Shoulder dystocia presents risks to both the mother and fetus. Problems for the fetus can include:
- Fractures to the collarbone and arm
- Damage to the brachial plexus nerves. These are the nerves that go from the spinal cord in the neck down the arm. Damage to these nerves can cause paralysis in the arm or shoulder.
- Asphyxia (lack of oxygen to the body) leading to brain injury or death
- Fetal death
Risks for the mother can include:
- Postpartum hemorrhage (heavy bleeding after birth)
- Severe tearing of the perineum (tear between the vagina and rectum)
- Uterine rupture (rupture of the uterus during the labor)
- Rectovaginal fistula (an abnormal connection between the rectum and vagina)
- Symphyseal separation (this condition is characterized by excessive movement of the pelvis) with or without femoral neuropathy (nerve dysfunction of the legs)
What is shoulder dystocia?
Shoulder dystocia refers to a condition where after the delivery of the fetus’s head, the fetus’s shoulder may get stuck inside the mother’s pelvis. In most cases, the child comes out normally; however, it may pose a severe threat to the mother and the child. Dystocia causes slow or difficult labor or birth. Shoulder dystocia affects 0.6-0.7% of women during deliveries.
Shoulder dystocia is a medical emergency because it may result in life-threatening fetus injury.
Who is at risk of getting shoulder dystocia?
Shoulder dystocia can affect any woman; however, women with certain risk factors are at an increased risk of getting shoulder dystocia. Risk factors include:
- Macrosomia: In this condition, the baby weighs more than eight pounds (4000 g). Macrosomia can increase the risk of shoulder dystocia. However, most of the fetuses with macrosomia are born safely. Sometimes, fetuses with a healthy weight have dystocia.
- Preexisting diabetes or gestational diabetes: Having diabetes before or during the pregnancy can result in macrosomia.
- Previous history of shoulder dystocia
- Being pregnant with multiple fetuses
- Being overweight or gaining too much weight during pregnancy
Some factors associated with labor and birth include:
- Getting oxytocin for inducing labor
- Getting an epidural to help with pain during the labor
- Having a very short or very long second stage of labor (the second stage of labor involves pushing and delivering the child)
- Assisted vaginal birth (a method of labor where the physician uses tools like forceps or vacuum to pull the baby through the canal)
How is shoulder dystocia treated?
The physician treats shoulder dystocia in one of the following ways:
- Episiotomy or a small cut over right or left of the vagina when the physician confronts shoulder dystocia.
- McRoberts maneuver: Press the woman’s thighs up tight against her belly
- Suprapubic pressure: Press on your lower belly just above the pubic bone.
- Reach up into the vagina to try to turn the baby.
- A C-section or other surgical procedures to release their shoulders. These are done only in severe cases of shoulder dystocia.
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