Although most pregnant women anticipate a normal, uncomplicated delivery, there are exceptions to the rules. A shoulder dystocia is one of the more frequent complications in the delivery room, and, unfortunately, there is no surefire way to predict it.
A shoulder dystocia means that extra maneuvers must be done to deliver the baby’s shoulders. If not managed properly, the baby could sustain permanent injuries to its neck and arms. The most common scenario is the successful delivery of the baby’s head, but the rest of its body is “stuck.” Once this occurs, the mother’s thighs should be flexed back as much as possible toward her abdomen. This is called a McRobert’s Maneuver. Here are things that should not be done if there is a shoulder dystocia:
- Pulling on the baby’s head in an attempt to deliver shoulders
- Pressure on the top of the uterus (aka fundal pressure) in an attempt to deliver the baby. This only aggravates the problem more. A better approach would be supra pubic pressure meaning gentle pressure right above the bladder in order to help dislodge the baby’s shoulders
- More than three attempts to deliver the baby with a vacuum extractor
Although a shoulder dystocia cannot be predicted, there are women who will have risk factors for its occurrence and include:
- A woman who has a short stature of 4’11" or less
- A woman with gestational or Type 2 Diabetes
- A woman who has gained more than fifty pounds during her pregnancy
- A woman who has had a previous shoulder dystocia
- A woman who has been pushing for greater than two hours
- A woman who had had a difficult or prolonged labor
- A woman with an estimated fetal weight of ten pounds or greater
Contrary to popular belief, an ultrasound does not predict which babies are at risk for having a shoulder dystocia. However, if you have any of the risk factors above, it is not unreasonable to ask your OB practitioner if he or she is prepared to handle a shoulder dystocia should it occur.
Although I have said this many times, it still bears repeating: a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.