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