Shoulder dystocia is a type of obstructed labor where, after the delivery of the baby’s head, the anterior shoulder of the infant cannot, or requires significant manipulation to be delivered. Shoulder dystocia can be life-threatening to the infant if it is not delivered, due to the birth canal compressing the umbilical cord.
It’s important for doctors to pay close attention before and during the delivery for potential warning signs that suggest the infant may suffer from shoulder dystocia.
- The need to induce labor with an oxytocic
- Prolonged first or second stages of labor
- The appearance and subsequent retraction of the infant’s head, also known as the turtle sign
- Head bobbing in the second stage of labor
- Failure of the infant’s head to realign with its body after its head emerges
- No shoulder descent or rotation
- An instrument-assisted delivery
- If you experienced shoulder dystocia in a previous delivery
Maternal Risk Factors
The majority of shoulder dystocia cases are unexpected, but there are certain maternal risk factors that have been established:
- Fetal macrosomia
- Maternal obesity
- If the mother is older than 35
- If the mother is short in stature
- If the mother has a small or abnormal pelvis
The greatest concern of shoulder dystocia is damage to the upper brachial plexus nerves, which provide the motor and sensory components of the hand, arm, and shoulder. Other complications include:
- Klumpke paralysis, a variety of partial palsy in the lower roots of the brachial plexus, and can result in intrinsic minus hand also known as claw hand, hand muscle paralysis, and weakness or loss of use of certain muscles in the shoulder or arm.
- Erb’s Palsy, a paralysis of the arm. Depending on the nature and severity of the damage, the paralysis can either heal over a period months, require rehab, or even require surgery.
- Fetal hypoxia, when the infant is deprived of an adequate supply of oxygen, which can increase the risk of sudden infant death syndrome (SIDS).
- Cerebral palsy, a group of permanent movement disorders that appears in early childhood.
- Maternal postpartum hemorrhage, which can be external and / or internal. Internal bleeding is more dangerous, but if either is severe enough and doesn’t receive adequate medical attention, it can result in death.
- Infant death.
How to Manage Shoulder Dystocia
Managing shoulder dystocia is a focus point for many obstetrical nursing units, and some courses encourage routine drills to speed up the response time in deliveries that risk the health of the mother and infant. A common treatment mnemonic, ALARMER, attempts to reduce the harm to the mother by going from the least to the most invasive procedure.
- Ask for help. This can include asking the patient to push harder, asking nursing to alter the angle of the bed, and calling for a pediatrician, an obstetrician, and anesthesia.
- Leg hyperflexion, also known as the McRoberts' maneuver. This widens the mother’s pelvis and flattens the lumbar spine, and is successful in more than 40% of cases.
- Anterior shoulder disimpaction, by pushing against the posterior shoulder.
- Rubin maneuver, which is performed by inserting the fingers of one hand behind the anterior shoulder of the infant and rotating it towards its chest.
- Manual delivery of the infant’s posterior arm.
- Episiotomy, a surgical incision in the perineum to enlarge the vaginal opening.
- Roll the mother over on all fours to free the impacted shoulder.
If none of these maneuvers work, an obstetrician may attempt to fracture the infant’s clavicle in order to avoid a surgical delivery. If a surgical option is required, physicians have two surgical treatment measures to assist the birth.
- Zavanelli’s maneuver, where the infant’s head is pushed back in to perform a cesarean section.
- Maternal symphysiotomy, where the birth canal is made larger by breaking the connective tissue between the mother’s pelvic bones in order to allow the shoulders to pass through.
If you or a loved one suffered from inadequate treatment for shoulder dystocia resulting in unnecessary injuries and medical expenses, you may choose to seek a birth injury claim. It’s vital that you contact a firm with the knowledge and experience necessary to properly evaluate your case. At Kinnard, Clayton & Beveridge, we offer the highest level of comprehensive legal counsel, support, and representation in the Nashville area. Contact us today to talk with our birth injury attorneys about your case.