Baby Caring for your baby Feeding your baby. Ambassadors Ambassadors Celebrity Advocate Council. Mission stories Spotlights Impact Stories. Shoulder dystocia. E-mail to a friend Please fill in all fields. Please enter a valid e-mail address. Thank you! Your e-mail was sent. Save to my dashboard Sign in or Sign up to save this page. Saving Just a moment, please.
You've saved this page It's been added to your dashboard. In This Topic. What is shoulder dystocia? Are you at risk for shoulder dystocia? Risk factors for shoulder dystocia include: Macrosomia. This is when your baby weighs more than 8 pounds, 13 ounces 4, grams at birth. If your baby is this large, you may need to have a cesarean birth also called c-section. This is surgery in which your baby is born through a cut that a doctor makes in your belly and uterus womb.
Having preexisting diabetes or gestational diabetes. Diabetes is a medical condition in which your body has too much sugar called glucose or blood sugar in your blood. This can damage organs in your body, including blood vessels, nerves, eyes and kidneys. Preexisting diabetes is when you have diabetes before you get pregnant.
Gestational diabetes is a kind of diabetes some women get during pregnancy. Diabetes is a risk factor for having a large baby. Here's what to expect if you're expecting a larger-than-average newborn. While some babies do experience birth injury, giving birth in Australia is very safe. Most birth injuries to babies are temporary, and in many cases treatment is available. Birth trauma affects many women. But there are ways to reduce your risk of an emotionally traumatic childbirth, while support and treatment are available if you experience symptoms.
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Please check and try again Please enter recipient's email Recipient's email is invalid. Please check and try again Agree to Terms required. Thank you for sharing our content. A large baby is not the only risk factor for shoulder dystocia, and there may be things one can do to help prevent it. Crazy enough, most cases occur in …. Crazy enough, most cases occur in birthing people with normal or average-sized babies.
A health care provider may have concerns about shoulder dystocia happening again if it happened in a past pregnancy, or if there are other risk factors. They may even suggest a C-section instead of attempting a vaginal delivery. This article is all about the risks of shoulder dystocia, options parents have if this happens, and what it may look like during delivery.
Originally published June 27, , this article was updated and republished on April 20, Like a transverse baby , a baby with shoulder dystocia may not be able to exit the birth canal without some kind of assistance. It can make it difficult to avoid the need for a C-section. Shoulder dystocia is considered an emergency and may cause a provider a lot of anxiety during delivery.
Getting a baby out and keeping the birthing person safe is their main priority. If shoulder dystocia happens, the birthing parent may need assistance in getting the baby out in a timely manner to avoid risks to both the parent and the baby. Even then, a large majority of babies who are smaller can still have shoulder dystocia. Even though it may not happen often, it is important to know more about it in the event it does happen. A provider may end up calling in a team of helpers to assist in getting the baby out.
It can affect not only the baby but the birthing parent if it occurs. Shoulder dystocia usually happens unexpectedly. Therefore, it is typically hard to predict. Sometimes a provider may be able to tell that it is coming when a baby is taking longer than expected to come out after the head has been born. As mentioned above, most of the time shoulder dystocia is unable to be predicted.
It is important to note that even if these are suspected or are present, an early induction does not guarantee the elimination of the risk of shoulder dystocia. There is also a chance that the provider may suggest skipping an induction, and going straight to a Cesarean or not offer a TOLAC Trial of labor after Cesarean as an option.
Cesareans also have risks to the birthing person and baby. In addition, C-sections also carry risks for future pregnancies and deliveries. When shoulder dystocia happens, it is crucial for the provider to get the baby out safely and quickly. A provider will oftentimes be able to determine if they will be able to deliver the baby vaginally with support.
If they do not feel like it is possible to do so safely, they may suggest an emergency Cesarean. One of the most common injuries is brachial plexus palsy.
This is when the nerves in the brachial plexus are damaged during the delivery. These nerves control the ability to move and control the muscles in the arm. I read the books, found a doula, and an OB that was supportive of my birth plan. At 37wks4days, my OB sent me to get an ultrasound because I had measured 42cm at my 37 wk appt. Ultrasound showed a healthy, 9lbs13oz baby with normal amounts of fluid.
At my 38 week apt, my OB asked me to re-evaluate my birth plan. Basically, she is concerned about the size and the past history of SD. She wants to support whatever decision I make, but has stated that if there is complications with a vaginal birth, she will medically speaking, have no grounds to stand on.
Since this last apt, I have found myself conflicted for the first time. I have been researching like crazy. I feel like I may be in the small percentage of women that have a medical reason for opting for a C-section. I would greatly appreciate any feedback! This is your decision and you have to do what feels best for you.
The doctors comment of having no grounds to stand on if complications occur is untrue. It is not her job to perform surgery without consent. It seems that you were on your back and possibly being directed to push with your previous birth? These can increase the risk of SD. As for estimating weight via ultrasound… not very accurate. However, you generally make slightly bigger babies with subsequent pregnancies. The research does not support the use of c-section or induction to prevent SD.
Good luck with your decision making — it can be really hard when you are in the middle of very different perspective… ultimately it has to be what you are most comfortable with.
There are risks either way — choose which ones you want. Hi I am in a similar position to you but i also have Gestational Diabetes.
My 38 weeks scan showed baby measuring 4,g. I have to make the decision to either go against the consultant and be induced or have thr c section. I also have ployhydramniosis. Can i ask whether you had a natural birth or whether you opted for the c section?
Tell your provider to get you off your back or butt! Oh, these births were at home…. I was born barely 6 lbs, and the rest was polyhydramnios never diagnosed, but she assured me she had a lot of fluid — PROM. I actually had a son in , and it has always bugged me the way that they delivered my son.
The doctor or nurse whom ever was helping him had taken his elbow and shoved it into my stomache to push the baby down. I totally lost my breath , like the wind was knocked out of me. Later i found out that my son had a broken collar bone.
Sadly my mom admits today that she has never seen anything like that before. I kinda still suffer from that happening and not being told what was going on. I had a water birth in Jan of and they had to use the McRoberts when baby got a little stuck.
Baby came out easily with it, and I actually never realized there was an issue until I googled what a McRoberts was almost a year after the birth. I did tear, but not too bad. Now I am due any moment, and just got a call today from my midwifery group telling me they feel strongly that I should not have another water birth.
Honestly, I wish I could have know this sooner, since for months I have been preparing for a similar birth in the water. Maybe they forgot about my situation until I brought it up at my last appointment and they had some time to think about it?
So — my question — is it bad that I still want a water birth? Should I be more worried of a repeat with possible bad consequences since I already had one baby who got stuck? Would you recommend giving up the idea of a water birth if I were your patient? Thanks for reading. Still processing this new, and disappointing, information. I think you need to discuss this with your midwives. A waterbirth will not increase the chance of you having a shoulder dystocia but I am guessing your midwives are worried about managing it in the water — it is more difficult to access you and your baby.
Might be a good idea to explore other birth attendants. But if the attendants panic, that makes it worse. Pelvises are not made of concrete, and babies heads mold, and most of the time someone calm and reassuring can get the baby rotated better so it can be born with no damage to itself or mom. It was a suprise to all as we were expecting a 8lb baby and i ened up having a 10ln 2oz baby. I am short myself and only gained 14lbs with the pregnancy. Now he is 6 months old and he has his arms both of them in a backwards postion.
His arms are kinda behind his back. THey are tight i have to manully rotate them foward. I have tried to find info on this and come up with nothing. I wish i had answers would love to hear if anyone has gone though this or something similar with there child. The fact that your son seems to have problems with both arms and possibly his ankles suggest that this may be something else. Hopefully a reader will pop up and share their experience.
Amanda, Hi! Did you ever receive a diagnoses? Your little one and birth experience sounds similar to mine. We are in the process of getting a diagnosis, and I just wondered what your outcome was. Those affect both groups of brachial plexus nerves resulting in both arms being injured. I hope you have gotten your little one into see a Brachial Plexus Center. A few prolonged decels in 2nd stage.
Mum was flipped onto her back to check for full dilatation why with a multi, seriously!?! Then of course she stayed there, was given an epis to expedite the delivery, and immediate downward traction by the Reg, despite the in charge MW asking to wait for restitution. There was no movement of the mother at all, only SPP applied, traction on the baby and telling the mother to push. I student asked if we shoud do McR, but as her knees were already at her chest since before the head was born I was told no, this IS McR.
I believe birth occurred after some kind of internal manoeuvre rubins 2? This is difficult to comment on as there are a number of questions… why was the woman on a CTG?
Otherwise this is not evidence based. Was the woman being coached to push? An upright position will expedite a birth quicker than an episiotomy with a multi. Yes… when a baby is compromised you might not wait, and may encourage the mother to get the baby out quicker or assist her to.
And a baby would need to be very compromised to attempt to pull it out without waiting for another contraction… not just a few prolonged decels. Just my thoughts without the benefit of being there. Thank you Rachel or your reply. I feel that if she had not been put on her back for the VE , and encouraged to push with her body as was already starting to happen , the baby would have been born soon after and her position would have facilitated an easier birth of the shoulders.
Until I am an experienced practitioner though, its hard to go wth your instincts! That makes more sense. This was possibly not a physiological birth… she had an APH. The baby was potentially at risk hence monitoring and action to expedite the birth.
And, yes I think your reflection re. Instead of randomly applying various maneuvers, figure out what is causing the SD, and then apply the maneuver that is most appropriate.
Less time will be wasted, and less harm should occur if the maneuver is targeted to the specific presentation. But if you can do the best internal assessment possible and THEN proceed, that probably leads to better outcomes though of course we have no research to confirm that. I had a SD with baby 4 who had one arm behind her back.
I think it was her trying to move her arm to the front. After the SD did not resolve, my MW reached in and assessed her position, found the arm behind the back, and moved it to the front and out.
Baby came quickly at that point. All this took place in the tub with no problems. Baby was pink and had good heart tones throughout, which gave us flexibility in our approach. The arm behind the back is a rare form of SD but a tricky one because most of the other maneuvers would not help.
I was VERY thankful to have a MW who assessed before she just randomly started applying maneuvers, and who never panicked or pulled. Baby was fine, needed no resuscitation, and I had no tears. If a mother is delivering on all fours and she is forced to turn over, can she end up with injuries, for example to the tailbone or hips? No research that I know of… but I know anecdotally that some women experience tailbone pain after birth.
The tail bone coccyx uncurls to create space for the baby. Sometimes it does not go back to where it started. I know one woman who had problems until she had another baby and during that birth her coccyx moved back into place. I clicked on the article you cited and I actually read it. They specifically state that in a peer reviewed clinical study, moms were randomized into an induction of labor group and a natural labor group….
Thanks for pointing out this oversight Trevor — I appreciate readers challenging and contributing to my work — and often change it in response none of us are perfect and I learn from being open to other opinions.
I have taken out this statement along with the statements about augmentation and instrumental delivery although I found references for the later. I took them out because the association between augmentation and instrumental delivery and SD could be misinterpreted… babies who are going to get stuck are probably more likely to require augmentation and instrumental delivery to get them through the pelvis — so those factors are not necessarily causal.
In addition this research does not really support my hopefully somewhat intelligent argument that hurrying birth can cause problems. My aim is not to scare expectant mothers only to share information and discussion. This post in particular is aimed a practitioners and I would be interested to know your thoughts on the rest of the post re.
Im completely brand new to this. I recently gave birth and my son suffered from. Im worried sick and the doctors are no help. They want to wait a couple of months before taking any action. The condition usually resolves itself but may need physiotherapy and rarely surgery. Have you looked up a Brachial Plexus Center near you? Your son needs seen by specialists. My son has a brachial plexus also homebirth shoulder dystocia. The first 3 months before his nerve surgery, we worked on Range of Motion exercises.
I reviewed all the links for suitability for a previously traumatised pregnant woman, not wanting to re-traumatise her. I got to the video link at the end and realised it was a birth I had attended several years ago as a newly independent homebirth midwife. I was the second midwife and was so glad to be working with such a calm, experienced colleague, as this was the first dystocia I had encountered I had been a qualified midwife about 5 years by then, and had mainly worked in a hospital birth centre seeing predominantly normal birth.
I am pleased to report his little baby is now a healthy young girl. I have not seen a shoulder dystocia since in a couple of hundred births as an Independent homebirth midwife. Thank you for presenting this information so clearly. How lovely to have a comment from the midwife in the movie! I am currently 34 weeks pregnant with my first baby. I had a growth scan at 30 weeks where baby was measuring on the 85th percentile. Yesterday my midwife measured fundal height I was in tears for the rest of the day.
Moreover, the Birth Center is in the same building as the Labor Unit so transfer is not an problem, I simply cannot understand this.. I cannot understand it either. Anyhow, the estimation of size is very inaccurate whether by measurement or scan. I am sorry that you are faced with this. Can you insist on birthing in the unit and ask to sign a waiver to cover them if anything does happen? A birth centre midwife… or a homebirth midwife for that matter should be able to manage a SD because it is a emergency that can happen without warning ie.
With my first son I had a successful, yet difficult delivery that I later found out was shoulder dystocia. My son weighed only 7lbs 7oz. I had an epidural with my son at about 7 cm dilation, as I felt the contractions were exhausting me. I am now 32 weeks pregnant with our second child and my doctor has mentioned to me the choice of an elective c-section based on my last moderate dystocia.
I was completely unprepared for this and would really prefer to have a vaginal delivery. I have been practicing the hypnobirthing method and hope to go without an epidural this time.
Has anyone had a small baby dystocia and then an uncomplicated second delivery? I still remember the nurse telling us that my son had his arm up by his head…could that have caused the dystocia?
I do not want to endanger our baby but I feel like an elective c section is extreme. Thanks for the advice! Hi Adrienne When a baby has their arm up they their head or around their neck they can get a little stuck as they leave the pelvis. I love how you explain these things. I was born with SD but thankfully suffered no lasting consequences. I do at least feel empowered that by insisting on as unmanaged and mother-led labour as possible, I can hopefully reduce my risk.
Hi there, I am 38w4d with my second baby. My first was born 7lb 5oz, and I had insulin-controlled GDM, and induction at 39w7d. This time I also have GDM, but have had excellent glucose control with diet and exercise. We are with an insurance company that uses only their own providers, so our options for care have been very limited, and the doctors and midwives are very procedure-driven. An ultrasound a week and a half ago suggested a large baby projected slightly over 10lbs with normal fluid levels.
I have been doing my research, and feel that since my sugar levels have been well-controlled, my risks for shoulder dystocia are not significantly higher than any other woman with a large baby, and I believe that my body can do this! I am a tall woman 6ft and my husband is tall as well 6ft 3in , so having a large baby does not seem strange to me.
I am concerned that if we were to encounter shoulder dystocia, that my health care providers would respond in unhelpful ways that could exacerbate the situation instead of calmly resolving it. Of course, C-section was her first suggestion, followed by induction at 39 weeks. Her descriptions of all the things that could go wrong were clearly geared to scare me into accepting the C-section.
Anyway, all that to say, what are your thoughts? Would that be worth considering, in your opinion? Thanks for any advice you can give, and for this really helpful article!
I can make recommendations or give you an opinion on what I think you should do. The rationale for induction of labour for GDM is due to the increased chance of stillbirth The risk to the baby is uncontrolled blood sugars. There is no evidence to support induction or c-section for suspected large babies. Instead she seems to be recommending a standard institutional policy which maximises profits and is not aligned with evidence.
Did she inform you of the risks associated with c-section or induction for the baby? The biggest cause of fetal hypoxia is pitocin. You need to do what feels right for you. Well, better late than never, but wanted to come back and thank you for the encouragement and information you offered me during a very stressful and difficult time.
Thank you. After doing lots of research and prayer! On the recommendation of our midwife, we did choose to use herbal tinctures to stimulate labor when my daughter was a few days overdue. I appreciate the resources and support you offered me at such a vulnerable time. And thank you for coming back and letting us know how your birth went.
My son suffered shoulder dystocia apart from cuts and bruises eventually he was fine despite having an agpar of 1. I suffered third and fourth degree tears. I lost over ml of blood, stayed in a week and had two blood transfusions. I cannot have any more children and I am devastated. I have frequent nightmares and cannot understand why it has caused me so much damage.
Desperately need some support. Please seek some counselling or support. You have been through a traumatic experience — I am pleased your baby was fine, but a healthy baby and mother are not the only important outcomes from birth. You need to process what happened with someone who can support you. I have a baby shoulder dystocia birth when by daughter was born 15 years ago. I suffered from hip pain and a hip flexor problem afterwards.
I managed it with Physio and it stabilised for several years, though I had tightness in the SI region. I strained the hip flexor three years ago. Could all this be the result of the birth? Are there any UK specialists who can help. I am in sever pain quite frequently and do stretching exercises every day. I hope one of my readers can offer you suggestions for therapists in the UK. IS there a way to print the information in this article without including the 20 plus pages of comments?
Can you set your printer to only print pages 1 to whatever? I can do this with my printer software… not sure what you are using. My first baby weighed 4. Here is the source for that statement: Romoff, A. What needs to be considered is that more babies are born weighing less than 4kg… therefore more babies under 4kg have SD. However, if you look at the proportion of SD occurrence you get a better picture.
So, a bigger baby is statistically more likely to get stuck. And you have already demonstrated your ability to birth a big baby. First baby, long labor but normal, and an average 2nd stage. Mama pushed on toilet then hearttones dropped so we got her onto the bed, semi-sitting-ish it was a squishy bed and hearttones returned to normal. Baby crowned and all was well with the birth of her head and I was prepared to wait for the next ctx. She did not rotate and sure enough her pink head turned blue and then purple.
I tried some gentle traction — nothing, then tried to reach anterior shoulder, but there was absolutely no room and baby started to rotate to posterior. We worked and worked, mama pushed so hard and I pulled harder than I ever had on any baby. I hooked my finger under her armpit it was the only thing I could get a hold of and I was sure I was going to break something — how could that little arm withstand such force? But Nothing. This baby was so, so, so stuck!
Then I felt baby try to breathe — her chest moved and my heart sank: I knew she was truly in secondary apnea and we just needed to get her out no matter what. Thank you God! I grasped that slippery little hand and pulled the posterior arm out and the rest of her came — floppy, white body, black head. Milked the cord, mouth to mouth and some resuscitation and she came around 4 minutes later — slow, but steady.
Something about her told me she was going to be just fine. But I will tell you when she was stuck I seriously thought I might not be able to get her out. And I have never thought that about any SD I have managed before probably I truly believe the rule of thumb is to believe in your abilities as a trained midwife and to not give up!
These urgent situations are why I am there — I have the skills, I know what to do if someone needs help. She weighed 7 14 oz. The mama is average size and her pelvis was roomy and nice. There were NO birth injuries and mama only had a tiny labial tear and was elated! From the time the head was out until birth was 6 minutes.
What a scary situation for everyone! The back of the pelvis has far more room, and if needed you can get your hand in with woman on all fours. Reblogged this on wondermumnz. I really enjoy reading your articles Rachel, again and again I always find a lot of information to use in my practice. I would like to know also about the times in a shoulder dystocia. How much time do we have in a shoulder dystocia to get that baby out?
I would appreciate your response! Thank you! There is no absolute answer. In a SD there will be a reduction or a cessation of circulating oxygen depending on where the cord is, how occluded it is, how compromised the circulation is to the head, etc. Thank you for that Rachel, last year I attended a birth with shoulder dystocia and now is like my theme. I try to look for more and more information and what you post is amazing as always!
Previous birth was induced due to ob. All went great and quite quickly 3hrs first stage, 30ins second stage. I was on gas and air and all fours with a hands off mw throughout until the head came out. The mw told me that the baby is stuck, pressed the alarm button and made me turn to do McRoberts while the room was filled with people. Eventually she managed to get his posterior arm out successfully.
I had a second degree tear and he was assessed and cried after a bit, and we were not too traumatised by the experience as everybody was calm and professional. My son was an average baby weighting less than 3. This time around I diagnosed with cholestasis at 32 weeks and am now facing a very likely induction at weeks.
I enjoyed giving birth naturally, but feel that enduring a string of consecutive procedures that could spiral out of control is more risky than going for a c-section at the first alarming bells. What is your view on this? Hi Marcy I can understand why you are anxious about your birth. Perhaps talk to your care providers about being in a position that will help to slow down the birth without also making your pelvis smaller.
For example, lying on your side will take away the gravity of an upright position but also allow the back of your pelvis to open and make room for the baby.
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