Last Updated on January 4, 2025 by Michelle Wan
Shoulder dystocia is a rare but serious childbirth complication that occurs when one or both of a baby’s shoulders get stuck behind the mother’s pelvic bone during delivery. This situation requires immediate and skilled intervention to safely deliver the baby while minimizing risks to both the mother and child. Proper treatment is crucial to avoid complications like nerve damage, fractures, or oxygen deprivation.
In this article, we’ll explore the techniques used to treat shoulder dystocia, how healthcare professionals manage emergencies, and the potential long-term outcomes for affected families.
Understanding Shoulder Dystocia
What Happens During Shoulder Dystocia?
Shoulder dystocia occurs during the second stage of labor when the baby’s head has been delivered, but the shoulders remain stuck. This impedes further delivery and requires swift action to prevent complications.
Common Risk Factors:
- Macrosomia: Babies with a birth weight over 8 pounds 13 ounces.
- Maternal Obesity: Excess weight increases the likelihood of pelvic restrictions.
- Gestational Diabetes: Can result in larger-than-average babies.
- Prolonged Labor: Extended delivery time increases the risk of complications.
Immediate Steps to Treat Shoulder Dystocia
When shoulder dystocia occurs, the healthcare team uses specific maneuvers and techniques to safely deliver the baby while minimizing harm.
McRoberts Maneuver
This is often the first step in treating shoulder dystocia. The mother’s legs are flexed and brought back toward her chest, widening the pelvis and reducing the angle between the sacrum and spine.
Suprapubic Pressure
A healthcare provider applies pressure just above the pubic bone to gently push the baby’s shoulder downward, helping it dislodge from the pelvis.
Internal Rotational Maneuvers (Woods Corkscrew or Rubin Maneuver)
These techniques involve rotating the baby’s shoulder to a more favorable position for delivery. The Woods maneuver rotates the baby’s shoulders like a corkscrew, while the Rubin maneuver reduces the shoulder’s diameter.
Delivery of the Posterior Arm
In some cases, the doctor may guide the baby’s lower (posterior) arm out first to reduce shoulder width and facilitate delivery.
Episiotomy
An incision may be made in the vaginal opening to create more space for the baby’s shoulders. This is typically done if other maneuvers have not worked.
Zavanelli Maneuver (Last Resort)
In extreme cases, the baby’s head is gently pushed back into the birth canal, and an emergency cesarean section is performed. This method carries significant risks and is rarely used.
Managing Maternal and Neonatal Risks
For the Baby:
- Monitoring Oxygen Levels: Ensuring the baby does not experience prolonged oxygen deprivation.
- Treatment of Injuries: Addressing fractures, brachial plexus injuries, or other birth-related trauma promptly.
For the Mother:
- Post-Delivery Care: Treating any lacerations, excessive bleeding, or other injuries sustained during delivery.
- Monitoring for Postpartum Hemorrhage: A known complication of shoulder dystocia.
Preventing Complications
Immediate Medical Attention
Swift recognition and response are critical. Shoulder dystocia must be treated as an emergency to prevent serious complications, including:
- Hypoxic-Ischemic Encephalopathy (HIE): Brain injury caused by oxygen deprivation.
- Brachial Plexus Injury: Nerve damage affecting the baby’s arms or shoulders.
- Fractures: Breaks in the baby’s clavicle or humerus.
Training and Preparedness
Medical teams are trained to anticipate and manage shoulder dystocia using simulation exercises and best practices.
Long-Term Outcomes
While many babies recover fully after treatment, some may face long-term challenges. Early intervention and specialized therapies can significantly improve outcomes.
For the Baby:
- Physical Therapy: To improve mobility and strength if nerve damage occurs.
- Occupational Therapy: To support fine motor skill development.
- Ongoing Medical Care: For conditions like Erb’s palsy or other nerve-related issues.
For the Mother:
- Physical Recovery: Monitoring and treating any pelvic floor injuries or tears.
- Emotional Support: Counseling or support groups can help mothers cope with the stress and trauma of a complicated delivery.
Legal Considerations for Shoulder Dystocia
In some cases, shoulder dystocia may result from preventable medical errors, such as:
- Failure to recognize risk factors like macrosomia or gestational diabetes.
- Delayed response to signs of fetal distress.
- Improper use of delivery tools like forceps or vacuum extractors.
If you suspect medical negligence contributed to shoulder dystocia injuries, consulting a birth injury attorney can help you seek compensation for medical expenses, therapy costs, and long-term care.
How Thomas & Wan LLP Can Help
At Thomas & Wan LLP, we understand the physical, emotional, and financial toll shoulder dystocia can take on families. With decades of experience handling birth injury cases, we are here to help you:
- Investigate the circumstances of your delivery.
- Identify potential instances of medical negligence.
- Pursue compensation to support your child’s recovery and future care.
Shoulder dystocia is a challenging and potentially dangerous childbirth complication, but prompt and skilled treatment can make all the difference in ensuring a safe outcome. Understanding the techniques and strategies used to manage this condition empowers families to advocate for the best 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 secure the justice and support your family deserves.
