Shoulder Dystocia

Shoulder dystocia is a birth complication. During childbirth, the child’s shoulder gets caught in the mother’s pelvis.

Shoulder Dystocia

What is shoulder dystocia?

Shoulder dystocia is a rare but feared complication of childbirth. It occurs in about one percent of all births. Shoulder dystocia is when the child’s front shoulder becomes stuck at the mother’s pubic symphysis or pelvis after her head has protruded. This keeps the baby’s torso from leaving the mother’s body.┬áSee bestitude for Meanings of Altitude Sickness.

A distinction is made between a high and a low shoulder straightness. A high shoulder straightness is when the infant’s shoulders are lengthwise rather than crosswise. This causes the anterior shoulder to catch on the mother’s symphysis. The pubic symphysis then hinders the stepping down of the shoulder.

The transverse position of the shoulder on the mother’s pelvis is referred to as low shoulder straightness. This shape is created by the lack of shoulder rotation. Ultimately, shoulder dystocia results in a delay in the further birth process.

Causes

In most cases, shoulder dystocia is caused by the child being oversized. Doctors speak of this when the baby weighs more than 4000 grams. This is particularly the case for mothers who suffer from diabetes (diabetes mellitus). Their children often have a macrosomia, in which the width of the shoulders is greater than the circumference of the head.

However, more recent evidence sees more than average growth of tissue that is insulin intensive. These include the shoulder and torso areas. Occasionally, excessive use of the Kristeller handle, pushing along too early, or vaginal delivery using forceps or a suction cup can also result in shoulder dystocia.

In addition, there are some risk factors that make shoulder dystocia more likely. The main reason for this is that the mother is overweight . In such cases, there is often extensive fat deposits within the pelvis. These prevent the baby from inserting its shoulders into the mother’s pelvis in the correct position. Other risk factors include pelvic anomalies in the mother and a rapid expiration of the expulsion period.

Symptoms, Ailments & Signs

A typical feature of shoulder dystocia is the birth arrest after the child’s head has already appeared. In the case of a high shoulder straightness, the child’s head is encased by the maternal vulva like a ruff. Arresting labor causes more time to pass, which in turn increases the risk of oxygen starvation.

It is not uncommon for shoulder dystocia to fracture the collarbone or upper arm. The nerve plexuses in the child’s arm can also be affected. Even signs of paralysis are within the realm of possibility. In severe cases, the baby can even die due to traumatic brain damage or lack of oxygen.

Diagnosis & course of disease

The occurrence of shoulder dystocia is usually very surprising for the obstetrician. This rare complication does not announce itself before birth. However, some factors can provide indications of a possible shoulder dystocia even before the birth process. For example, the expulsion phase lasts longer in some cases. Difficult passage of the head can also indicate dystocia.

It can be recognized by the retraction of the child’s head after it has emerged. Doctors also refer to this process as the turtle phenomenon. Shoulder dystocia carries the risk of long-term effects such as brain damage. These are caused by a lack of oxygen, for example, because the child’s head becomes entangled in the umbilical cord. The mortality rate from shoulder dystocia is between 2 and 16 percent.

Complications

Shoulder dystocia is usually a complication during childbirth. This leads to a complete standstill during the birth, which can be life-threatening for both the child and the mother. In the worst case, the child or the mother dies.

However, this case only occurs very rarely and especially if the complication is not treated. Furthermore, the patient’s collarbone can also break, so that a surgical intervention is necessary immediately after birth. Various paralysis or sensory disturbances can also occur as a result of the injuries and complicate the further life of the child.

No prediction can be made about the further course of this paralysis. Brain damage is also possible. If there is a lack of oxygen, the child’s internal organs can also be irreversibly damaged. Shoulder dystocia can usually be treated well with medication. Surgical interventions may also be necessary. However, there are no particular complications and the course of the disease is positive.

When should you go to the doctor?

If you have shoulder dystocia, you should see a doctor. This disease cannot heal itself, so treatment by a doctor is always necessary. The earlier the symptoms are recognized and treated, the better the further course of the disease. In most cases, shoulder dystocia is recognized at birth by the doctor or midwife and then treated immediately.

There are no further complications or other complaints. Only in serious cases can the child be injured. If injuries occur in the child after birth, a doctor must be consulted in any case to guarantee proper healing of these injuries.

In some cases, injuries to shoulder dystocia can lead to psychological upsets or depression in parents or relatives. A psychologist should be consulted to avoid further psychological problems.

Treatment & Therapy

The type of therapy for shoulder dystocia depends on the form it is in. If the shoulders are straight, a tocolytic is administered first to stop the mother’s contractions. In order to obtain more space, a vaginal perineal incision (episiotomy) is then carried out. The next step is to perform the so-called Roberts maneuver.

In this procedure, the obstetrician extends the mother’s legs, resulting in an enlargement of the conjugate vera by approximately one centimeter. The manual application of pressure directly above the pubic symphysis also supports the child’s rotation in the longitudinal axis. It is even possible to adjust the child’s shoulders to the oblique diameter. If the rotation is successful, a maximum bending movement takes place within the hip joint. This gives the front shoulder more space.

If the Roberts maneuver does not lead to the desired result, intubation anesthesia must be carried out in order to be able to loosen the pelvic floor. If the shoulder is low, the child’s head is turned after an extended episiotomy. Likewise, the shoulders are rotated in the longitudinal axis. Performing the Kristeller maneuver, which is used to exert pressure on the fundus roof, is considered a useful support. With a low shoulder cross stand, the risk of complications is lower.

Other possible treatment maneuvers include the Gaskin maneuver, the Woods manoeuvre, the Rubin manoeuvre, or rear arm release.

Prevention

To avoid shoulder dystocia, the risk factors that trigger it should be recognized early. In the case of diabetes mellitus, a macrosomy-related birth complication can often be counteracted by adjusting the metabolism. If the baby is already overweight, a caesarean section is usually carried out.

Aftercare

The pediatrician or physiotherapist will provide information on how to deal with the affected children and on aftercare for shoulder dystocia. Long-term physiotherapy, which is carried out consistently from the second to third week of life, is important. The therapeutic goals of change include developing and maintaining muscle functions, avoiding movement restrictions as a result of muscle shortening and stimulating the muscles.

Physical therapy is also used to support spontaneous development in the case of plexus paresis, to prevent poor posture and to improve coordination. In addition to the supporting movement exercises in children’s physiotherapy, the parents receive instruction in exercises that they have to do at home. Only continuous practice ensures that the nerve functions recover and the muscles are strengthened.

During physiotherapeutic treatment, the caregivers also learn how to carry and position the child in different positions, adapted to their developmental steps. This is intended to prevent additional damage to the brachial plexus. Neurophysiological treatment methods such as the Bobath concept and/or the Vojta therapy are recommended and prescribed throughout Germany for the follow-up treatment of shoulder dystocia.

However, these intensive therapeutic procedures can cause great reluctance in infants and children. Many parents therefore suffer from fears and worries that they should talk to the treating person about. Suddenly stopping therapy can cause serious problems.

You can do that yourself

Since shoulder dystocia is a complication of childbirth, planning the delivery early and having a trained obstetric team around is strongly recommended. The birth of the child should under no circumstances take place independently and alone in the home. The possibility of driving to the nearest hospital with the help of a relative or of alerting an ambulance should be organized in good time. Otherwise, there may be serious complications for the mother giving birth or the offspring.

If the birth stops, it is essential to seek medical help because the lives of mother and child are at risk. In the case of an inpatient birth or a delivery in the presence of a midwife, the instructions of the medical staff must be followed. Under all circumstances, calm should be maintained. Additional stress and excitement from the mother-to-be or relatives make the situation even worse. Communication with the obstetrician is necessary throughout the birth process. Changes, abnormalities or special features must be discussed with each other immediately and open questions should be clarified.

Since developments during delivery are often surprisingly sudden, it is important not to allow any additional panic or anxiety to arise and to trust the obstetricians.