Shoulder dystocia

KEY POINTS

  • Shoulder dystocia is a birth injury that happens when one or both of a baby’s shoulders get stuck inside the mother’s pelvis during labor.

  • In most cases of shoulder dystocia, babies are born safely. But it can cause problems for both mom and baby.

  • It’s often hard for health care providers to predict or prevent shoulder dystocia.

  • When shoulder dystocia happens, your provider tries to move your body and your baby into a better position to help get your baby out.

  • If your provider recommends a scheduled c-section, ask if you can wait until at least 39 weeks to give your baby time to develop before birth.

What is shoulder dystocia?

Shoulder dystocia is a birth injury (also called birth trauma) that happens when one or both of a baby’s shoulders get stuck inside the mother’s pelvis during labor and birth. In most cases of shoulder dystocia, babies are born safely. But it can cause serious problems for both mom and baby. Dystocia means a slow or difficult labor or birth. 

It’s often hard for health care providers to predict or prevent shoulder dystocia. They often discover it only after labor starts. Shoulder dystocia happens in 0.2 to 3 percent of pregnancies.

Are you at risk for shoulder dystocia?

Shoulder dystocia can happen to any woman. We do know that some things may make you more likely than others to have shoulder dystocia. These are called risk factors. A risk factor is something that makes you at risk for a condition. Having a risk factor doesn’t mean for sure that you’ll have shoulder dystocia. And risk factors for shoulder dystocia don’t seem to be helpful in predicting if you’ll have it. It’s hard for providers to predict or prevent. 

Risk factors for shoulder dystocia include: 

  • Macrosomia. This is when your baby weighs more than 8 pounds, 13 ounces (4,000 grams) at birth. If your baby is this large, you may need to have a cesarean birth (also called c-section). This is surgery in which your baby is born through a cut that a doctor makes in your belly and uterus (womb). Most babies with macrosomia who are born vaginally (through the vagina) don’t have shoulder dystocia. In most cases of shoulder dystocia, the baby’s weight is normal.
  • Having preexisting diabetes or gestational diabetes. Diabetes is a medical condition in which your body has too much sugar (called glucose or blood sugar) in your blood. This can damage organs in your body, including blood vessels, nerves, eyes and kidneys. Preexisting diabetes is when you have diabetes before you get pregnant. Gestational diabetes is a kind of diabetes some women get during pregnancy. Diabetes is a risk factor for having a large baby.
  • Having shoulder dystocia in a previous pregnancy
  • Being pregnant twins, triples or other multiples
  • Being overweight or gaining too much weight during pregnancy

Conditions that are part of labor and birth also are risk factors for shoulder dystocia. These include: 

  • Getting a medicine called oxytocin to induce your labor (make your labor start).
  • Getting an epidural to help with pain during labor. An epidural is pain medicine you get through a tube in your lower back that helps numb your lower body during labor. It’s the most common kind of pain relief used during labor.
  • Having a very short or very long second stage of labor. This is the part of labor where you push and give birth.
  • Having an assisted vaginal birth (also called operative vaginal birth). This means that your provider uses tools, like forceps or a vacuum, to help your baby through the birth canal. Forceps look like big tongs. Your provider places them around your baby’s head in the vagina to help guide your baby out. A vacuum is a suction cup that goes around your baby’s head in the vagina to help guide your baby out. This is the most common risk factor for shoulder dystocia.

What problems can shoulder dystocia cause?

Most moms and babies recover well from problems caused by shoulder dystocia.

Problems for the baby can include:

  • Fractures to the collarbone and arm
  • Damage to the brachial plexus nerves. These nerves go from the spinal cord in the neck down the arm. They provide feeling and movement in the shoulder, arm and hand. Damage can cause weakness or paralysis in the arm or shoulder. Paralysis is when you can’t feel or move one or more parts of your body.
  • Lack of oxygen to the body (also called asphyxia). In the most severe cases, this can cause brain injury or even death. This is rare.

Problems for the mother can include:

  • Postpartum hemorrhage (also called PPH). This is heavy bleeding after giving birth.
  • Serious tearing of the perineum (the area between the vagina and the rectum). Surgery may be needed to repair the tearing.
  • Uterine rupture. This is when the uterus tears during labor. This is rare.

How is shoulder dystocia treated?

If your provider thinks you may be at risk for shoulder dystocia, she can prepare you ahead of time for what to expect during labor and birth. And she can make sure staff and equipment are ready at the hospital. 

If your provider thinks your baby is large or if you have diabetes, your provider may recommend scheduling a c-section. If so, ask about waiting until at least 39 weeks of pregnancy to have your baby. This gives your baby the time she needs to grow and develop before birth. Scheduling a c-section should be for medical reasons only. Your provider may want to schedule a c-section if:

  • She thinks your baby weighs at least 5,000 grams (about 11 pounds).
  • You have diabetes and she thinks your baby weighs at least 4,500 grams (9 pounds, 15 ounces).

If you have shoulder dystocia, your provider can try several methods to move you and your baby into better positions to open your pelvis wider and move your baby’s shoulders. Your provider may: 

  • Press your thighs up against your belly. This is called the McRoberts maneuver.
  • Press on your lower belly just above your pubic bone. This is called suprapubic pressure.
  • Help your baby’s arm out of the birth canal
  • Reach up into the vagina to try to turn your baby. Or turn you over so you’re on all fours (on your hands and knees).
  • Give you an episiotomy. This is not done routinely but only in cases in which a larger opening to the vagina is helpful and the incision won’t affect the baby.
  • Do a c-section, other surgical procedures or break your baby’s collarbone to release his shoulders. These are done only in severe cases of shoulder dystocia that aren’t resolved by other methods. 

Last reviewed June, 2019