#36 Shoulder Dystocia

If you’re physically small and your baby is physically big, you could be at risk for shoulder dystocia while giving birth. Shoulder dystocia occurs when a baby’s shoulder gets hung up on their mother’s pubic bone, potentially resulting in injury to both the baby and the mother. The baby needs to be delivered in five minutes because there is decreased blood supply to the baby’s brain while the baby is in the birth canal.

If a baby is large and there is a risk for shoulder dystocia, your doctor may suggest delivering your baby by c-section. This avoids the risk of shoulder dystocia entirely. But what happens if you are delivering your baby vaginally and your baby’s shoulder gets stuck? At this point, for a doctor to do a c-section, the baby’s head will need to be pushed back into the pelvis. There are better ways to handle shoulder dystocia.

An old technique for freeing your baby’s shoulder is called the McRobert’s maneuver. With this technique, the physician needs to flex (bend) the mother’s knees and hips with the help of the nurses. The nurses need to be well-trained, knowledgeable, confident, and above all, calm. There should be two nurses, one managing each leg. The goal is to use the flexion of the legs and hips to increase the room in the pelvis of the mother so the baby can move beyond the pubic bone.

Alternative birthing positions may help prevent shoulder dystocia. In the U.S., most mothers deliver on their backs. Having the mother on her hands and knees, or even on her side, are good alternative options to help prevent shoulder dystocia. Again, the most important safety precaution is for the physician and nurses to remain calm and not lose their composure.

When I was in residency in Minneapolis, we had many Hmong women deliver in the hospital. Hmong women are small, but they were able to deliver large babies without developing shoulder dystocia because they sat on the floor on their feet with their knees and hips bent (flexed). This is very much like a verticle McRobert’s maneuver. I will never forget one Hmong mom who was 4’ 8” tall who delivered a 10-pound 4-ounce baby. I did have to move her to the delivery room table, but I was able to rotate the baby 180 degrees and deliver the baby without incident.

If your doctor expresses concern for the size of your baby and suggests delivering your baby by c-section, ask if this suggestion is made because your doctor is concerned about your baby’s shoulder getting caught on your pubic bone. If this is a concern for you physician, ask what your physician does when confronted with shoulder dystocia. You will then need to decide whether to accept the suggestion of a c-section, or whether you want to choose to have a vaginal birth with the possibility of shoulder dystocia.