Shoulder Dystocia During Childbirth - Healthocrates

Shoulder dystocia is an emergency during labor and delivery that is caused when the baby’s head has been delivered but its shoulders are stuck and cannot be delivered naturally. A shoulder dystocia can be caused due to several reasons as outlined below.

Shoulder Dystocia Causes

Entrapped shoulders: Sometimes during delivery, the shoulders of the fetus may get entrapped behind the mother’s pelvic bone. This can cause shoulder dystocia as the shoulders get stuck and cannot be delivered properly. In fact, this is one of the leading causes of shoulder dystocia during birth. It is also believed that applying excessive fundal pressure (downward pressure on the maternal belly) to help the baby descend into the birthing canal may also cause its shoulders to get entrapped behind the pelvis, thus leading to shoulder dystocia.

Improper rotation of baby’s shoulders during birth: By rotating the baby’s head, its shoulders can be aligned in the antero-posterior diameter of the birthing canal, which is the right position for easy delivery of shoulders. However, some doctors may rotate the shoulders improperly, thus causing shoulder dystocia.

Applying unnecessary lateral traction: Sometimes, there may be a little delay in the baby’s shoulders being delivered after its head has cleared the birthing canal. This can be a natural delay and does not necessarily indicate dystocia. However, inexperienced doctors (and even some experienced ones) may not recognize the difference. Thus, excessive lateral traction may be applied to the baby’s neck so as to free the shoulders. However, lateral traction only serves to push the baby’s head towards either of its shoulders and they get stuck, thereby causing shoulder dystocia instead of helping it along.

Baby’s shoulders folded inward during birth: Sometimes, a baby’s shoulders can get folded inward during birth. When this happens, it becomes more difficult to deliver the shoulders and a dystocia can occur. In addition to this, a dystocia can also occur if the baby is mal-presented (not in the head down presentation) or mal-positioned (positioned incorrectly with shoulders first etc) for the birth.

Administering Epidural: An epidural is a type of anesthesia that is administered to help the mother during labor. It reduces the pain of labor but contractions still proceed as normal for a pain free vaginal birth. As a result of the epidural, the mother loses most of her sensation to push. When this happens, the pushing may not be a natural process which may cause the fetus to descend improperly into the birthing canal. This in turn results in an impacted shoulder, thus causing shoulder dystocia.

Improper use of forceps during birth: Forceps is a medical device that is used to assist the birthing process. A forceps looks like a pair of tongs and typically grips around the baby’s head so that the baby can be assisted out of the birthing canal. It is true that forceps can be very effective in difficult deliveries, but when used improperly, can contribute to severe injuries. Incorrect handling of the forceps can also turn the head of the baby in the wrong direction, thus impacting its shoulders and causing shoulder dystocia.

Incorrect use of vacuum extractor: A vacuum extractor is another medical device that is used to assist deliveries. The soft plastic cup of the vacuum extractor is affixed to the top of the baby’s head, and then the doctor applies vacuum pressure gently, thereby moving the fetus into the desired proper birthing position. However, it is possible for too much pressure to be exerted by the doctor, which can cause nerve damage leading to brachial plexus palsy. In some cases, excessive suctioning or incorrect maneuvering of the baby inside the birth canal can lead to shoulder impaction and eventually shoulder dystocia.

Thus, many factors can cause shoulder dystocia during birth. A women's pregnancy, and the labor and delivery can be the most wonderful experience in the world. However, just like any health related procedure, there are risks involved, and it is important for the patient to discuss the possible risks, procedures, and alternatives as carefully as possible before there becomes an emergent, life-altering problem in the labor and delivery room setting.

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