Shoulder Dystocia Explained

Childbirth is usually a moment of joy and anticipation, but when complications occur, the consequences can be life-changing. One such complication is shoulder dystocia for a baby. Here, we address what shoulder dystocia is, how it’s caused, what happens next, and whether you can make a birth injury claim.

What is Shoulder Dystocia?

Shoulder dystocia is a complication that can occur during vaginal childbirth when the baby’s head is delivered but one or both of the shoulders become stuck behind the mother’s pubic bone. This prevents the baby from moving smoothly through the birth canal. 

In normal deliveries, after the head is delivered, both the head and body will turn sideways so that the baby’s shoulders can pass through the pelvis. However, if the baby is large, not in the best position, or the mother’s pelvis is small, shoulder dystocia may occur.

How common is Shoulder Dystocia?

Shoulder Dystocia is a rare condition, occurring in approximately 0.7% of vaginal births. However, statistics can vary because the condition is sometimes over and under diagnosed. 

What causes Shoulder Dystocia?

There is no single cause of shoulder dystocia. In many cases, it is unpredictable. However, certain risk factors can increase the likelihood of it occurring, including:

• Fetal size – larger babies are more likely to experience should dystocia
• Diabetes – gestational or pre-existing diabetes can contribute to larger birth weights and therefore the risk of shoulder dystocia
• Labour complications – prolonged second stage of labour or assisted delivery using forceps or a vacuum
• Previous history – the risk of shoulder dystocia in a second delivery is higher for those who experienced it previously

Despite these risk factors, shoulder dystocia can also occur without warning. 

How is Shoulder Dystocia detected? 

Doctors and midwives should be alert to the risk of shoulder dystocia, especially if the risk factors mentioned earlier are apparent. The obvious symptom is that the baby’s delivery is not progressing as it should, for example the baby seems to be progressing and then retracting in the birth canal. A red puffy face may also be an indicator that the baby is stuck.

In these circumstances, the medical staff need to act quickly to prevent any long term injury to the baby.

What to do if baby has Shoulder Dystocia

If shoulder dystocia is suspected or confirmed, mum should be told to stop pushing, immediately. Additional medical professionals may be summoned to assist, and Mum may be put into a different birth position. 

For example, with assistance from the medical staff, mum may be positioned with knees bent and legs pulled up as high as possible. Pressure may also be applied to Mum’s tummy (above the pubic bone) to help release the baby’s stuck shoulder.

These measures commonly resolve the situation. If not, medical professionals may need to make shoulder dystocia manoeuvres to physically manipulate the baby’s position by hand. In this case, an episiotomy may be needed to physically assist the baby out.

If these measures do not work, other emergency measures may be required. For example, an experienced doctor may need to break the baby’s collar bone, or a caesarean section may be needed.

How does Shoulder Dystocia affect the baby?

If a baby has shoulder dystocia and is not delivered quickly, it may suffer from oxygen deprivation and other shoulder dystocia complications. Oxygen deprivation occurs because, at this stage of the delivery, the umbilical cord is squashed alongside the baby in the birth canal, meaning less oxygenated blood reaches them.

Shoulder dystocia often causes injury to the baby’s nerves, particularly the brachial plexus nerves, which supply the sensory and motor components of the shoulder, arm and hands. This type of injury is more commonly known as Erb’s palsy.

The reason for this type of injury is not known, but it is thought that the stretching of the nerves, and in extreme cases, tearing of the nerves, is caused by the force of the contractions. Physical application of pressure by medical staff may also contribute to this type of injury.

What are Shoulder Dystocia complications for the mother?

As well as complications for the baby, shoulder dystocia can also lead to complications for the mother. These include:

• Extreme heavy bleeding after birth
• Severe perineum tearing
• A rectovaginal fistula
• Uterine rupture
• Separation of pubic bones

Can I make a clinical negligence claim if my baby has Shoulder Dystocia?

If your baby experiences shoulder dystocia at birth, you may be able to make a clinical negligence claim.

Clinical and medical negligence claims in this area focus on:

Whether the medical staff correctly identified the risk and symptoms of shoulder dystocia

Whether shoulder dystocia management was managed appropriately and safely during delivery

Sadly, despite comprehensive training, shoulder dystocia is not always identified by healthcare professionals. 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 and would like to speak with a member of the Fletchers clinical negligence team, please contact us.