Shoulder Dystocia Symptoms

What Is Shoulder Dystocia?

Shoulder dystocia is a condition that happens during childbirth when a baby’s head passes through, but one or both shoulders get stuck behind the pelvic bone.

When shoulder dystocia occurs, a baby gets wedged in the birth canal because of their shoulders. While there are certain factors that can increase the risk of shoulder dystocia, especially if a baby is larger than average, it can happen unexpectedly.

Doctors have special techniques to safely deliver babies, and with timely care, many situations are resolved without lasting problems. However, sometimes birth injuries occur.

The labor and delivery team’s early detection of shoulder dystocia symptoms is essential. If you think your doctor may have missed the symptoms of shoulder dystocia during the birth of your child, you probably have questions.

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What Are Common Shoulder Dystocia Signs and Symptoms?

Here are some common warning signs and symptoms of shoulder dystocia:

• Failure to progress: When labor stalls, either because the cervix isn’t dilating or the baby isn’t moving down the birth canal, it could mean the baby is too large and might get stuck during delivery.
• Fetal elbow: If only one of the baby’s arms is delivered while the other remains trapped, this could indicate shoulder dystocia.
• Increased maternal effort: When the mother might need to push for a longer period of time, yet there is little to no progress in the baby’s descent.
• No external rotation: Normally, after the baby’s head is delivered, it rotates to the side. In cases of shoulder dystocia, this rotation may not occur.
• Protracted descent: When the baby descends more slowly than usual during the second stage of labor, it could be one of the possible shoulder dystocia warning signs.
• Turtle sign: After the baby’s head emerges, it retracts back against the mother’s perineum (area between vagina and anus), resembling a turtle retracting its head into its shell. This is one of the most definitive shoulder dystocia symptoms.
• Visible fetal shoulder: In some cases, the baby’s shoulder can be seen or felt lodged behind the mother’s pubic bone.

What Happens If a Baby Has Shoulder Dystocia?

If a baby has shoulder dystocia, the baby’s head delivers, but one or both shoulders become stuck behind the mother’s pubic bone. Immediate medical interventions are needed to safely deliver the baby and prevent complications, such as birth injuries.

Here are some complications of shoulder dystocia to be aware of.

Harm to the Baby

Shoulder dystocia can affect the baby in the following ways.

Broken Arms or Collarbone

The difficult birth associated with shoulder dystocia can cause bones in the baby’s arms or collarbone (clavicle) to break or fracture. Doctors will use ultrasounds and X-rays to see whether a baby’s arms and collarbone were injured after delivery.

Brachial Plexus Nerve Damage

The brachial plexus nerves of a baby may be damaged due to shoulder dystocia complications. The brachial plexus is a network of nerves in the shoulder that carries sensory and movement signals from the spinal cord to the hand and arm.

Damage to these nerves can cause Erb’s palsy. Also known as Erb-Duchenne paralysis or brachial plexus palsy, this condition results in injury to the upper arm. This injury can occur from a physician pulling on the head when trying to get the baby out of the birth canal.

Brain Damage Caused by Asphyxia

In extreme cases, shoulder dystocia can reduce oxygen flow to the brain (asphyxia) if a baby is not removed from the birth canal in enough time. Prolonged and severe asphyxia can cause brain damage, which can lead to:

• Cerebral palsy (CP)
• Developmental delays
• Intellectual disabilities
• Learning difficulties

Babies with compressed umbilical cords are at higher risk of brain damage due to reduced oxygen from blood flow blockage caused by chest and cord compression.

Harm to the Mother

Shoulder dystocia does not typically result in permanent damage to the mother.

However, severe shoulder dystocia may cause:

• Hemorrhaging, which can lead to death if not treated in time
• Infections from ruptures and tears to the uterus, cervix, rectum, or vagina
• Nerve damage, which can lead to incontinence (inability to control urine)

Here are some of the more common shoulder dystocia complications in mothers.

Perineum Tearing

If one or both of the baby’s shoulders get stuck, the mother’s perineum may tear severely. Perineum tearing can make walking and sitting difficult.

Inadequate treatment of perineal tears can cause chronic perineal pain and bowel, urine, and gas incontinence.

Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is when the mother has heavy bleeding after birth. Giving birth to a baby with shoulder dystocia increases the mother’s chances of a PPH.

PPH can be life-threatening, leading to severe blood loss, shock, and, if untreated, maternal death.

Uterine Rupture

Uterine rupture is when the mother’s uterine wall splits open. It is more common in mothers who have a vaginal delivery after having a cesarean section (C-section) in a previous pregnancy.

A uterine rupture can be complete or incomplete. A complete uterine rupture goes through all three layers of the uterus. It is a very serious condition that requires immediate treatment.

Shoulder Dystocia Risk Factors and Causes

While the causes of shoulder dystocia are not always known, some risk factors make it more likely.

The following risk factors increase the likelihood of shoulder dystocia:

• Birthing position: The supine (lying down) position limits the room in the pelvis. However, the hands-and-knee position maximizes pelvic room.
• Fetal macrosomia (large baby): Babies who weigh more than 8 pounds, 13 ounces are more likely to experience shoulder dystocia.
• Position of the baby: Babies in the breech (feet-first) position are more likely to have shoulder dystocia.
• Small pelvis: Mothers with a small pelvis are more likely to have babies who experience shoulder dystocia.

What Can Be Done for Shoulder Dystocia Symptoms?

Shoulder dystocia can cause severe complications in babies and mothers. If shoulder dystocia symptoms are present, there are several things delivery teams can do.

Consider a C-Section Delivery

If you’ve had a child with shoulder dystocia in the past or your baby is larger than average, your doctor may recommend a C-section. A C-section ensures that shoulder dystocia does not happen by delivering your baby through an incision in your abdomen.

A C-section may be the safest delivery method if you have other risk factors that increase the chances that you and your baby might have complications, such as gestational diabetes.

Medical Interventions for Shoulder Dystocia Symptoms

There are several medical interventions that your delivery team can perform if symptoms of shoulder dystocia arise. One of the most common tools is called the HELPERR mnemonic.

The HELPERR mnemonic involves:

• H — Help: Your obstetrician will call for additional help from other health care providers. These providers may include a neonatologist, an anesthesiologist, and extra labor and delivery staff.
• E — Evaluate for episiotomy: Your medical team will determine whether you need an episiotomy to assist with delivery. An episiotomy is an incision in your perineum to make the vaginal opening larger. Your health care provider will only perform this procedure if they need additional room for rotation maneuvers.
• L — Legs: Your labor and delivery team may ask you to press your thighs up against your belly (the McRoberts maneuver). This method helps rotate and flatten your pelvis.
• P — Pressure: Your doctors may use suprapubic pressure. They will press down on your abdomen above your pubic bone in an attempt to rotate the baby’s shoulder.
• E — Enter maneuvers: Your health care team may perform internal rotation or enter maneuvers. They may do this by reaching into your vagina to turn the baby.
• R — Remove posterior arm: Your delivery team may use Jacquemier’s maneuver. They will remove one of your baby’s arms from the vagina, making it easier for their shoulders to pass through.
• R — Roll the patient: Finally, your medical team may use the Gaskin maneuver. They will ask you to use the hands-and-knee birthing position.

It’s important to understand that not all of these interventions are used for every case of shoulder dystocia. The appropriate intervention depends on the specifics of the situation and the judgment of the medical professional.

Your obstetrician may also decide to perform one of the following:

• Clavicle fracture involves breaking the baby’s collarbone to release the shoulders.
• Symphysiotomy involves making an incision between your pelvic bones to make your pelvic opening larger.
• Zavanelli maneuver involves pushing the baby’s head back into the birth canal to perform a Cesarean section.

If you think your delivery team did not properly handle symptoms of shoulder dystocia and your child was harmed because of it, we may be able to help. Get a free case review right now.

Shoulder Dystocia Symptoms and Medical Malpractice

Your delivery team is responsible for being vigilant in identifying and addressing shoulder dystocia symptoms to prevent complications.

When health care providers fail to recognize and appropriately manage shoulder dystocia symptoms, it can result in injury to the baby.

If your baby was harmed after shoulder dystocia, it could mean birth injury medical malpractice has occurred.

Get Legal Help for a Shoulder Dystocia Birth Injury

If your child suffered from a birth injury after shoulder dystocia symptoms were not properly responded to, you may have legal options.

The Birth Injury Justice Center is committed to helping families get the financial compensation they need to provide the best possible care for their child.

Call (800) 914-1562 or fill out our free case review form to see if we can help. Our compassionate and highly trained Patient Advocates are available to talk with you 24/7.