Although shoulder dystocia poses a risk of health complications during labor, most mothers and babies survive and recover well. The newborn can suffer from collarbone or arm fractures and nerve damage, but these injuries can be managed with proper treatment.
What is shoulder dystocia?
Shoulder dystocia is an obstetric emergency that is relatively common and occurs when the baby's anterior shoulder becomes lodged behind the mother's pelvic bone, preventing the baby from progressing through the birth canal.
Shoulder dystocia affects about 3% of vaginal deliveries in the United States and 5% of vaginal deliveries worldwide.
What causes shoulder dystocia?
Shoulder dystocia can be caused by factors such as:
- Size of the baby, especially the width of the baby’s shoulders
- Size of the mother’s pelvis and birth canal
- Angle of the baby during delivery
Shoulder dystocia is more likely in full-term and male babies because they are generally larger than preterm and female babies. Mothers with gestational diabetes are more at risk of shoulder dystocia complications during delivery.
How is shoulder dystocia handled?
Shoulder dystocia puts both mother and baby in jeopardy. It is treated as an emergency, since the baby can die or suffer major brain damage due to lack of oxygen. As a result, obstetricians/gynecologists (OB/GYNs) have a very small window of opportunity to intervene in the event of shoulder dystocia.
OBs can use a range of manipulative techniques and obstetric procedures to treat shoulder dystocia. When shoulder dystocia is discovered during delivery, the doctor's priority is to determine the baby's anterior shoulder's orientation (angle, depth, etc.). Because the precise orientation will influence which obstetric procedures and/or maneuvers will be the most effective in dislodging the shoulder, accurate assessment of shoulder position and orientation is crucial. Certain techniques are meant to be used with certain orientations.
Following a thorough examination of the shoulder's orientation, the doctor must decide on a strategy for dealing with the issue, including which procedure to use. This is when things can get a little complicated. It is critical to manage the dystocia and deliver the baby as soon as possible.
Excessive haste, overly aggressive manipulation, hyperflexion of the infant's neck, or the use of excessive force can result in serious injury to the newborn. To overcome the baby's shoulder dystocia without hurting the mother or child, a high level of skill is needed.
What birth injuries are associated with shoulder dystocia?
When shoulder dystocia occurs, the risk of a birth injury increases dramatically. Broken bones and facial disfigurement are typical physical stress injuries in newborns. When a doctor or midwife applies too much force or pressure to release the baby's trapped shoulder, birth injuries can occur.
Shoulder dystocia can cause the following birth injuries:
- Erb's palsy: Erb's palsy is a birth injury caused by damage to the brachial plexus nerves in the shoulder and neck, which connect the brain to the arms and hands. When these nerves are injured during childbirth, it can lead to Erb's palsy, which is characterized by arm/hand paralysis.
- Klumpke's palsy: Klumpke's palsy is a nerve injury caused by an injury to a nerve channel in the lower spine that leads to paralysis of the newborn's hands or lower arms.
- Cerebral palsy: Shoulder dystocia that is not properly managed can result in a temporary lack of oxygen to the infant's brain, due to excessive trauma, prolonged pressure, or compression of the umbilical cord. Cerebral palsy is a disorder that impairs the brain's ability to control body movements.
- Brain damage: If the newborn is deprived of oxygen for an extended period of time, permanent brain damage may result. The extent of brain damage often depends on how long the baby was deprived of oxygen, as well as post-delivery interventions.
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