Shoulder Dystocia

What is shoulder dystocia?

Dystocia is the term used for difficult labor or delivery of a baby. Shoulder dystocia occurs when the baby's head is delivered, but the shoulders cannot be delivered because they are too wide and stuck behind the mother's pubic bone or the opening to the birth canal.

How does it occur?

Shoulder dystocia may occur when:

• A baby is unusually large. Women who are overweight or have diabetes are more likely to have large babies.
• The opening of the mother's pelvis is too small for the baby's shoulders to come out.

How is it diagnosed?

Shoulder dystocia is usually unpredictable and is first noticed during delivery. If your healthcare provider suspects that you are at risk for shoulder dystocia, you may have an ultrasound scan before you go into labor. The ultrasound scan will help your provider know how big the baby is and whether the baby's size might be a problem during delivery.

What is the treatment?

You will need help from your healthcare provider to deliver the baby safely.

If it is clear before you go into labor that the baby is too big or your pelvis is too small to deliver the baby, a cesarean section can be planned. A cesarean section, or C-section, is a surgical procedure for delivering babies.

During labor your provider may decide that a C-section is necessary if:

• It takes you a long time to dilate completely.
• The pushing phase of labor takes a long time.
• The baby's head doesn't move down the birth canal when you push.

Your provider may do one or more of the following procedures to allow the baby to be delivered safely without a C-section:

• Cut a large episiotomy to widen the opening of your vagina.
• Move the baby's shoulder by pressing downward on the baby's head.
• Raise your legs up and push them back against your stomach to widen your pelvic opening.
• Put pressure on the baby's shoulder above your pubic bone.
• Try to turn the baby's shoulder.
• Reach into your vagina, put pressure on the baby's arm, and deliver the arm and then the shoulder and rest of the baby.
• Break the baby's clavicle (collarbone) to make the shoulders narrower so they fit through the opening.

How long will the effects last?

Usually there is not any permanent damage. However, the longer the problem lasts during delivery, the greater the risk of complications for you and the baby.

Possible complications for the mother include:

• rupture (tearing) of the uterus
• hemorrhage (heavy bleeding) after the delivery
• bruising or tearing of the cervix or vagina
• tearing of the rectum
• bruising or irritation of the bladder.

Possible complications for the baby are:

• injury to the nerves in the arm and hand, possibly causing the arm to be paralyzed (the paralysis may go away or it may be permanent)
• breaking of the arm or collarbone
• puncture and collapse of the baby's lung when the collarbone breaks
• lack of oxygen, which can cause problems with the nervous system, brain damage, or death.

What can be done to help prevent shoulder dystocia?

If you are at risk for shoulder dystocia (especially if you have diabetes), it is important to try to estimate the size of your baby with an ultrasound scan before labor. If shoulder dystocia seems likely, a C-section can be planned to avoid the problem. If you have had another child with shoulder dystocia, a C-section can be done to prevent the same problem with future deliveries. It is important to keep track of the date of your last menstrual period, so that your healthcare provider does not let you deliver too far past your actual due date.