Shoulder Dystocia

What is shoulder dystocia?

Dystocia is the word that is sometimes used to describe a labor that is slow or difficult. Shoulder dystocia is what happens during a birth when the baby's head is delivered but the shoulders get stuck behind the mother's pubic bone.

How does it occur?

Shoulder dystocia may happen 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 small.

Shoulder dystocia is usually unpredictable. However, if your healthcare provider thinks you might be at risk for shoulder dystocia, you may have an ultrasound scan and a pelvic exam to measure the size of your pelvis 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 team to deliver the baby safely.

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

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.

If your baby’s head delivers and the shoulders get stuck, your provider may do one or more of the following procedures to allow the baby to be delivered safely:

• Cut a large episiotomy to widen the opening of your vagina.
• 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 are:

• tearing of the uterus
• 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 if the collarbone breaks
• lack of oxygen, which can cause problems with the nervous system, brain damage, or death

Unfortunately, even if an unexpected shoulder dystocia is managed perfectly, there still may be an injury to the baby.

What can be done to help prevent shoulder dystocia?

If you are at risk for shoulder dystocia (especially if you have diabetes), your provider may 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.