Last Updated on January 6, 2025 by Michelle Wan
Shoulder dystocia is a rare but serious complication that occurs during childbirth when one or both of a baby’s shoulders become stuck behind the mother’s pelvic bone after the head has been delivered. This condition requires immediate recognition and intervention to minimize risks to both the baby and the mother.
Understanding the signs of shoulder dystocia can help medical professionals respond promptly and appropriately, preventing severe injuries such as nerve damage, fractures, or oxygen deprivation. This article provides an in-depth look at the signs of shoulder dystocia and how they are addressed during delivery.
What is Shoulder Dystocia?
Shoulder dystocia occurs during the second stage of labor when the baby’s head is delivered, but the shoulders remain lodged in the birth canal. This condition interrupts the natural progression of delivery and can lead to complications if not resolved quickly.
While shoulder dystocia is often unpredictable, certain risk factors—such as fetal macrosomia (a larger-than-average baby) or prolonged labor—can increase its likelihood.
Key Signs of Shoulder Dystocia
Turtle Sign
The most recognizable sign of shoulder dystocia is the “turtle sign.”
- After the baby’s head is delivered, it retracts back toward the mother’s perineum rather than progressing through the birth canal.
- This retraction resembles a turtle pulling its head back into its shell and indicates that the shoulders are stuck.
Prolonged Second Stage of Labor
- Shoulder dystocia may be suspected if the second stage of labor (when the baby is pushed out) takes significantly longer than expected.
- Difficulty in delivering the shoulders after the head is already delivered is a key indication.
Fetal Distress
- Signs of fetal distress, such as abnormal heart rate patterns, may indicate that the baby is struggling due to reduced oxygen supply caused by shoulder dystocia.
No Progression After Delivery of the Head
- A lack of progress in delivery after the baby’s head has emerged is a critical sign that the shoulders are obstructed.
Maternal Indicators
- Excessive bleeding during delivery or visible bruising around the vaginal opening may suggest complications consistent with shoulder dystocia.
Risk Factors Associated with Shoulder Dystocia
While it is not always possible to predict shoulder dystocia, certain factors may increase the likelihood of this complication:
- Fetal Macrosomia: Babies weighing over 8 pounds 13 ounces.
- Gestational Diabetes: May contribute to larger-than-average babies.
- Prolonged Labor: Lengthy second-stage labor can increase the risk.
- Maternal Obesity: Linked to a higher likelihood of shoulder dystocia.
- Past Shoulder Dystocia: A history of shoulder dystocia in previous deliveries increases recurrence risks.
Potential Complications of Shoulder Dystocia
When shoulder dystocia is not promptly resolved, it can lead to serious complications for both the baby and the mother:
For the Baby:
- Brachial Plexus Injuries: Damage to the network of nerves controlling the arm and hand, potentially causing conditions like Erb’s palsy.
- Fractures: Broken collarbone or arm due to excessive pressure during delivery.
- Hypoxic-Ischemic Encephalopathy (HIE): Oxygen deprivation if the delivery takes too long.
For the Mother:
- Severe Vaginal Tears: Injury to the vaginal or perineal area.
- Postpartum Hemorrhage: Excessive bleeding after delivery.
- Emotional Trauma: The stress of experiencing a complicated delivery.
Managing Shoulder Dystocia: Immediate Interventions
Prompt recognition and management of shoulder dystocia are critical to ensuring a safe outcome. Medical professionals use several maneuvers and techniques to address this complication:
- McRoberts Maneuver: Adjusting the mother’s legs to open the pelvis and reduce the angle of obstruction.
- Suprapubic Pressure: Applying pressure above the pubic bone to dislodge the baby’s shoulder.
- Rotational Maneuvers: Rotating the baby’s shoulder to create more room for delivery.
- Delivery of the Posterior Arm: Removing the baby’s lower arm first to reduce shoulder width.
- Emergency Cesarean Section: In extreme cases, surgical intervention may be necessary.
How to Reduce Risks of Shoulder Dystocia
While shoulder dystocia is often unpredictable, the following steps can reduce its risk:
- Monitoring fetal growth during pregnancy to identify macrosomia.
- Managing maternal conditions like gestational diabetes.
- Planning for delivery with a healthcare provider familiar with potential complications.
When to Seek Legal Help
In some cases, shoulder dystocia and its resulting injuries may be preventable with proper medical care. Negligence may occur if healthcare providers fail to:
- Recognize and manage risk factors during pregnancy.
- Monitor fetal distress and respond appropriately.
- Use delivery tools or techniques correctly.
If you believe medical negligence contributed to injuries caused by shoulder dystocia, consulting a birth injury attorney can help you understand your legal options and seek compensation for medical expenses, therapy, and emotional distress.
How Thomas & Wan LLP Can Help
At Thomas & Wan LLP, we understand the emotional and financial toll shoulder dystocia can take on families. Our experienced attorneys are committed to helping families affected by birth injuries seek justice and secure the resources they need.
We offer:
- Free Consultations: Discuss your case with no obligation.
- Comprehensive Investigations: Partnering with medical experts to build a strong case.
- Compassionate Support: Guiding you every step of the way.
Recognizing the signs of shoulder dystocia is critical to ensuring a safe delivery and minimizing complications. While this condition can be challenging to predict, understanding the warning signs and risk factors empowers families to advocate for proper care.
If your family has been affected by shoulder dystocia and you believe medical negligence played a role, contact Thomas & Wan LLP today for a free consultation. Let us help you navigate this journey and secure the support your family deserves.
