Birth Trauma: Shoulder Dystocia
What is Shoulder Dystocia?
Shoulder dystocia is a traumatic experience for both the labouring mother, her baby and her partner. It refers to when one of the baby's shoulders gets stuck behind the pelvic bone and prevents the baby's body being born. (see shoulder dystocia video)
Shoulder dystocia happens during the second stage of labour and can occur during either a normal or instrumental birth; it can even occasionally occur during a c-section. It is a very serious pregnancy complication and needs to be treated with great urgency; otherwise the outcome can be detrimental or even fatal for the baby.
Normally, during birth the baby's head is delivered, followed, after a short delay by the rest of its body. However, with shoulder dystocia this delay is lengthened, meaning the baby cannot begoin to breathe because its chest is being compressed. The umbilical cord is also being compressed resulting in the baby's oxygen supply being cut off.
It is therefore very important that the baby's shoulder is released as quickly as possible so that the baby can be safely delivered and breathe air.
Fortunately, shoulder dystocia only happens in around 0.5% of UK births. Although there is always a risk of it occuring, it is not possible to determine those most at risk. However, it is known that there is a higher incidence of shoulder dystocia when babies are over 4.5kg in weight, if the mother has gestational diabetes; where there is a history of previous shoulder dystocia; during induced labours; if labour progresses slowly.
Although larger babies are deemed to be more at risk, in reality most larger babies are born safely without the problem occuring. It is not always possible to predict the weight a baby may be as ultrasounds become less accurate at detecting weight near the end of pregnancy and many babies who have shoulder dystocia weigh less than 4kg.
If your caregivers suspect your baby will be very large you will normally be advised to attempt a normal birth as c-sections and induced births are not normally advised. However, if a previous baby suffered shoulder dystocia then your consultant or midwife may discuss the option of having a caesarian.
What Happens During Shoulder Dystocia
Shoulder dystocia can be etremely frightening for both the birthing mother and her partner. It is an emergency situation and this means every second counts. Your midwife will summon extra help immediately.
Your obstetrician or midwife will tell you to stop pushing and they will reposition you so that the baby gets as much room as possible inside the birth canal. You may be asked to lie on your back and your legs will be pushed towards your chest. The midwife of obstetrician will then push on your abdomen, just above your pelvic bone, to try to release the baby's shoulder. This is known as the McRoberts Manoeuvre.
It may also be necessary to perform an episiotomy (ie make a small cut in the perineum) in order to enlarge the vaginal opening.
The obstetrician will then attempt to move the baby within the birth canal to dislodge its trapped shoulder. In the majority of cases a safe birth follows.
After Effects of Shoulder Dystocia
Both mother and baby will be carefully monitored following a shoulder dystocia birth as problems can unfortunately result from the experience.
The baby may suffer from the following:
Nerve damage/ Brachial Plexus Injury: The nerves in the baby's neck allow movement and feeling to the arms. Whenever one of the shoulders gets stuck during shoulder dystocia the nerevs in the baby's neck can be injured. This can result in a condition known as Brachial Plexus.
Around 1 in 10 babies who have suffered from shoulder dystocia can end up with a brachial plexus injury. This may mean the baby will have some paralysis in its affected arm but in the majority of cases the paralysis is temporary and resolves itself within a few hours or days. Around 1 in 100 babies will unfortunately suffer permanent damage. The two main formas of brachial plexus injury are Erb's Palsy and Klumpke's paralysis.
Other injuries to the baby that may result from shoulder dystocia include fracture of the arm or shoulder which usually heals fairly quickly. However, sometimes brain damage or even death can result if the baby cannot be freed quickly enough and the oxygen levels are cut off for too long. This is why shoulder dystocia is such an emergency situation and why time is so very important.
The mother may suffer from:
Vaginal Tears: the vagina can tear during any birth but this is particularly likely to happen during a shoulder dystocia situation. The tear may extend through to the back passage (ie, a third degree tear) or to the vaginal wall (vaginal laceration). However, any tears which do occur will be repaired very carefully by your midwife or a doctor.
Heavy Post Partum Bleeding: You may experince a post birth haemorrhage and it may be necessary to have a blood transfusion and possibly surgery to control the bleeding.
Emotional Problems: After going through the traumatic experience of experiencing shoulder dystocia during the birth of your baby you may suffer emotionally. Some women feel it must be their fault and they may also feel they will never want to have another baby again. Some feel unable to bond with their baby and some may feel anger towards their caregivers, partner or even the baby. These feelings are natural and the mother needs to accept no-one was to blame for the problem occuring. She may need to be referred to a specialist for counselling as post-natal depression and post traumatic stress disorder can result from a shoulder dystocia birth.
You midwife and doctor will be watching out for any symptoms suggesting you have been emotionally affected and your partner should also be made aware of the symptoms to look out for as prompt help can make a huge difference.
Related Articles
Treatment of Shoulder Dystocia
Further Information about Birth Trauma and Erb's Palsy
Erbs Palsy Group
Erb’s Palsy Group
60 Anchorway Road
Coventry
Warwickshire CV3 6JJ
Tel: 024 7641 3293
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