Can Shoulder Dystocia be Prevented?

Dystocia means difficult childbirth.

Shoulder dystocia is considered a medical emergency. Doctors may panic by pulling on the baby’s head which stretches and injures the nerves in the stuck shoulder. The baby may die from compression of the umbilical cord within the birth canal.

Has your doctor determined if your pelvic area can deliver a baby if shoulder dystocia should occur? Are you at risk for high birth weight or gestational or maternal diabetes? Have you had a previous childbirth which also suffered shoulder dystocia?

Shoulder dystocia can be prevented if the medical team has shoulder dystocia experience and is well prepared to deal with dystocia complications, should they arise.

Can shoulder dystocia be avoided?

Shoulder dystocia can be avoided. The overall incidence of shoulder dystocia varies based on fetal weight. Shoulder dystocia occurs in 0.6 to 1.4 percent of all infants with a birth weight of 5 lbs 8 oz to 8 lbs 13 oz. The bigger the baby, the higher the percentage of shoulder dystocia cases increasing to 5 to 9 percent risk in mothers who have diabetes.

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Pulling on the baby's head stretches and injures the nerves in the stuck shoulder. The injured nerves are between the shoulder and the neck.

There are numerous maneuvers which should be done. If one doesn’t work, doctors note the timing and go onto the next. Knowing these maneuvers, practicing these maneuvers, and making these maneuvers part of obstetric training is essential to the health and safety of mothers and babies.

The maneuvers should accomplish one of the following – increase the pelvis size, decrease the diameter of the shoulders, or alter the relationship of one or the other in order to pass through the birth canal. In most cases, the maneuvers will be successful.

But not always...the odds are in the mother and baby’s favor if the hospital staff knows what to do.

Is Erb's palsy preventable?

Yes. When shoulder dystocia goes wrong, the result is Erb’s Palsy. Like shoulder dystocia, Erb’s palsy can be prevented when an obstetrician identifies patients at risk by taking a medical history, by estimating the baby’s birth weight, by testing for gestational diabetes with a glucose tolerance test.

Is shoulder dystocia predictable?

Yes. There are three categories of shoulder dystocia predictors: Has the mother had a previous childbirth where shoulder dystocia occurred; maternal obesity; and maternal age. Maternal obesity is defined as having a body mass index or BMI of 30 or greater. Over 35 years of age is considered old by pregnancy standards.

More risk factors for shoulder dystocia are:

• Abnormal pelvic anatomy
• Gestational diabetes
• Post-dates pregnancy
• Short stature
• Suspected macrosomia (large baby weight)
• Assisted vaginal delivery (forceps or vacuum)
• Protracted active phase of first-stage labor
• Protracted second-stage labor

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Larger babies are more likely to get stuck. Diabetic mothers’ babies will have a larger head circumference. Diagnostic tools should focus on which babies will be larger than normal especially when mothers are diabetic.

If the doctor, nurse practitioner, or midwife fails to recognize these signs and/or take the required precaution, this may be viewed in the legal world as negligent behavior or medical malpractice for a birth injury lawsuit.