Information - shoulder dystocia

Shoulder dystocia during a vaginal birth is considered an obstetric emergency, as the potential consequences for both mother and baby can be devastating.

The complication arises if a baby’s shoulder gets lodged in the mother’s pelvis during delivery. During the labour, the baby naturally turns as they are being delivered. Shoulder dystocia arises if, during this process, the baby’s head is delivered, but their shoulders become stuck, meaning delivery without assistance isn’t possible.

Time is of the essence for the obstetric team managing the labour as the baby’s chest is compressed, and the umbilical cord is pressed tightly between the baby’s body and the mother, so no oxygen is reaching the baby. The general rule is that there is a period of only 10 minutes before there is a significant chance of long-term harm for the baby.

There are various manoeuvres and techniques that can be successfully used to dislodge the baby and ensure they are delivered safely. All obstetricians and midwives should be well trained in these, and hospitals will perform drills to ensure their staff are well-practiced.

Shoulder dystocia can often occur unexpectedly. However, there can be factors that increase the chance of shoulder dystocia occurring, such as if the mother has diabetes or a BMI higher than 30; if the birth has been induced; or if it is an assisted vaginal delivery.

Those providing antenatal care to the expectant mother should assess whether there is an increased risk of shoulder dystocia occurring, and prepare for the same if so.

If shoulder dystocia does occur, those managing the labour need to employ the recognised procedures to ensure the best chance of a positive outcome for mother and baby.

The risks to the mother can include cervical, vaginal or perineal lacerations, requiring extensive repair; bladder injury; spontaneous separation of the symphysis pubis and postpartum haemorrhage.

The risks to the baby include injury to a group of nerves, known as the brachial plexus, which provide function to the upper limbs; fractures of the collarbone or humerus; neonatal asphyxia and, in rare cases, death.

If too much force is applied when attempting to deliver the baby, this can result in fractures to the baby’s arm, or injury to the nerves that allow the arm to function. This can mean permanent damage, known as Erb’s Palsy, often requiring surgery in an attempt to restore as much function as possible.

Shoulder dystocia is difficult to predict, but it is important that those who are providing the care can recognise the potential risk factors, advise the patient and prepare accordingly. If it occurs unexpectedly in labour, those managing the labour need to be able to act swiftly to deliver the baby as soon as possible, whilst ensuring no avoidable injuries are caused to either mother or baby.

At CNCI, we have dealt with a number of successful clinical negligence claims involving instances of shoulder dystocia, where the way in which the situation was handled by the medical professionals was deemed to be negligent, resulting in permanent nerve damage to the babies, and in some cases, injuries to the mother also.