Shoulder Dystocia

Thirty-thousand babies in the United States are born each year with shoulder dystocia. That's one out of every 100 births. Shoulder dystocia is described in an American Family Physician research article as "one of the most frightening emergencies in the delivery room".


Shoulder dystocia takes place when a baby gets stuck by the shoulders behind the mother's pelvic bone during delivery. This happens when a baby is already in the birth canal, so to ease the baby out, a doctor has to do immediate maneuvers.

Shoulder dystocia can happen when:

  • A baby is unusually large. Overweight women and women with diabetes are at risk for having large babies. The incidence of shoulder dystocia varies based on fetal weight, occurring in 0.6 to 1.4 percent of all infants with a birth weight of 2,500 g (5 lb, 8 oz) to 4,000 g (8 lb, 13 oz), increasing to a rate of 5 to 9 percent among fetuses weighing 4,000 to 4,500 g (9 lb, 14 oz) born to mothers without diabetes. Shoulder dystocia occurs with equal frequency in primigravid and multigravid women, although it is more common in infants born to women with diabetes.

  • The mother's pelvic opening is too small for the baby's shoulders to come out.

  • A woman has a history of births with shoulder dystocia.


Although there are risk factors for shoulder dystocia, health care providers cannot usually predict or prevent it. They often discover it only after labor has begun.


While labor induction in women with gestational diabetes who require insulin may reduce the risk of macrosomia and shoulder dystocia, the risk of maternal or neonatal injury is not modified.


Maneuvers to Help Alleviate the Dystocia


There are several things that can be done to help solve the problem of the shoulder dystocia. Since each birth is different not everyone of these will work every time, so multiple maneuvers are likely to be tried in very rapid succession to help resolve the situation in a positive manner. Here are some of the suggested techniques:

  • Suprapubic Pressure: This pressure is at the pubic bone, not at the top of the uterus. This might allow the shoulder enough room to move under the pubis symphysis.

  • Gaskin Maneuver: Get the woman into a hands and knees position. This will also change the diameters of her pelvis, though is not always possible with epidural anesthesia.

  • McRobert's Maneuver: Flex the mother's legs toward her shoulders as she lays on her back, thus expanding the pelvic outlet. One study showed that this alleviated 42% of all cases of shoulder dystocia.

  • Woods Maneuver: This is also known as the corkscrew, the attendant tries to turn the shoulder of the baby by placing fingers behind the shoulder and pushing in 180 degrees.

  • Rubin Maneuver: Like the Woods maneuver, two fingers are placed behind the baby's shoulder, this time they are pushing in the directions of the baby's eyes, to line up the shoulders.

  • Zavanelli Maneuver: Pushing the baby's head back inside the vagina and doing a cesarean. This is the mostly frequently asked about method, but also one of the most dangerous.

Is It Preventable?


Traditional thought is that shoulder dystocia is unpredictable and unpreventable. However, the United Brachial Plexus Network says using the proper positioning during labor will help reduce the chances of shoulder dystocia. To prevent the complication, experts recommend a mother not lie on her tailbone during delivery. This is because the position reduces the amount of space a baby has to pass through and increases the likelihood of a forceps or vacuum delivery. In some cases, a woman who presents multiple risk factors for shoulder dystocia is told a C-section is the safest option for delivery.


Software Makes Childbirth Safer


A new software program is bringing peace of mind by calculating the risk of shoulder dystocia with permanent injury.


The software uses the mom's height and weight along with other factors to calculate risk. A read-out indicates the probability of the baby getting into trouble during birth. It spots the condition up to 60 percent of the time.


According to Dr. Lerner "It is better for the doctor, for the patient, and most of all, it's better for the baby."


While a shoulder dystocia isn't a very common occurrence, knowing what potential risk factors are for you and your baby can help you make wise choices for your labor and birth.

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