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What Is Baby Shoulder Dystocia?
Shoulder dystocia is a birth injury that happens when one or both of a baby’s shoulders become trapped in the pelvis during birth. The shoulder gets stuck behind the pubic bone that is behind the pubic hair. It may also get stuck at the sacrum, the bone at the back of the pelvis.
During the second stage of labor, a pause happens in the birth process, where the baby's head is already out of the birth canal, but the body is yet to come out. Shoulder dystocia occurs when this delay is longer than usual, and it calls for an emergency for the baby to be born.
The condition happens in approximately 1 in every 200 births (0.5%). The baby’s shoulders commonly get stuck during vaginal delivery. It may also occur during cesarean delivery
Why Does Infant Shoulder Dystocia Happen?
The primary reason why shoulder dystocia happens is that the baby is too big. In other situations, the emergency happens because:
- The baby is in the wrong position
- The mother is in a position that restricts the pelvis room
- The mother is overweight
- The mother had labor induced
- The mother is having two or more babies
It can also happen if the labor process goes too fast or very slowly.
Can Shoulder Dystocia Be Prevented?
The condition is a highly unpredictable. There is very little the mother can do to prevent it. However, managing conditions like diabetes and too much weight during pregnancy can help prevent the situation. If the baby is big, you can reduce the likelihood of shoulder dystocia by lying on your side or being on all fours when giving birth.
Signs and Symptoms of Shoulder Dystocia
A doctor can detect signs of shoulder dystocia when they see the head being delivered but the rest of the baby's body takes a long time to come out. Doctors refer to the symptoms as the "turtle sign." The head is first delivered then seems to go back into the birth canal. They describe the situation as a turtle that sticks out its head and then puts it back into its shell.
If the doctor realizes that the baby's trunk is not coming out with ease and may have to take additional actions to help with delivery, they will diagnose shoulder dystocia. It is a major concern that can necessitate an emergency C-section.
Shoulder Dystocia and Birth Injuries
When shoulder dystocia happens, it increases the risk of other related birth injuries. Anxiety may cause doctors to apply much force to try to get the baby out of the birth canal, causing injuries to the baby. Physical trauma injuries like facial damage and broken bones are common.
Other serious injuries include:
- Cerebral Palsy: When shoulder dystocia is not well managed, it can lead to temporary loss of oxygen to the baby's brain. This happens in ways like compression of the umbilical cord, prolonged pressure, and excessive trauma. When a baby lacks enough oxygen during birth, they can develop cerebral palsy or permanent brain damage that impairs their ability to control the body's movements.
- Erb’s Palsy and brachial plexus: This child's injury happens when the brachial plexus nerves in the neck or shoulder area are injured. These nerves connect the brain to the arms and hands. When they get damaged, they cause Erb’s palsy, which paralyzes the arms and hands of the baby.
- Clavicular and humerus fractures: Both of the baby's arms can be injured, and the collarbone can also break. Broken bones in an infant can be hard to detect, leaving the baby in too much pain for long.
These birth injuries related to shoulder dystocia can be avoided if the medical team is quick enough to recognize the dystocia. This allows them to quickly take steps to help the baby out of the position or deliver it through a caesarian section.
What to Do if Shoulder Dystocia Occurs
Your midwife or obstetrician will know that there is a possibility of shoulder dystocia in every birth. When it occurs, it should be treated as an emergency and ask for extra help from the medical team. They will take steps immediately to release the baby's body. This is important to help the infant start breathing air into the lungs.
In the case where a C-section is not scheduled, the midwife may take specific steps to attempt to move both the mother and baby into a position that allows the baby to move out. Proper management of shoulder dystocia includes:
- Episiotomy: This entails performing a surgical cut at the vaginal opening during childbirth to widen the passage.
- Collarbone fracture: The doctor may break the baby’s collarbone to help release the stuck fetal shoulders in severe cases.
- McRoberts Maneuver: This is flexing the mother’s legs and bringing the thighs as close to the abdomen as possible.
- Kristeller maneuver: apply pressure to the uppermost of the abdomen towards the birth canal. More studies are crucial on the safety of this procedure.
- Wood’s Corkscrew maneuver: The doctor may reach inside the vagina to manually rotate the baby in an attempt to free the stuck shoulder
- Applying Suprapubic pressure: The doctor may press on the mother's lower abdomen directly above the mother's pubic bone to push the baby's shoulder away from the pelvic bone.
Monitoring a mother during pregnancy and throughout labor and delivery can help an obstetrical team reduce the likelihood of serious shoulder dystocia complications.
Newborn babies may suffer complex complications as a result of shoulder dystocia. If you believe that the doctors could have avoided it, you can reach out to a birth injury attorney to help you get compensation for the damage.