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A. Shoulder dystocia is when the baby’s head has been born but one of the shoulders becomes stuck behind the mother’s pubic bone, delaying the birth of the baby’s body. If this happens, extra help is usually needed to release the baby’s shoulder.
In the majority of cases, the baby will be born promptly and safely.
A. Shoulder dystocia occurs in about one in 150 (0.7%) vaginal births.
A. Shoulder dystocia usually occurs unexpectedly during childbirth and most of the time it is not possible to predict when it will happen. However, it is more likely to occur if:
Shoulder dystocia is more likely with large babies but nevertheless there is no difficulty delivering the shoulders in the majority of babies over 4.5 kg. Half of all instances of shoulder dystocia occur in babies weighing less than 4 kg.
Ultrasound scans are not good at telling whether you are likely to have a large baby and therefore they are not recommended for predicting shoulder dystocia, if you have no other risk factors.
A. In most instances, shoulder dystocia cannot be prevented because it cannot be predicted.
If you have diabetes or have developed diabetes in pregnancy, you will usually be offered early induction of labour or planned caesarean section. This will reduce the risk of shoulder dystocia.
If you don’t have diabetes, early induction of labour does not prevent shoulder dystocia, even if your baby is suspected to be large. Caesarean section is also not routinely recommended in this situation.
A. Your obstetrician will be aware that in every birth there is a possibility of shoulder dystocia.
Shoulder dystocia is an emergency and therefore, when it does occur, speed is of the essence. The baby’s shoulder needs to be released quickly so that the baby’s body can be born and he or she can start breathing air into the lungs.
It is important to remember that obstetricians are trained in how to release the shoulders using certain manoeuvres and in the great majority of cases your baby will be delivered promptly and safely.
The obstetrician or midwife will usually:
With these simple measures, the majority of babies are born safely.
If the shoulder is not released easily with the above measures, either:
Once the shoulders are free, your baby will be born, and a paediatrician will examine him or her. Your obstetrician will talk to you about what happened.
A. Vaginal tears are more common after shoulder dystocia and may extend to the back passage. Heavier bleeding than normal after birth (postpartum haemorrhage) is also more common and you may require additional treatment and/or a blood transfusion.
A. About one in ten (10%) babies who have shoulder dystocia will have some stretching of the nerves in the neck, called brachial plexus injury (BPI), which may cause loss of movement to the arm.
The most common type of BPI is called Erb’s palsy. It is usually temporary and movement will return within hours or days. Permanent damage is rare.
It is important to remember that BPI can occur without shoulder dystocia. BPI can also occur in babies born by caesarean section.
Sometimes shoulder dystocia can cause other injuries including fractures of the baby’s arm or shoulder. In the majority of cases, these heal extremely well.
Even with the best care, in a very few cases, a baby can suffer brain damage if he or she did not get enough oxygen because the delivery was delayed by shoulder dystocia.
A. If your baby’s birth was complicated by shoulder dystocia, there is an increased risk of shoulder dystocia in future pregnancies; around one in ten women will have shoulder dystocia again in a future pregnancy.
In view of this, your obstetrician will discuss your options for next time taking into account your individual circumstances and preferences.
You may wish to consider a vaginal delivery if it was easy to release your baby’s shoulders, your baby was fine and you have no other risk factors. If it was difficult to release your baby’s shoulders, your baby had any injuries or the experience has affected you and your family, you may wish to consider a planned caesarean section.