Understanding shoulder dystocia 

Here we explain what shoulder dystocia is and why this very rare birth complication can happen

What is shoulder dystocia?

Shoulder dystocia happens during a vaginal delivery and it's when one of your baby’s shoulders becomes stuck behind your pubic bone. It happens in fewer than one per cent of births, so it’s rare. In most cases, the baby’s head and one of the shoulders is born with no problem but the other shoulder becomes wedged. This can delay birth and you may need some additional help to free your baby’s shoulder.

It’s a serious situation but in most cases, the baby is born quickly and safely.

When is it likely to happen?

The chances of shoulder dystocia are higher if you:

• Had a previous labour where this happened
• Have diabetes 
• Are very overweight with a body mass index (BMI) of over 30
• Have a long or induced labour
• Have an assisted delivery with ventouse or forceps.

Can shoulder dystocia be predicted?

Because it’s not possible to scan or test for shoulder dystocia, it can’t be predicted. If you have diabetes, you may be offered an induction before your due date or you may be offered a planned Caesarean. 

What will happen if my baby has shoulder dystocia?

Your midwife and other staff in the delivery room have been trained to deal with it and they’ll quickly follow a plan to deliver your baby safely. The room may suddenly fill up with people, which can be a little scary, but they are there to help you and your baby. It is an emergency, however, because  your baby needs to be born so that they can start to breathe. If it’s not dealt with quickly, both you and the baby would be at risk.

Your doctor and midwife will:

• Tell you to stop pushing
• Consider or perform an episiotomy (a small cut to the entrance of the vagina, allowing more room for your baby)
• Place you on your back with legs up against your chest, called the McRoberts manoeuvre
• Apply pressure on your stomach just above the pubic bone – this can help release your baby’s shoulder.

If these steps are unsuccessful, your obstetrician or midwife may try to manually free the shoulder by putting their hand up inside you. Another way to free the baby’s shoulder is to ask you to get on all fours.

Are there any complications of shoulder dystocia?

You may end up tearing or bleeding more heavily than normal but this will be closely monitored. Your baby may have some loss of movement in the affected arm, called brachial plexus injury (BPI), which will often correct itself quickly. It’s possible for the baby to have a more severe injury to the arm ⁴ or shoulder, or even a fracture – this sounds alarming but it will heal quickly.In very rare cases, babies can suffer from brain damage caused by lack of oxygen if the shoulder can’t be released quickly, and that’s why your team will act fast.