Infant Shoulder Dystocia

What is Infant Shoulder Dystocia and How is it Caused?

Shoulder dystocia is a complication that occurs during delivery when an infant’s shoulders become lodged in the mother’s pelvic, often because the baby is proportionately too big for the birth canal (cephalopelvic disorder, known as CPD).

Other causes of shoulder dystocia happen when the baby is born face first (sometimes called the turtle syndrome), pulled out by the face causing undue stress on the neck, or when the baby is born feet first, also creating undue stress on the shoulder and neck area.

What are the Symptoms and Risks of Infant Shoulder Dystocia?

Shoulder dystocia is noticed when the baby’s shoulders are still stuck in the mother’s pelvic area after the head has already came out. When attempting to pull the infant out completely, physicians may cause injuries such as brachial plexus palsy,  broken bones, and facial injuries. Depending on if an injury occurs after shoulder dystocia, the symptoms may include:

  • Nerve damage and pain in the injured area
  • A claw-like hand appearance
  • Light paralysis of the affected limb

Mothers are also at risk of medical complications if shoulder dytocia occurs, such as hemorrhaging, uterine rupture, and lacerations.

What is Brachial Plexus Palsy?

Brachial plexus palsy occurs when there is damage to the brachial plexus nerves, and includes injuries such as Erb’s palsy and Klumpke’s Palsy. These conditions are typically happen after shoulder dystocia, usually when the nerve damage is so severe that the nerves have been torn, moved, or completely detached.

Risk Factors Associated with Infant Shoulder Dystocia

The risk of shoulder dystocia is heightened with

  • Maternal diabetes
  • Fetal macrosomia
  • A late labor and delivery
  • Prior instances of shoulder dystocia during delivery
  • Induced labor
  • Epidural use
  • Maternal obesity
  • Pregnant with more than one baby

Is Infant Shoulder Dystocia Preventable?

Shoulder dystocia is, in most instances, a preventable complication during childbirth as physicians who monitor and detect fetal distress can schedule an emergency C-section prior to any injuries happening.

In addition, infants with a higher birth weight and is diagnosed with cephalopelvic disorder (CPD) should be candidates for C-section delivery. It’s ultimately up to the physician to make the decision as to whether a C-section will reduce the risks of shoulder dystocia or if the risks of a C-section outweigh the dangers of injuries associated with shoulder dystocia.

What is the Treatment for Infant Shoulder Dystocia?

Treatment will depend on if injuries occur after shoulder dystocia. In many cases, the infant is still delivered successfully without harming the brachial plexus nerves or damaging any other part of the body. Therefore, treatment will coincide with treatment options for the injuries sustained. For example, brachial plexus injuries may require physical therapy, massaging, and in severe cases, surgery.

Doctors generally attempt medical maneuvers in order to help get the baby out safely and prevent injuries. Typical types of medical maneuvers include internal rotation, the McRoberts manuever, the Zavanelli maneuver, and suprapubic pressure.