Understanding Shoulder Dystocia

Shoulder dystocia can affect a baby and mother in several ways.  Understanding its causes, prevention measures, and potential consequences is crucial for parents and healthcare professionals. 

In this article, we look at the impact of shoulder dystocia, exploring:

• What it is
• How common it is
• Its signs and symptoms
• How it happens
• Possible complications
• The risks it poses
• Ways to prevent it
• What to do if you child has shoulder dystocia
• How to start a birth trauma claim with Fletchers 

What is Shoulder Dystocia?

Shoulder dystocia is a childbirth complication. It is characterised by the difficulty of delivering a baby’s shoulders after the head has passed through the birth canal. It happens when one or both of the baby’s shoulders become stuck behind the mother’s pelvic bone. This can lead to a delay in the completion of childbirth, increasing the risk of complications for both the mother and the baby. 

How Common is Shoulder Dystocia?

Shoulder dystocia is considered an uncommon but serious complication during childbirth, occurring in roughly 0.2% to 3% of vaginal deliveries. While rare, its impact can be significant, making awareness crucial for expectant parents. The risk of shoulder dystocia increases with factors such as larger baby size (macrosomia), maternal diabetes, or prolonged labour.

What Causes Shoulder Dystocia?

Shoulder dystocia happens when a baby’s shoulder becomes lodged behind the mother’s pelvic bone after the head has been delivered. Common causes include fetal macrosomia, maternal obesity, gestational diabetes, and the use of instruments such as forceps or vacuum delivery. In many cases, shoulder dystocia is unpredictable, but certain risk factors can make it more likely.

What Are the Potential Shoulder Dystocia Complications for Baby? 

Shoulder dystocia can have various consequences, both immediate and long-term. 

Short-Term Complications

In the short term, it may lead to birth injuries such as brachial plexus injuries, which affect the nerves controlling the arm and hand. Fractures, particularly to the baby’s clavicle or arm bones, can also occur. 

In severe cases, oxygen deprivation during prolonged shoulder dystocia can lead to hypoxic-ischemic encephalopathy. This condition affects the baby’s brain function.

During childbirth, if the baby’s head passes through the birth canal while the shoulders remain lodged, it can result in compression of the umbilical cord. This can reduce oxygen flow to the baby.

Long-Term Complications

Long-term consequences may include:

• developmental delays
• physical disabilities such as cerebral palsy and Erb’s palsy
• the need for ongoing medical interventions

However, it is important to note that not all babies who experience shoulder dystocia will face long-term complications. Outcomes vary depending on the severity of the case and the timeliness of interventions 

Complications for Mothers

Shoulder dystocia can have significant impacts on mothers. The prolonged and intense efforts to resolve shoulder dystocia can lead to:

• increased maternal discomfort
• potential injuries
• a heightened risk of postpartum complications.
• Extreme heavy bleeding after giving birth (postpartum hemorrhage).
• Severe tearing of the area between your vagina and anus (perineum).
• Rectovaginal fistula: A rectovaginal fistula is an abnormal connection between your vagina and rectum.
• Uterine rupture: A uterine rupture means your uterus tears during labor.
• Separation of your pubic bones. 

Mothers who experience shoulder dystocia may face a longer recovery period. This recovery will likely be both physical and emotional as they grapple with the unexpected challenges of childbirth. Furthermore, the experience may contribute to feelings of anxiety or distress related to the well-being of the newborn. 

What Are the Risk Factors for Shoulder Dystocia? 

Several factors contribute to the occurrence of shoulder dystocia:  

Foetal Factors

Foetal factors may involve a larger-than-average baby size, often referred to as macrosomia. The risk of shoulder dystocia with a big baby increases because the baby may be too large for vaginal delivery. This can cause them to get stuck behind the mother’s pelvic bone. Research suggests that foetal macrosomia is the largest risk factor for babies suffering shoulder dystocia. 

Maternal Factors

If a mother has gestational diabetes, the risk level of shoulder dystocia increases. This is because it is more likely that babies born of diabetic mothers have wider shoulders, chests, and abdominal circumference than babies who have non-diabetic mothers. Therefore, increasing their likelihood of becoming stuck during delivery. 

Obesity increases the risk of shoulder dystocia during childbirth. This is due to a combination of maternal and foetal factors associated with excess body weight. Here are several reasons why obesity is considered a risk factor for shoulder dystocia: 

• Obesity increases the chances of gestational diabetes and foetal macrosomia.
• Obesity can alter the shape of the maternal pelvis, causing difficulty for the baby to navigate the birth canal.
• Excess fat tissue in the abdominal area can impede the progress of the baby during delivery.

• Obesity is associated with changes in hormones and can affect maternal metabolism. This can influence foetal growth and development.

Research has also shown that if a mother has suffered shoulder dystocia issues in previous pregnancies, the risk of a reoccurrence increases significantly. Up to 10-20% of women have the same complication in the subsequent birth. 

Obstetric Factors

Obstetric factors include the use of certain birthing positions, such as the lithotomy position (lying flat on your back). This position can prevent the sacrum from moving during birth, which narrows the room in the mother’s pelvis for the baby’s shoulders to fit through. 

Improper use of birthing tools such as forceps being used with excess force can result in the baby being pulled forcibly. This can cause damage to their shoulder. 

How to Prevent Shoulder Dystocia 

Preventing shoulder dystocia involves identifying and managing risk factors during pregnancy and labour. Regular prenatal check-ups are essential for monitoring the baby’s growth. These check-ups can also help identify any potential issues, such as macrosomia. Mothers with gestational diabetes should actively manage their blood sugar levels to reduce the risk of delivering a larger-than-average baby. 

During labour, healthcare professionals can adopt certain techniques to minimise the risk of shoulder dystocia. These may include changing the mother’s birthing position, avoiding the use of excessive force, and employing manoeuvres to dislodge the baby’s shoulders safely.

What Are the Signs of Shoulder Dystocia? 

Recognising the symptoms of shoulder dystocia is crucial for prompt intervention. Some common signs include: 

• Difficulty delivering the baby’s shoulders after the head has emerged
• A delayed delivery of the baby’s body
• The need for additional assistance, such as forceps or vacuum extraction, to complete the birth
  

Healthcare professionals are trained to identify these signs and take immediate action to address the situation. 

What to Do if You Think Your Child Has Shoulder Dystocia? 

If you suspect that your child may have experienced shoulder dystocia during birth, seek medical attention promptly. Healthcare professionals can:

• assess the baby’s condition
• perform necessary diagnostic tests
• initiate appropriate interventions to address any complications

Early detection and intervention can significantly improve outcomes for both the mother and the baby. 

Starting a Birth Trauma Claim With Fletchers Solicitors

Clinical negligence claims in this area focus on whether the medical staff correctly identified the risk and symptoms of shoulder dystocia and how the delivery was managed thereafter.  Sadly, despite comprehensive training, shoulder dystocia is not always identified by healthcare professionals and, in these circumstances, attempting to deliver a baby in a routine manner by pulling can cause severe injury.  The level of compensation for injuries sustained because of a failure to properly manage  shoulder dystocia is often in the hundreds of thousands of pounds.

If you think you, or your child, may have suffered an injury as a result of negligent medical treatment, speak to our experts today.