BirthInjury FYI

Birth Injury Resources


Do You Suffer From a Birth Injury?

Shoulder Dystocia



What is Shoulder Dystocia?

Shoulder Dystocia refers to a complication that can occur during the birth process, in which the baby's shoulder is caught behind the pelvic bone of the mother. When this occurs, there are increased risks for both the mother and the infant. The baby is unable to breathe in this position, so an immediate response is crucial.

Often, the first step is to change the position of the mother to allow her pelvic region to open and the baby's shoulder to pass through. If she can rest on her hands and knees, this may be enough to allow the shoulder to dislodge. Another, common choice is the McRobert's Maneuver, where the mother's legs are flexed up toward her shoulders. In conjunction with this method, pressure can be applied above the pubic bone by one of the delivery staff. The goal is to allow enough room for the baby to shift into a better position. If these maneuvers do not prove successful, another technique must be employed as quickly as possible. The person attending may attempt to rotate the baby by using his or her hand to reach up into the birth canal and turn the child. The actual method used to turn the infant may vary by circumstance. In some cases, the elbow of the free arm is flexed and used like a crank to rotate the infant. If this is not possible, pressure can be applied to the free shoulder in order to turn the baby's body and release the trapped shoulder. This method is sometimes called the Woods Maneuver, or "corkscrew." As a last resort, the baby's head may be pushed back inside the mother's body so that a caesarian section may be performed.

What Causes Shoulder Dystocia?

Although certain factors may somewhat increase the likelihood that a shoulder dystocia will occur, no definitive cause is known. Some potentially contributing circumstances include a baby with a birth weight greater than nine pounds (although approximately one-quarter to one-half of shoulder dystocia cases occur in normal birth weight infants), a diabetic mother, a mother with a weight greater than two hundred pounds, or a prolonged pregnancy. Still, none of these possible risks are conclusive indicators that a shoulder dystocia is likely. About 23% of cases occur even when none of the risk factors are present.

What Are the Potential Consequences?

Possible complications for the infant may include birth injury (brachial plexus injuries), skeletal injuries (especially to the collarbone), or in rare cases, permanent brain damage. For the mother, there can be a risk of serious blood loss or uterine rupture, which could result in death.