Shoulder dystocia occurs during labor when the baby's head is born but there is a delay and/or difficulty in the delivery of the baby's shoulders. This often happens when the baby's shoulder becomes wedged behind the mother's pubic bone.
Definition of Shoulder Dystocia
The term dystocia means "difficult delivery." Bear in mind that various providers define shoulder dystocia in different ways. Some diagnose it whenever there is a delay in the birth of the baby's shoulders. Other providers diagnose shoulder dystocia only if they use various maneuvers to assist the birth of the shoulders and still others may only refer to shoulder dystocia when there are injuries.
Incidence of Shoulder Dystocia
Physicians report that shoulder dystocia occurs in about 1% of all births. However, some studies have shown that it is likely that this statistic may be even higher. Some incidences of shoulder dystocia may be under-reported if physicians are reluctant to make a note of this in the patient's records for fear of liability.
Risk Factors for Shoulder Dystocia
While shoulder dystocia cannot be predicted especially prior to labor, there are some known risk factors to be aware of:
- Gestational diabetes - When the mother has diabetes, it can increase the size of the baby, thereby increasing her risk of shoulder dystocia.
- Large Baby - Also known as "macrosomia", this may make it more challenging for the baby to pass through the mother's pelvic outlet.
- Maternal Obesity - This is based on the mother's pre-pregnant BMI (body mass index.)
- Postdates Pregnancy - Giving birth after 42 weeks increases your risk of this complication.
- Prolonged Pushing - Pushing for many hours is more likely to result in shoulder dystocia.
It is important to note that there is no formula to predict when shoulder dystocia may or may not occur and that it can happen with babies of all sizes.
Maneuvers for Shoulder Dystocia
Your care provider will likely have a number of methods to use to help to deliver your baby as safely as possible. Some of these maneuvers include:
- Suprapubic Pressure - A birth assistant (such as a labor nurse) applies pressure to the mother's lower abdomen while the care provider presses down on the baby's head in order to free up the baby's shoulders.
- McRobert's Position - The mother lies on her back with her knees brought to her chest to widen her pelvis and flatten her spine. This is often used in combination with suprapubic pressure.
- Gaskin Maneuver - The mother moves to an all fours position which increases the diameter of the pelvic outlet and allows gravity to move the posterior shoulder to an anterior direction.
- Zavanelli Maneuver -This maneuver involves returning the baby's head to the vagina and performing an immediate cesarean.
As frightening and life-threatening as this obstetric complication can be, there are some things that parents should find out to help reduce their chances of having shoulder dystocia or preventing injury if it does happen:
- Find out if your care provider is familiar with all of these maneuvers, especially the Gaskin maneuver. (An educational dvd of this maneuver is available online.)
- Request that the labor bed not be broken down for pushing, to allow for easy position changes.
- If you have a history of large babies or shoulder dystocia, plan to push in an all fours position and be sure your care provider is supportive of you using this position to birth your baby.
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