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Table of Contents
What is Shoulder Dystocia?
Why Does Shoulder Dystocia Happen?
Several factors can increase the chances of shoulder dystocia, though it is often difficult to predict. Some known risk factors include:
- Having a larger baby: This can occur in pregnancies where the mother has diabetes, including gestational diabetes.
- Previous shoulder dystocia: If shoulder dystocia happened in a previous birth, the risk is much higher for subsequent births.
- Induction of labour
- Types of birth: Assisted births with forceps or vacuum, or births after prolonged labour, can sometimes be associated with an increased risk.
- Maternal factors: Being very overweight and conditions like diabetes may increase the likelihood of shoulder dystocia.
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However, it’s important to note that shoulder dystocia can occur even in pregnancies without any known risk factors.
How Is Shoulder Dystocia Treated?
If the doctor or midwife suspects shoulder dystocia – it will be treated as a medical emergency.
There are several techniques used to free the baby’s shoulders, such as:
- McRoberts’ Maneuver: You will be asked to lie back and bend your knees tightly toward the abdomen to widen the pelvis.
- Suprapubic Pressure: Pressure is applied just above the pubic bone to help dislodge the baby’s shoulder.
- Other manoeuvres or interventions: In some cases, more advanced techniques may be needed, such as repositioning the baby’s shoulders or delivering the baby’s arms. An episiotomy may need to be performed.
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While these methods are usually effective, they carry risks of complications, such as injury to the baby’s nerves (brachial plexus injury) or trauma to the mother, including perineal tears or bleeding. In life-threatening and very rare situations where the manoeuvres aren’t working, the midwife or doctor may have to break a baby’s collarbone or arm to deliver.
Understanding the Risks
- For the baby:
- Injury to the nerves in the shoulder (brachial plexus injury) can affect arm movement, with permanent damage such as Erb’s Palsy
- In rare cases, lack of oxygen (hypoxia) can lead to more serious complications such as hypoxic brain injury and
- The baby may require resuscitation after a difficult delivery to assist with breathing or heart contractions.
- Tears in the vaginal or perineal area
- Postpartum haemorrhage (severe bleeding).
- Birth-related trauma
Informed Consent and Your Right to Know
One of the most important parts of maternity care is ensuring parents are fully informed about potential risks and options for managing them. In the case of shoulder dystocia, healthcare providers have a duty to discuss risk factors, management strategies, and possible outcomes with families.
Informed consent means that before any decisions are made—whether it’s the decision to proceed with a vaginal birth or to opt for a caesarean section—your healthcare provider should explain all the risks and benefits. This allows you to participate in decision-making about your care actively.
The case of Mrs Montgomery, which is well-known in medical and legal circles, highlights this issue. Mrs Montgomery was not properly informed of the risk of shoulder dystocia despite her concerns about her baby’s size. This case changed how doctors approach patient communication, emphasising the importance of discussing risks with families, especially when the risks are significant.
What Can You Do?
- Ask Questions: If you have concerns about the size of your baby or other risk factors, talk openly with your healthcare provider. Ask about the potential risks of shoulder dystocia and how it can be managed during your delivery.
- Know Your Options: For some high-risk situations, like pregnancies with previous shoulder dystocia, your doctor may discuss options such as an elective caesarean section or timely induction to reduce the risk of shoulder dystocia. You still have the choice but we encourage you to ask questions.
- Stay Informed: Understanding what shoulder dystocia is and what to expect can help you feel more empowered as you approach your birth.
Emotional Support and Birth-related Trauma
Experiencing shoulder dystocia can be frightening and traumatic for some parents. If your delivery involves shoulder dystocia, it’s important to seek emotional support from trusted family members, friends, or groups like Birth Trauma Australia. Processing and understanding what happened can help your healing journey, and you should never hesitate to reach out for support when needed.
Pregnancy and Birth after Birth Trauma
Giving Birth After Shoulder Dystocia: What You Need to Know
What are the Chances of Shoulder Dystocia Happening Again?
Risk Factors for Recurrence
- Previous shoulder dystocia: A history of shoulder dystocia is one of the most significant risk factors for recurrence.
- Baby size (macrosomia): Larger babies, especially those over 4kg (about 8.8 pounds), are at higher risk for shoulder dystocia. If your previous baby was large, the chances of another large baby in subsequent pregnancies may be a consideration.
- Gestational diabetes: Diabetes during pregnancy increases the risk of having a larger baby, which in turn raises the chance of shoulder dystocia.
Risk Factors for Recurrence
- Early Discussions with Your Provider: Make sure your healthcare provider knows about your previous experience with shoulder dystocia. They will assess your individual risk factors and work with you to develop a birth plan.
- Monitoring Baby’s Size: Your provider may recommend ultrasounds later in pregnancy to estimate your baby’s size. While these estimates are not always 100% accurate, they can help make decisions about delivery options.
- Managing Gestational Diabetes: If you had gestational diabetes in a previous pregnancy, you will likely be closely monitored in future pregnancies to manage your blood sugar levels and reduce the risk of having a larger baby.
- Delivery Options:
- Vaginal Birth: Many women who have experienced shoulder dystocia previously can still have a successful vaginal birth. Your care team may recommend being prepared with specific management techniques if shoulder dystocia occurs again.
- Elective Caesarean Section: In some cases, especially if your baby is measuring large or if there are other concerns, your provider may suggest an elective caesarean section. This option can reduce the risk of shoulder dystocia, but like all surgeries, it carries its risks that you’ll need to weigh with your healthcare team.
Emotional Considerations and Support
It’s understandable to feel apprehensive about giving birth again after experiencing shoulder dystocia. Many women worry about the physical and emotional challenges of another delivery. Talking through these concerns with your healthcare provider and seeking emotional support from groups like the BTA’s Peer2Peer Social Support Group can help. Remember, birth after shoulder dystocia can be a positive and empowering experience. By working closely with your care provider and making informed choices, many women go on to have safe and healthy births after experiencing shoulder dystocia in a previous pregnancy.
