Shoulder Dystocia

You’ve gotten through labor. You’re 10cm dilated and 100% effaced. It’s time to push. Baby’s head has been delivered. But, the maternity provider says, the rest of baby’s body is not getting through the birth canal. One or both of your baby’s shoulders is stuck behind your pubic bone. Shoulder Dystocia is a medical emergency for you and your baby.

Complications

Shoulder dystocia is different from cephalopelvic disproportion in which the baby’s head and mother’s pelvis are a mismatch for delivery. Because the difficulty is at the baby’s shoulder, the Brachial Plexus, a bundle of nerves located at the shoulder, may become damaged. The predominant complication for newborns with Shoulder Dystocia is Brachial (Erb’s) Palsy.

The baby’s clavicle may be broken. And, in rare cases, the baby may lose oxygen supply due to the umbilical cord being blocked. This can lead to brain damage or death.

Mothers may experience a separation of the pubis symphysis, the cartilage that connects the two sides of the pelvic bone. Mothers also may sustain uterine damage or experience postpartum hemorrhage.

Risk Factors

Gestational Diabetes and big babies: Gestational Diabetes is diabetes that appears during pregnancy. It can lead to a big baby because the baby is getting a higher than normal amount of glucose. A baby over 8lb 13oz is considered to have developed macrosomia (a big body) and is more likely than a smaller baby to experience shoulder dystocia.

Overweight Mother: Being overweight at the time of pregnancy or gaining more than the recommended amount of weight during pregnancy can lead to a larger baby. For tips on healthy weight gain during pregnancy, check out my post: New Years Resolutions That Work

Family Birth Weight Statistics: If the mother, father, or an older sibling experienced macrosomia, there is a higher likelihood the new baby will be big as well.

Shoulder Dystocia cannot be predicted for sure. But, your provider will perform physical examinations and use ultrasound to estimate the size of the baby. Estimation and present risk factors may lead your maternity provider to recommend a C-section prior to labor.

A Few Solutions

There are multiple interventions your maternity provider may try during labor to solve Shoulder Dystocia. The least invasive is the Gaskin Maneuver.

Gaskin Maneuver: The birthing person rolls onto all fours and gives birth in hands and knees position. Ina May Gaskin is a midwife for which this method is named.

Suprapubic Pressure: In an effort to squeeze the baby’s shoulder out underneath, your provider may externally push down on your pubis.

Zavanelli Maneuver: The maternity provider may call for the operating team and reverse delivery in favor of a C-Section.

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