A shoulder dystocia is a complication encountered at the time of vaginal delivery. This is when a baby’s head has delivered, but the shoulders are stuck in the birth canal and do not deliver using standard delivery technique. Complicating approximately 1.5 percent of all vaginal deliveries, this obstetric emergency is often unpredictable, but is something that obstetricians and midwives must recognize and treat quickly.
After the delivery of a baby’s head, the shoulders should deliver easily with gentle downward guidance by the obstetric provider. If they remain stuck, however, a shoulder dystocia is recognized, and additional delivery techniques will be used to deliver the baby. These can include:
- Flexing the mother’s legs further back to make more room (McRoberts maneuver)
- Applying pressure above the pubic bone to try to dislodge the stuck shoulder (suprapubic pressure)
- Rotating the baby in the birth canal to help the shoulder slip out (Woods corkscrew or Rubin maneuvers)
- Reaching in to deliver the arm that is not stuck under the pubic bone, which will then make more room in the pelvis so that the arm that is stuck can fit under
- Cutting an episiotomy
- Fracturing the baby’s clavicle to make the diameter between the shoulders smaller
- Having the mother turn on a hands-and-knees position to make more room in the pelvis (Gaskin maneuver)
While some of these may seem extreme and the idea of breaking a bone to help permit your baby’s delivery may seem dramatic, keep in mind that decreasing the amount of time that your baby’s brain is deprived of oxygen is the most important goal.
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