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Shoulder Dystocia
When Baby Gets Stuck and Delivery Stops
By Shannon McKelden
Until this moment, labor has progressed normally. Pushing is going well and the baby's head emerges from the birth canal. Delivery is imminent. Suddenly things grind to a halt. Instead of leading the rest of the body out, the baby's head withdraws. The birth attendant diagnoses shoulder dystocia, and time is of the essence.
According to ShoulderDystociaInfo.com, approximately .5 percent of all deliveries are complicated by shoulder dystocia. In the United States, that amounts to roughly 20,000 births a year.
"Shoulder dystocia is when, after the birth of a baby's head, the baby's shoulder gets caught under the mother's pubic bone preventing delivery of the rest of the baby," says Dr. Henry M. Lerner, a Harvard Medical School graduate, noted expert on shoulder dystocia and producer of the ShoulderDystociaInfo.com Web site. "It becomes apparent within seconds after the delivery of the head. At that point the doctor or midwife has approximately five minutes to resolve this stuck shoulder before the risk of brain damage due to decreased oxygen flow to the baby's brain occurs."
The risks to both mother and baby are severe – a life-and-death emergency that must be resolved skillfully and expeditiously. Dr. Lerner also mentions it is a major cause of medical liability claims in obstetrics.
Maternal risks include vaginal and/or rectal tears, an increase in bleeding or damage to the pelvic or lower extremity nerves. However, the risks to the infant are far more serious and life-threatening.
"If the baby is stuck for too long, decreased blood flow to its brain can result in either fetal death or cerebral palsy-type neurologic injury," Dr. Lerner says. "The labor and delivery itself can result in either pressure or overstretching of the nerves that run from the baby's upper spinal cord to the shoulder, arms and hands – the brachial plexus – causing temporary or permanent injury to those structures."
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