Shoulder Dystocia

Although very rare, shoulder dystocia can be a very traumatic emergency during labour.  It involves one of your baby’s shoulders getting stuck behind your pelvic bone after the head has already been born.

There are three main reasons why this may happen during labour:

  1. Your pelvis is small
  2. Your baby is big
  3. Your baby is not in a good position for delivery

 

At the end of the second stage of a normal labour, the baby is born head first. The head will be facing your back. After the head is born, the baby’s head, shoulders and body then turn to allow the baby to move through your pelvis easier.

If the shoulder gets stuck, your delivery will be classed as an emergency and your baby needs to be born as quickly as possible to ensure she is able to breathe properly. Your baby is stuck inside you and her umbilical cord is squashed which means that she will not be getting enough oxygen from the blood supply. Your baby will also be unable to breathe properly as her lungs are still compressed. You will need to listen to your midwife and the medical team with you and follow all their instructions as they will know the best way to get your baby out safely. If you are having a home birth, your midwife team will still know and have experience of how to get your baby out safely.

Shoulder dystocia is very rare with only 2% of babies being affected. Unfortunately there is no way of preventing shoulder dystocia from affecting your baby as there is no way of predicting if or when it will happen. Shoulder dystocia can affect any baby and woman, however, you are at a higher risk of your baby suffering from shoulder dystocia if:

  • Your baby is big
  • You are suffering from gestational diabetes
  • You are overweight
  • In a previous birth, your baby experienced shoulder dystocia
  •  You need to have an assisted birth
  • You need to have your labour induced

What happens if my baby has shoulder dystocia?

Midwives are trained to deal with anything that a labour can throw at them and all labours are different. If your midwife discovers that your baby is stuck by their shoulder she will tell you to stop pushing and immediately call for help. You will find that more midwives, maybe a doctor or consultant, obstetricians, anaesthetist and paediatrician may enter the room. It will all happen very quickly and can be very traumatic and scary. Unfortunately, there is not always time to explain in detail what is happening but if you trust your midwife, she will ensure you are looked after.

Usually, you will be asked to change position to help baby turn and glide through your pelvis. You may be asked to lie on your back with a midwife each side of you who will help pull your legs up with bent knees. There will also be a midwife who will put pressure on your lower tummy to try and help free your baby’s shoulder. For the majority of babies with shoulder dystocia, this is all that is needed to ensure their safe delivery.

However, if your baby is still struggling, your midwife will perform an episiotomy and will ease their hand inside your vagina to try and help baby out.  You may need to change position to hands and knees.

After these methods, very few babies are still stuck, however, in a few very serious cases your doctor may need to break your baby’s collar bone in order to pull your baby out. Although, this is very traumatic, it is also very rare and your baby should heal completely and quickly afterwards.

The very last option is to deliver you baby by caesarean section. You will need to be put under a general anaesthetic (you will be put to sleep), and your baby will need to be moved back into your uterus before being lifted out.

Unfortunately, if your baby is not helped out quickly there is a very small chance that your baby will be unable to breathe any oxygen and will unfortunately be classed as a stillbirth.

After the birth

Due to the position of baby during the delivery there is a higher risk to you of postpartum haemorrhage (severe bleeding after birth). It is also likely that you may suffer from severe tearing and will need to be stitched.

You will also be suffering from a huge mix of different emotions including shock, fear, guilt and possibly depression.  You will be worried about the health of your baby and may be angry with those who are close to you. You will need to share your emotions and talk about your traumatic birth. You should ask questions regarding your birth to your midwife and ensure that you understand what happened during your labour. Once your midwife signs you off, you will be able to continue to talk about your experience with your Health Visitor.

Most babies who are born with shoulder dystocia do not have any problems after the birth or in later life. It is likely that your baby will receive extra check-ups during her early life just to ensure everything is alright.

A few babies may have experienced a lack of oxygen during the delivery and may need extra help or time in the special baby unit at the hospital.

A very small number of babies born with shoulder dystocia suffer from damage to the brachial plexus. This is the name given to the collection of nerves in your baby’s arm and shoulder. Your baby may suffer from numbness and possibly some restriction to movement of the arm. Most cases of damage to the brachial plexus improve on their own with time although a minority will need physiotherapy and daily exercises and tasks to aid healing.  Some babies need help to learn how to manage with their needs.

If your baby needed to have a bone broken during delivery, they will be given pain relief medication and they should heal quickly.They will receive extra check-ups during their early life to ensure all is well.

There is a very small risk that your baby may suffer from some form of brain damage due to the lack of oxygen during their birth.

If you are concerned about your baby suffering from shoulder dystocia during birth, speak to you midwife who will be able to help you prepare and answer any questions that you have.

If you have suffered from a traumatic birth with shoulder dystocia, ensure that you get answers to any questions that you have regarding the birth or what may happen in the future.

by Jenny, mum to William and James

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