In plain words
Shoulder dystocia happens when a baby's head is born but one shoulder stays behind the mother's pubic bone. It is an uncommon emergency. Most babies who have it are not seriously harmed, but it can cause injury to the baby's arm or collarbone and, more rarely, more serious problems. The risk is higher with a , with , and after a previous shoulder dystocia. Many cases cannot be predicted, even when risk factors are present. Care teams are trained in specific maneuvers to free the shoulder, and they practice these in drills. Mothers may hear about the risk during pregnancy, especially with gestational diabetes or a large baby. It is a reason the team stays close during the moments after the head is born.
The deeper version
Shoulder dystocia is the need for additional obstetric maneuvers after gentle downward traction fails to deliver the anterior shoulder following delivery of the head. It is uncommon among vaginal births, with rates that rise with birth weight and maternal diabetes. The Pedersen hypothesis explains much of the association with macrosomia: maternal glucose crosses the placenta but maternal insulin does not, so fetal hyperglycemia drives fetal hyperinsulinemia, promoting adiposity and disproportionate shoulder and trunk growth. The same mechanism raises fetal oxygen demand and can cause after birth. ACOG Practice Bulletin 178 (2017) reviews risk factors, the limits of prediction, and maneuvers. Brachial plexus injury and clavicle fracture are the main morbidities, and prior shoulder dystocia is a strong predictor of recurrence.
Where it comes up
- When the baby is injured at birthLoss and Complications
- Hospital, birth center, or homeGetting Ready for Birth
- Gestational diabetesPregnancy: Your Body
What mothers here say about shoulder dystocia
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Sources
- American College of Obstetricians and Gynecologists — Practice Bulletin 178: Shoulder dystocia, 2017
- Pedersen J — The Pregnant Diabetic and Her Newborn, 1967