Shoulder Dystocia

ExitCare ImageShoulder dystocia is a situation that can occur during a vaginal delivery. After the baby's head is delivered, the shoulders get stuck at the opening of the vagina and pubic bone. This can be a very serious condition. It occurs in 0.6 to 1.6% of deliveries. This is an emergency situation.

Unfortunately, the caregiver is unable to tell who will have shoulder dystocia before delivery. There is no way to prevent it, since you cannot tell who is going to have the problem. When shoulder dystocia occurs, the mother and baby are at risk for having an injury or complication. Labor should not be caused to start (induced) if there is a suspicion of shoulder dystocia.

Signs of shoulder dystocia when in labor include:

  • Very slow movement of the baby down the birth canal.

  • "Turtle sign." The baby's head moves in and out of the opening of the vagina during contractions.

Shoulder dystocia can cause serious injury to the baby, including:

  • Fracture of the collarbone (clavicle).

  • Nerve damage in the shoulder and arm (Erb's palsy).

  • Injury to the nerves in the baby's neck and shoulder (brachial plexus injury).

  • Decrease in oxygen, resulting in brain damage and death in some cases.

  • Muscle and speech disability, resulting from brain damage (cerebral palsy).

Injury to the mother may include:

  • Severe tearing (laceration) of the vagina and rectum.

  • Laceration of the cervix.

  • Hemorrhage (heavy bleeding).

  • Infection.

  • Separation of the pubic bone, with nerve damage to the area.

  • Unable to hold and control the stool.

Pregnant women who are more likely to get shoulder dystocia are:

  • Pregnant women with diabetes.

  • Women with a very small pelvis.

  • Obese women.

  • Women with a deformed pelvis, from birth or accident.

  • Ultrasound evidence of a macrosomic baby (a baby weighing 8 1/2 pounds or more).

Studies show a cesarean section is not necessary when:

  • The mother is only suspected of having shoulder dystocia.

  • The mother has had a previous birth with shoulder dystocia.

A cesarean section may be needed if the mother has previously had a baby that:

  • Was smaller than the baby currently in the womb.

  • Had nerve damage or other serious injury.

There are certain techniques that your caregiver has been trained to use when shoulder dystocia occurs. These techniques will help deliver the baby safely. These techniques also keep the mother safe. Postpartum care following shoulder dystocia is not different than any other vaginal delivery, unless there are injuries or complications.