Shoulder dystocia

What is shoulder dystocia?

Shoulder dystocia can happen during childbirth. It happens when one of your baby’s shoulders gets stuck behind your:

• pubic bone (the bone behind your pubic hair)
• sacrum (the bone at the back of your pelvis, above your tailbone)

Your baby will need emergency help to be born.

Shoulder dystocia happens in about 1 in every 100 vaginal births.

What happens when there is shoulder dystocia during birth?

During the second stage of labour, there is normally a pause after the baby’s head has been born, before the body comes out.

When shoulder dystocia occurs, this delay is longer than normal. There are also other signs your midwife or doctor will look for to diagnose shoulder dystocia.

What causes shoulder dystocia?

It’s impossible to predict whether shoulder dystocia will happen. But there are some things that make it more likely. These include if you:

• have experienced shoulder dystocia during a previous labour
• have had your labour induced
• have had other interventions during labour
• are having a large baby (this is called fetal macrosomia)
• are very overweight
• have diabetes

Shoulder dystocia can also happen if your labour goes very slowly.

How is shoulder dystocia treated?

Shoulder dystocia is a medical emergency.

While your baby is stuck, they can’t breathe and their umbilical cord may be squeezed. Your baby will need help to be born quickly so they can get enough oxygen.

What actions are taken if shoulder dystocia happens?

If your doctor or midwife suspects shoulder dystocia, they will first tell you to stop pushing. They will immediately call for help, since you may need other specialist doctors and nurses to help care for you or your baby.

Sometimes, simply changing your position can free the shoulder. You might be asked to lie flat on your back with your knees pulled back as far as they can go. This is called the 'McRoberts position'. Your midwife or doctor may also gently press above your pubic bone to help free your baby’s shoulder.

Another position that can work is for you to get onto your hands and knees (all fours).

Sometimes, your midwife or doctor will need to put their fingers or hand inside your vagina to free your baby’s body. You may need an episiotomy first. If this is the case, your midwife or doctor will explain what’s happening and ask you to consent to the procedure.

Other emergency treatments

In very rare cases, your midwife or doctor will need to break your baby’s collarbone to get them out. It will heal quickly afterwards.

Another option is for you to have an emergency caesarean under general anaesthetic. Once the anaesthetic has taken effect, your baby will be pushed back into your uterus and delivered through a cut in your tummy.

Both of these options are emergency treatments.

What should I expect after the birth?

Most babies recover from shoulder dystocia very well. But because they may have been injured or deprived of oxygen, they may need to be watched more closely or spend time in the neonatal intensive care unit.

Some babies will need physiotherapy, and you may need help with breastfeeding if your baby has been injured.

You might feel shocked, guilty or worried about your baby. Your doctor, midwife, or a maternal child health nurse can help you deal with these feelings.

Your doctor or midwife will also talk with you about why the shoulder dystocia might have happened.

Can shoulder dystocia be prevented?

Shoulder dystocia is unpredictable so there’s very little you can do to prevent it.

Your doctor or midwife will talk with you about the risk of shoulder dystocia if you’ve had a previous baby with shoulder dystocia.

You may be at increased risk if you have:

• a large baby
• diabetes during pregnancy

Your doctor or midwife will discuss with you how to manage your risk.

What are the possible complications of shoulder dystocia?

The difficult birth associated with shoulder dystocia can sometimes cause injuries to your baby. These can include:

• a fracture of your baby’s collarbone or upper arm
• nerve damage affecting your baby’s shoulders, arms, hands or fingers

Sadly, there is a risk that lack of oxygen during birth can lead to brain damage or even death.

Sometimes shoulder dystocia can lead to complications for you, including:

• birth injuries such as tears or nerve damage
• postpartum haemorrhage (bleeding)

These complications are rare, and doctors and midwives are highly trained to deal with them.

If you have a tear or haemorrhage, it can take some time for you to recover.

It can also be hard emotionally if you have had a difficult birth. Talk with your doctor or midwife about support services and treatments after a difficult birth or birth trauma.

Resources and support

The Australasian Birth Trauma Association provides resources and support to help recovery after birth-related trauma.

Centre of Perinatal Excellence (COPE) also has information and resources on recovering from a traumatic birth.