Carl R. Darnall Army Medical Center - Health Library

Shoulder Dystocia

(Stuck Shoulder Delivery)

Pronounced: showl-dur dis-TO-see-ah

Definition

Shoulder dystocia is a problem during birth. The baby’s head has been born but the shoulders are stuck. The shoulder become trapped against the mother’s pubic bone.

Most babies will be able to be born safely with some help. Sometimes the baby may be stuck in the birth canal too long. In this case complications like the following can occur:

  • For the baby:
    • Lack of oxygen
    • Broken arm or collarbone
    • Arm nerve damage
    • Paralysis
  • For the mother:
    • Tearing or bruising of the cervix, rectum, or vagina
    • Bruising to the bladder
    • Severe bleeding

Shoulder Dystocia
Shoulder Dystocia

The baby's shoulder is lodged behind the mother's pubic bone.

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Causes  ^

Shoulder dystocia happens because of one or both of the following:

  • Baby’s shoulders are too wide—larger babies are common in women with diabetes or late term pregnancies
  • Mother's pelvic opening is too small for child

Narrow Pelvic Opening
Pelvis birth

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Risk Factors  ^

Factors that may increase your baby's chance of shoulder dystocia include:

  • Mother has diabetes
  • Mother is significantly overweight
  • Mother has small stature which may mean small pelvis
  • A very large baby
  • Shoulder dystocia in previous birth

Signs and Symptoms  ^

There are no symptoms of shoulder dystocia.

Diagnosis  ^

The doctor or midwife will know when the birth process stops after the head is born.

Shoulder dystocia may be seen as a risk before birth. Prenatal tests will estimate the size of the fetus and the mother’s pelvis.

An ultrasound may be done before labor. This will help to determine if the baby is too large to fit safely through the birth canal. A vaginal delivery may not be a safe method if the baby is too large.

Treatment  ^

The care team will act fast if a shoulder dystocia occurs. The goal is to release the baby as fast as possible. This will allow the vaginal birth to continue. The doctor or midwife may:

  • Reposition the mother
  • Reposition the baby to try to move the shoulder away from the bone

A C-section may be needed if the baby remains stuck in the birth canal.

Prevention  ^

Shoulder dystocia cannot always be prevented. If you have a high risk of shoulder dystocia the doctor may offer:

  • Early induced labor—to delivery smaller baby
  • Planned C-section
RESOURCES:

American Congress of Obstetricians and Gynecologists
http://www.acog.org

American Pregnancy Association
http://www.americanpregnancy.org

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org

Women's Health Matters
http://www.womenshealthmatters.ca

REFERENCES:

ACOG Committee on Practice Bulletins—Gynecology, The American College of Obstetrician and Gynecologists. ACOG practice bulletin clinical management guidelines for obstetrician-gynecologists. Number 22, November 2000. Obstet Gynecol. 2000;96(5). Reaffirmed 2013.

ACOG Committee on Practice Bulletins—Gynecology, The American College of Obstetrician and Gynecologists. ACOG practice bulletin clinical management guidelines for obstetrician-gynecologists. Number 40, November 2002. Obstet Gynecol. 2002;100(5 Pt 1):1045-1050. Reaffirmed 2014.

Cesarean section. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116315/Cesarean-section. Updated July 7, 2017. Accessed September 12, 2017.

World Health Organization. Managing complications in pregnancy and childbirth: a guide for midwives and doctors. World Health Organization website. Available at: http://whqlibdoc.who.int/publications/2007/9241545879_eng.pdf. Updated 2007. Accessed September 12, 2017.

Last reviewed July 2018 by EBSCO Medical Review Board Beverly Siegal, MD, FACOG  Last Updated: 7/25/2018