Management of Shoulder Dystocia

Your doctor can identify shoulder dystocia when they see part of your baby’s head coming out of the birth canal but the rest of their body isn’t able to delivered. Doctors call shoulder dystocia symptoms “the turtle sign.” This means a fetal head will first come out of the body but will then seem to go back into the birth canal. This is said to be like a turtle that sticks its head out of its shell and puts it back in.

Certain women may be more at risk for having babies with shoulder dystocia than others. These include:

• having diabetes and gestational diabetes
• having a history of having a baby with large birth weight, or macrosomia
• having a history of shoulder dystocia
• having labor that’s induced
• being obese
• giving birth after the due date
• having an operative vaginal birth, which means your doctor uses forceps or a vacuum to guide your baby through the birth canal
• being pregnant with multiple babies

However, many women can have a baby that has shoulder dystocia without ever having any risk factors.

Doctors diagnose shoulder dystocia when they can visualize the baby’s head but the baby’s body can’t be delivered, even after some slight maneuvers. If your doctor sees your baby’s trunk isn’t coming out easily and they have to take certain actions as a result, they’ll diagnose shoulder dystocia.

When the baby is coming out, events happen fast in the delivery room. If your doctor thinks shoulder dystocia is taking place, they’ll work quickly to correct the problem and deliver your baby.

Shoulder dystocia can increase risks for both you and baby. Most mothers and babies with shoulder dystocia don’t experience any significant or long-term complications. However, it’s possible that complications, while rare, can occur. These include:

• excessive bleeding in the mother
• injuries to a baby’s shoulders, arms, or hands
• loss of oxygen to the baby’s brain, which can cause brain damage
• tearing of a mother’s tissues, such as the cervix, rectum, uterus, or vagina

Your doctor can treat and minimize most of these complications to ensure they won’t be long-term concerns. Less than 10 percent of babies with injuries after shoulder dystocia have permanent complications.

If you baby has shoulder dystocia while you’re giving birth, you could be at risk for the condition if you get pregnant again. Talk to your doctor about your risks prior to delivery.

Doctors use a mnemonic “HELPERR” as a guide for treating shoulder dystocia:

• “H” stands for help. Your doctor should ask for extra help, such as assistance from nurses or other doctors.
• “E” stands for evaluate for episiotomy. An episiotomy is an incision or cut in the perineum between your anus and the opening of your vagina. This doesn’t usually solve the entire concern for shoulder dystocia because you baby still has to fit through your pelvis.
• “L” stands for legs. Your doctor may ask you to pull your legs toward your stomach. This is also known as the McRoberts maneuver. It helps to flatten and rotate your pelvis, which may help your baby pass through more easily.
• “P” stands for suprapubic pressure. Your doctor will place pressure on a certain area of your pelvis to encourage your baby’s shoulder to rotate.
• “E” stands for enter maneuvers. This means helping to rotate your baby’s shoulders to where they can pass through more easily. Another term for this is internal rotation.
• “R” stands for remove the posterior arm from the birth canal. If your doctor can free one of the baby’s arms from the birth canal, this makes it easier for your baby’s shoulders to pass through the birth canal.
• “R” stands for roll the patient. This means asking you to get on your hands and knees. This movement can help your baby to pass more easily through the birth canal.

These don’t have to be performed in the order listed to be effective. Also, there are other maneuvers a doctor can perform for either mom or baby to help the baby deliver. The techniques will likely depend on you and your baby’s position and your doctor’s experience.

Your doctor can determine if you’re at risk for having a baby with shoulder dystocia, but it isn’t likely they’ll recommend invasive methods. Examples of such methods include a cesarean delivery or inducing labor before a baby gets too large.

Your doctor can anticipate that shoulder dystocia can happen. Talk with your doctor to learn about potential complications and how your doctor will manage shoulder dystocia if it does happen.