Shoulder dystocia is a specific type of obstetric emergency that occurs during childbirth.
What is shoulder dystocia?
Shoulder dystocia happens when, after the delivery of the head, one of the baby's shoulders gets stuck behind the mother's pubic bone, preventing the baby from being born easily. This situation requires immediate medical intervention to safely deliver the baby.
What are the risk factors for shoulder dystocia?
Several factors can increase the risk of shoulder dystocia, including:
- Maternal diabetes: Especially if it is poorly controlled.
- Obesity in the mother: Higher maternal weight can be associated with larger babies, which increases the risk.
- History of shoulder dystocia: If it has occurred in previous deliveries, there's a higher chance it will happen again.
- Post-term pregnancy: Babies that are larger because they are overdue.
- Macrosomia: This is when a baby has an estimated fetal weight above the 90th percentile for their gestational age.
- Labor factors: Induced labor and prolonged second stage of labor can also be factors.
Complications of shoulder dystocia
Shoulder dystocia can lead to a range of complications for both the baby and the mother due to the difficulties encountered during delivery.
Complications for the Baby
Many complications can occur for the baby, including:
- Brachial Plexus Injury: This is the most common type of injury associated with shoulder dystocia. The brachial plexus is a network of nerves that sends signals from the spinal cord to the shoulder, arm, and hand. During shoulder dystocia, these nerves can be stretched or torn if the baby's shoulder is caught and excessive force is applied to free it. This can result in temporary or permanent weakness, loss of sensation, or paralysis in the affected arm.
- Fractures: The clavicle (collarbone) or humerus (upper arm bone) may fracture as pressure is applied during attempts to release the trapped shoulder. These fractures usually heal well, but they can cause pain and discomfort to the newborn.
- Hypoxia: In severe cases, if the baby is stuck for an extended period, there can be a reduction in oxygen supply. This can lead to hypoxic-ischemic encephalopathy (HIE), a condition that affects the brain and can result in long-term neurological damage or, in extreme cases, death. Prompt delivery and immediate medical intervention are crucial to minimize these risks.
Complications for the Birthing Parent
There are also complications that can arise for the birthing parent.
- Excessive Bleeding (Postpartum Hemorrhage): Shoulder dystocia can increase the risk of heavy bleeding after delivery, partly due to prolonged labor or the intense efforts required to resolve the dystocia. This can be a significant concern and may require medical intervention such as medication to contract the uterus or, in some cases, surgical procedures.
- Tearing: The physical strain and maneuvers used to resolve shoulder dystocia, such as the application of force or varied positioning, can lead to severe tearing of the vaginal tissues and/or the perineum. These tears might extend to the muscles and might require surgical repair.
- Surgical Intervention: In cases where non-surgical methods fail to resolve shoulder dystocia, a cesarean section may become necessary to safely deliver the baby. In very rare circumstances, more drastic surgical interventions could be required, such as a symphysiotomy (cutting the fibrous cartilage of the pubic symphysis to widen the pelvis), although this is extremely uncommon in modern practice.
Prevention
While not all cases of shoulder dystocia can be predicted or prevented, managing risk factors like maternal diabetes and obesity can help. In some cases, especially when a large baby is expected, discussing delivery options with a healthcare provider can prepare for potential complications.
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