Birth Trauma: Treatment of Shoulder Dystocia
Shoulder dystocia is a medical emergency which needs to be treated with immediate urgency. Because it is almost impossible to know in advance who will be affected by the condition, all midwives need to be prepared to deal with it at all times when they are working with a labouring woman.
The treatment of shoulder dystocia can be attempted in a number of ways:
- Episiotomy: One of the first steps can be to perform an immediate episotomy, ie make a surgical cut in the perineum, the area between the vagina and the anus. It may benecessary to make the episotomy longer and deeper than normally required. If this action is undertaken it allows more space in the birth canal for the baby.
- Flexion of Legs ( McRoberts Manoeuvre): The labouring mother will be told to lie on her back and her knees will be brought up to her chest as much as possible. This allows the vagina to open up more fully which may help with the delivery.
- Manoevre of Baby's Head: The doctor will push on the baby's head very firmly in an attempt to move the shoulder away from the symphysis pubis, under which it is trapped. However, it is important he does not apply too much pressure to the head as he could end up damaging the baby's neck and nerves which can lead to a brachial plexus injury such as Erb's Palsy.
- Suprapubic Pressure: The doctor will apply pressure above the symphisis pubis in a downward and forward direction. This can help to release and free the baby's shoulder.
- Internal Rotation: If none of the above are successful, the doctor will next try to put her hand into the vagina and press on the baby's trapped shoulder in order to reduce the breadth. This can sometimes be successful and allow the baby's birth to proceed.
- Delivering the Posterior Arm: The doctor will attempt to put her hand into the vagina and try to get hold of the baby's posterior arm. She will bring it across his chest whilst keeping the elbow flexed to prevent injury to the upper arm bone. She will then bring the baby's arm out of the vagina and this will hopefully disimpact the trapped shoulder since the baby's shoulder diameter will be decreased.
- Changing the Mother's Position: The mother will be asked to go on all fours to allow the baby to fall forward in another attempt to dislodge the baby's shoulder.
- Breaking the baby's clavicle/ collar-bone to try to decrease the width of the baby's shoulders.
- Placing a special hook under the baby's armpit and attempting to deliver it.
Both of the above options are very much last resort options and sadly, they can result not only in serious injury to the baby but they can also lead to the death of the baby.
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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
