Shoulder dystocia is a birth injury (also called birth trauma) that happens when one or both of a baby’s shoulders get stuck inside the mother’s pelvis during labor and birth. In most cases of shoulder dystocia, babies are born safely. But it can cause serious problems for both mom and baby. Dystocia means a slow or difficult labor or birth. Shoulder dystocia happens in 0.2 to 3 percent of pregnancies.
Sign & symptoms –
There are no symptoms, and there’s no way to predict if shoulder dystocia will occur. Your obstetrician may only notice the condition after you deliver your baby’s head. It becomes clear when your baby’s head emerges and then pulls back in against the area between your vagina and rectum (perineum). This is called the “turtle sign.”
The following factors may cause shoulder dystocia:
• Fetal macrosomia: Your baby weighs more than 8 pounds, 13 ounces.
• Your baby is in the wrong position.
• Your pelvic opening is too small.
• You are in a position that limits the room in your pelvis.
Risk factors –
• A history of prior shoulder dystocia or brachial plexus injury
• Current fetal macrosomia
• Maternal obesity
• Diabetes mellitus
• Pregnant with twins or other multiples.
• Overweight and/or gaining excess weight during pregnancy.
• Short stature.
• Abnormal pelvic structure.
• Older than 35.
• Giving birth after your due date
• Dysfunctional labor patterns, especially a long deceleration phase followed by a long second stage.
Doctors use a mnemonic “HELPERR” as a guide for treating shoulder dystocia:
“H” stands for help. Your doctor should ask for extra help, such as assistance from nurses or other doctors.
“E” stands for evaluate for episiotomy. An episiotomy is an incision or cut in the perineum between your anus and the opening of your vagina. This doesn’t usually solve the entire concern for shoulder dystocia because you baby still has to fit through your pelvis.
“L” stands for legs. Your doctor may ask you to pull your legs toward your stomach. This is also known as the McRoberts maneuver. It helps to flatten and rotate your pelvis, which may help your baby pass through more easily.
“P” stands for suprapubic pressure. Your doctor will place pressure on a certain area of your pelvis to encourage your baby’s shoulder to rotate.
“E” stands for enter maneuvers. This means helping to rotate your baby’s shoulders to where they can pass through more easily. Another term for this is internal rotation.
“R” stands for remove the posterior arm from the birth canal. If your doctor can free one of the baby’s arms from the birth canal, this makes it easier for your baby’s shoulders to pass through the birth canal.
“R” stands for roll the patient. This means asking you to get on your hands and knees. This movement can help your baby to pass more easily through the birth canal.
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