Preventing Shoulder Dystocia During Delivery

When shoulder dystocia occurs during delivery, a quick and skilled medical response is imperative. This guide cuts through the complexity to provide you with vital information on recognizing, responding to, and resolving shoulder dystocia delivery, aiming for a protected birth for both mother and baby. Learn about the crucial maneuvers and aftercare practices that can help manage this birth injury.

Key Takeaways

• Shoulder dystocia is an unpredictable labor complication where the baby’s shoulder gets lodged behind the mother’s pubic bone after the head is delivered, leading to potential injuries such as brachial plexus injury for the baby and postpartum hemorrhage for the mother.
• Risk factors for shoulder dystocia include maternal obesity, gestational diabetes, macrosomia, a high BMI, induced and prolonged labor, and previous instances of shoulder dystocia. Despite these risk factors, ultrasounds are not reliable predictors without additional risk factors.
• Effective management and post-delivery care of shoulder dystocia involve maneuvers such as Woods screw and McRoberts, extraction techniques, patient repositioning, delayed umbilical cord clamping, infant resuscitation, and monitoring for complications.

Understanding Shoulder Dystocia

Shoulder dystocia is a birth complication in which one or both of the baby’s shoulders get lodged in the mother’s birth canal. This typically occurs once the baby’s head has been delivered, but a shoulder gets lodged behind the mother’s pubic bone. Healthcare professionals often receive little warning about the occurrence of shoulder dystocia due to its unpredictability. In cases where shoulder dystocia occurred, a clear definition is when the head-to-body delivery interval surpasses 60 seconds.

Shoulder dystocia can have serious consequences for both the baby and the mother. For the baby, this can translate into brachial plexus injury, which impacts the nerves controlling arm movement, fetal brain damage, or even death. The mother may face complications like postpartum hemorrhage.

Causes of Shoulder Dystocia

What leads to shoulder dystocia? The answer lies in a combination of interrelated factors – the size of the baby, the mother’s pelvic anatomy, and the position of the baby in the birth canal. Certain risk factors like maternal obesity, gestational diabetes, and macrosomia, which refers to an unusually large fetal weight, can increase the risk of shoulder dystocia.

Though larger babies are more prone to it, shoulder dystocia occurs in 0.5% to 1.5% of all births, including those with babies weighing under 4 kilograms, as the baby’s shoulders might get stuck.

Common Complications

Brachial plexus injuries are one of the most common complications associated with shoulder dystocia. This injury, which usually occurs during attempts to resolve the shoulder dystocia, can lead to temporary or permanent brachial plexus injury, causing loss of arm movement. After a shoulder dystocia delivery, healthcare professionals should monitor the infant for any signs of brachial plexus injury.

Another serious complication is hypoxic ischemic encephalopathy, which can occur when prenatal oxygen deprivation takes place as a result of shoulder dystocia. Moreover, shoulder dystocia can lead to postpartum hemorrhage, broken clavicle or humerus, and fetal hypoxia, further emphasizing the need for enhanced post-delivery care.

The identification of risk factors plays a critical role in managing shoulder dystocia. These risk factors include:

• Previous instances of the condition
• Diabetes
• High body mass index (BMI)
• Induced labor
• Prolonged labor
• Assisted vaginal birth such as the use of forceps or vacuum.

A history of shoulder dystocia significantly raises the risk of its recurrence in subsequent pregnancies. Ultrasound scans, however, are not reliable for predicting the likelihood of shoulder dystocia based solely on estimated fetal weight without the presence of additional risk factors.

To prevent shoulder dystocia recurrence following an initial event, careful monitoring of fetal growth and assessment of maternal risk factors are crucial in managing subsequent pregnancies.

Maternal Risk Factors

Specific risk factors for shoulder dystocia, such as a history of shoulder dystocia in previous deliveries and prepregnancy obesity, can be present in mothers.

Additionally, excessive weight gain during pregnancy can significantly increase the risk of shoulder dystocia.

Fetal Risk Factors

There are also several fetal risk factors that contribute to shoulder dystocia. These include estimated fetal weight, macrosomia, and abnormal presentation.

Shoulder dystocia and brachial plexus injury are associated with fetal macrosomia, a condition where the baby is significantly larger than average. In fact, fetal macrosomia is implicated in about half of the births complicated by shoulder dystocia or brachial plexus injury.

Effective Management Techniques

A variety of techniques are employed by healthcare professionals for shoulder dystocia management. These include:

• Rotational maneuvers like the Woods screw maneuver
• Extraction techniques like posterior arm or suprapubic pressure
• Patient positioning like the McRoberts maneuver

In certain cases, to aid in safe delivery, the posterior axillary traction maneuver can be gently used to reduce the shoulder caught in the sacral hollow. Changing the mother’s orientation can also alleviate shoulder dystocia, as seen with the all-fours maneuver, where the mother gets on her hands and knees. However, it’s important to note that during a shoulder dystocia emergency, pulling on the baby’s head is strictly contraindicated due to the risk of injury.

Rotational Maneuvers

To navigate the birth canal more effectively during delivery, rotational maneuvers play a crucial role in adjusting the baby’s position, including the alignment of the baby’s head.

The Woods screw maneuver, for instance, is executed by rotating the posterior shoulder clockwise, allowing the shoulders to corkscrew through the mother’s pelvis. The Rubin maneuver involves applying pressure to the anterior shoulder to narrow its width, easing the delivery process. The Reverse Woods Screw maneuver rotates the baby’s anterior shoulder counterclockwise to facilitate delivery.

Extraction Techniques

To dislodge the baby’s shoulder from the mother’s pelvic bone, extraction techniques are critical to resolve shoulder dystocia.

One such technique is the posterior axilla sling traction, which involves the use of a sling to exert targeted traction to the posterior arm, assisting in freeing the impacted shoulder. These techniques are crucial for managing shoulder dystocia, aiming to ensure a safe delivery for both mother and child.

Patient Positioning

Patient positioning techniques like the McRoberts maneuver are designed to reduce the risk of shoulder dystocia during delivery. The McRoberts’ maneuver is effective in alleviating shoulder dystocia, as demonstrated by its associated success rate.

Another positioning tactic used to minimize the occurrence of shoulder dystocia is the all-fours maneuver, where the mother gets on her hands and knees.

Post-Shoulder Dystocia Care

Certain post-delivery care practices are essential after a shoulder dystocia delivery. The umbilical cord should not be immediately clamped and cut after resolving a shoulder dystocia to enhance the baby’s blood volume and circulation, as this can help prevent potential umbilical cord compression.

Healthcare providers should wait approximately one minute before clamping the umbilical cord to allow sufficient time for placental autotransfusion to the baby, a process that involves transferring the baby’s blood from the placenta and umbilical cord after birth.

Resuscitating the Baby

Following a shoulder dystocia birth, the resuscitation of the infant is a critical component of post-delivery care.

Delayed cord clamping is recommended as part of the resuscitation process post-shoulder dystocia delivery. The baby must be assessed quickly and accurately by healthcare professionals to determine the need for resuscitation. A well-coordinated delivery team is essential to ensure immediate and effective resuscitation of the baby.

Monitoring for Complications

Another essential aspect of post-delivery care is monitoring for complications. Healthcare professionals should be prepared to address potential hypovolemic shock in a baby born after shoulder dystocia by promptly initiating volume expansion.

Legal Considerations and Support

You may consider suing for shoulder dystocia negligence if you or your child were victims of birth injuries, such as shoulder dystocia, especially when maternal risk factors and the impact on both child and mother are involved.

However, pursuing a medical malpractice lawsuit for shoulder dystocia negligence typically involves proving that the healthcare team failed to meet an expected standard of care, a process which can be legally challenging.

Filing a Medical Malpractice Claim

To file a medical malpractice claim for shoulder dystocia, it is required to show negligence on the part of the healthcare provider. Negligence can be determined by failure to predict shoulder dystocia or using inappropriate and excessive force during delivery. Evidence is crucial to prove that the physician did not adhere to the standard of care, which led to injuries from shoulder dystocia.

Shoulder dystocia malpractice claims often stem from a history of shoulder dystocia or shoulder dystocia injury, such as a brachial plexus injury.

Seeking Compensation

Seeking compensation is the next step once a medical malpractice claim is filed. Damages in a shoulder dystocia malpractice claim can cover:

• Medical costs
• Lost wages
• Pain and suffering
• Loss of enjoyment of life

If shoulder dystocia results in fatality, a higher compensation cap is allowed in wrongful death lawsuits compared to non-fatal injury cases.