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Shoulder dystocia: When and how does it happen?

When you're expecting, it's easy to dwell on what could go wrong during childbirth - especially if this is your first child or if you've had complications in the past. For women with normal pregnancies, shoulder dystocia is one of the most common complications during vaginal deliveries. It occurs when the baby's shoulder gets stuck behind your pubic bone. This position compresses the umbilical cord, which can put the baby at risk for oxygen deprivation.

Shoulder dystocia is an emergency. If not promptly (and properly) dealt with, it can lead to serious complications for both mother and baby, including:

  • Hemorrhage
  • Uterine rupture
  • Fetal hypoxia (oxygen deprivation)
  • Lacerations
  • Brachial plexus injuries (damage to the bundle of nerves in the baby's shoulder and arm)
  • Fetal death

Are you at risk?

Shoulder dystocia occurs at higher rates among bigger babies. In fact, it happens in 5 to 9 percent of deliveries involving babies who are at least 8 pounds, 13 ounces.

Other risk factors include:

  • Gestational diabetes
  • Post-dates pregnancy
  • History of shoulder dystocia
  • Assisted delivery (use of forceps or vacuum)

However, many cases of shoulder dystocia occur in normal pregnancies with no risk factors. This fact is part of what makes it so scary - it's not always possible to predict.

As a result, all hospitals, birth centers and medical professionals who handle labor and delivery should be well-trained in how to identify and manage shoulder dystocia. Many hospitals have protocols in place and conduct regular drills to ensure that these cases are handled swiftly and appropriately.

What to expect if it does happen

Fortunately, there are several ways to resolve shoulder dystocia while minimizing the risk of injury to mother and baby. These techniques include:

  • Changing the mother's position to make more room in the pelvis and help rotate the baby
  • Performing an episiotomy to allow more room for internal maneuvers
  • Attempting to rotate the fetus internally
  • Delivering the baby's other arm
  • Applying the right pressure above the mother's pubic bone

Severe cases may require more drastic measures such as fracturing the baby's collarbone, cutting the mother's pubic bone or performing a Cesarean section.

When a bad situation becomes worse

Sadly, not all cases of shoulder dystocia are properly handled. Perhaps the attending medical personnel failed to take action in time. Perhaps they weren't prepared with enough trained staff on hand. Or perhaps they took the wrong action - for example, by pushing on the top of your uterus, a maneuver that can make the situation worse. Mothers and babies can suffer lifelong consequences from these types of medical errors.

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