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Written by

Gina Conley, MS

Understanding Shoulder Dystocia

  • Birth, Medical, Pushing

Shoulder dystocia is a birth emergency when baby’s shoulders are caught above the pubic bone after baby’s head has been born. If shoulder dystocia happens to you, it is important to follow the immediate instructions of your provider and medical staff to resolve the dystocia. Please note that this blog is not medical advice, and for educational purposes only so that you can better understand why shoulder dystocia may happen, and possible movements you may be instructed to do.

Watch the video below to better understand how the baby is rotating through the pelvis and what happens when the shoulders get caught!

How does shoulder dystocia happen??

As the baby rotates through the pelvis, the head aligns with each pelvic level. After the baby’s head is born, they internally rotate back to the direction they were when they engaged into the pelvis. But, if their head rotates before the shoulders have entered the inlet, the shoulder can get caught on the pubic bone and prevent the baby from being born.

What happens if shoulder dystocia happens?

If shoulder dystocia happens, your provider may immediately announce it and instruct you to get into a position to help open the inlet more. This may be a butterfly pose, where you grab your ankles or feet, bring them together and pull them towards your chest. This brings the hips into external rotation and helps open the top of the pelvis more side to side. This can help the shoulders enter into the pelvis by increasing the pelvic diameter at the top.

Next, if the baby isn’t delivered with the butterfly pose and needs more help rotating through the pelvis, then you may be instructed to get into a half-kneeling lunge to create more space in the midpelvis. You may be told to press the knee out for asymmetrical external rotation of the upper midpelvis level or be told to drop the knee in while driving the hip crease back to help open the lower midpelvis to help the baby finish the rotation.

Helping the shoulders rotate: midpelvis openers

Opening the top of the midpelvis involves a wide knee on one side, better on the side baby is on. Think push the knee out for abduction and external rotation and shift the hips forward to help the shoulders start their rotation.

Once baby has started the rotation, you can focus on opening the bottom portion of the midpelvis. Shift the hip crease back, think femur into the socket, drop the knee inwards. Option to press into the arm for added adduction to emphasis the opening.

What increases your risk of shoulder dystocia?

The risk of shoulder dystocia according to a study by Mendez-Figueroa et al in 2021, found that in a sample size of 228,438, 1.7% of participants experienced shoulder dystocia. While we cannot predict when shoulder dystocia will happen or to who, there are some risk factors associated with shoulder dystocia, such as:

  • Instrument assisted delivery (could be that after baby’s head is born, they are encouraged to rotate too quickly causing the shoulder to get caught);

  • Gestational Diabetes can cause baby’s shoulder to be wider, increasing the risk of the shoulders not clearing the pelvic brim during descent before rotation;

  • Gestation of greater than 41 weeks (the longer you are pregnant, the bigger baby tends to become);

  • Epidurals could increase the risk, but likely due to lack of movement rather than the epidural specifically causing dystocia or more assistance with baby’s delivery (instrument, augmentation).

There are significant risks associated with shoulder dystocia for both mother and baby. There is an increased risk for mother of: “third- or fourth-degree perineal laceration, postpartum hemorrhage (>500 cc blood loss for a vaginal delivery and >1000 cc blood loss for cesarean delivery), blood transfusion, chorioamnionitis, endometritis, thromboembolism, admission to intensive care unit, or maternal death.” (Mendez-Figueroa et al, 2021) The risks associated with shoulder dystocia for baby include: “Apgar score of <7 at 5 minutes, a birth injury, neonatal seizure, hypoxic ischemic encephalopathy, or neonatal death.” (Mendez-Figueroa et al, 2021) Shoulder dystocia is less common, but if it occurs it is incredibly important to follow the immediate direction of your provider.

Learn more about the science of birth in our online childbirth education courses. We break down how the pelvis moves and how to create more space to help baby descend and rotate through your pelvis. We also break down some birth emergencies so you can be better prepared on knowing what to expect in the event of an emergency.

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References:

  • HEINONEN, K., SAISTO, T., GISSLER, M., KAIJOMAA, M., & SARVILINNA, N. (2021). RISING TRENDS IN THE INCIDENCE OF SHOULDER DYSTOCIA AND DEVELOPMENT OF A NOVEL SHOULDER DYSTOCIA RISK SCORE TOOL: A NATIONWIDE POPULATION‐BASED STUDY OF 800 484 FINNISH DELIVERIES. ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, 100(3), 538-547.

  • MENDEZ-FIGUEROA, H., HOFFMAN, M. K., GRANTZ, K. L., BLACKWELL, S. C., REDDY, U. M., & CHAUHAN, S. P. (2021). SHOULDER DYSTOCIA AND COMPOSITE ADVERSE OUTCOMES FOR THE MATERNAL-NEONATAL DYAD. AMERICAN JOURNAL OF OBSTETRICS & GYNECOLOGY MFM, 3(4), 100359.