's pubic bone. This helps move the back shoulder down, dislodging it from the pelvic bone.
At the same time, the McRobert's Maneuver is done. 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 baby has more room to deliver.
Moderate shoulder dystocia.If that does not work, your doctor may conduct a posterior arm delivery where the baby's arm which is positioned toward the back of the mother is identified and extended out of the vagina. This can lessen the impaction of the shoulder dystocia so that the baby can then be delivered.
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.
During all of these attempts, the doctor may also choose to perform an episiotomy. This is an incision along your perineum to widen the opening for your baby’s delivery.
Severe shoulder dystocia.The baby's clavicle may be intentionally broken to help the baby fit through. If this does not work, 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 then a c-sectioncan be performed in an attempt to minimize the 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. 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.