Mothers of babies who have suffered severe birth injuries, including shoulder dystocia, may have had certain risk factors.

What Is Shoulder Dystocia?

Shoulder dystocia is a condition which may occur during a vaginal delivery. In this condition, a baby’s head gets stuck in the birth canal because the infant’s shoulder is blocked by the pelvic bone.

Shoulder dystocia is associated with “the turtle sign” – when the baby’s head will come out of the mother’s body but then seem to go back into the birth canal. This movement has been likened to a turtle sticking its head out of its shell before pulling back in.

Due to the risk for complications associated with the condition, shoulder dystocia is considered an emergency condition which requires extra interventions by a doctor.

What Are Risk Factors for Shoulder Dystocia?

Unfortunately, risk factors of shoulder dystocia may be more common than expected. A pregnant mother is at a higher risk of having a baby with shoulder dystocia if she:

• Is obese
• Has diabetes
• Is pregnant with multiple babies
• Has previously given birth to a large infant or one with shoulder dystocia
• Has induced labor
• Receives an epidural to help reduce labor pain, which numbs the lower part of the body during labor
• Has a vaginal birth that requires the doctor to use tools such as forceps or a vacuum to help the baby get through the birth canal.

According to the March of Dimes, sometimes this birth injury still occurs even in cases where no risk factors are present.

Mothers who are at risk for shoulder dystocia can talk to their doctor about their options. Although invasive methods aren’t commonly used, a doctor may suggest a C-section delivery or inducing early labor before a baby is too large for a safe vaginal delivery.

Can the Delivery of a Baby with Shoulder Dystocia be Mitigated?

Once a doctor knows that a delivery is complicated by shoulder dystocia, they can take a variety of steps to help protect both mother and baby from injury and other complications. Exact interventions can vary, but some common strategies may be used.

The staff may apply pressure to the mother’s thighs, against her belly, or to the lower part of the mother’s belly in an attempt to dislodge the baby.

The mother may need an episiotomy, which is an incision in the perimeum, between the anus and the vaginal opening, which may allow the doctor more room to reach in and turn the baby’s shoulder, helping the baby to maneuver around the pelvic bone.

The mother is advised to stop pushing while her doctor tries to dislodge the impacted shoulder.

In many cases, something known as the McRoberts maneuver may be performed to help alleviate the narrowing that has caused the shoulder dystocia. During this obstetrical maneuver, the mother’s legs are hyperflexed to her abdomen, which may help flatten the spine and allow the impacted shoulder to rotate.

What Complications May Develop From Shoulder Dystocia?

Shoulder dystocia and the required interventions can be a physically traumatic experience for the mother and baby. In mothers, this condition can cause excessive bleeding and tearing of a mother’s cervix, rectum, uterus, or vaginal tissues.

Shoulder dystocia may also cause injuries to the baby. According to Healthline, less than 10% of babies have permanent complications from injuries due to shoulder dystocia. However, when these complications do occur, they can be catastrophic.

A baby born with shoulder dystocia may suffer nerve injuries to the shoulder, arms or hand. In some cases, the affected limb may shake or become paralyzed, but this often resolves in six months to one year.

In some cases, networks of nerves in the body known as the brachial plexus, which sends nerves near the neck down to nerves in the arm, will become damaged. The result may be a form of cerebral palsy known as Erb’s palsy.  With this condition, the baby’s arm may appear rotated toward the body or hang limply from the shoulder, the National Institutes of Health explains.

If the baby is stuck in the birth canal and unable to breathe for too long, the infant may suffer brain damage from the lack of oxygen.