Shoulder Dystocia

**This is not medical advice and is not a complete guide. Please do your own research**

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What is Shoulder Dystocia?​

Shoulder Dystocia is when during the pushing stage of a vaginal birth, the baby's head crowns or comes out, but the shoulders get stuck.

The shoulders usually get caught on the pubic bone, but can be stuck anywhere in the pelvic canal.

This is cause for concern because if baby stays too long in the birth canal, the cord can be compressed, leading to a lack of oxygen.

Even though the head may be out, they may not be able to breathe, so dystocia should be resolved fairly quickly.

And if the head is not out, baby definitely cannot breathe.

The longer baby is without oxygen, the more risk of brain damage and asphyxiation.

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There is a milder form of dystocia known as "sticky shoulders" that requires less intervention.

Common Causes/or "risk" factors for dystocia

• Poor positioning of mother eg. birthing on her back, or misaligned pelvis 

  
  

• "Large" baby (dystocia more common in over 4.5kg BUT still occurs frequently in under 4kg too, as positioning is the biggest factor)

  
  

• Previous shoulder dystocia 

  
  

• Almost all other risk factors are common

  only to assisted settings

  (eg epidural, coached pushing, induction etc) or are compounded in such settings (eg. epidural + birthing on back in lithotomy position) and are not something one would see in an unassisted birth setting, thereby minimising your overall risk )

  
  

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Prevention and minimising risk of dystocia

• Ensuring optimal positioning of mother in labour, by moving around instinctively, comfortably, and preferably upright while birthing

  
  

• Making sure baby is in

  optimal labour position

  
  

  
  

• Not pushing until your body tells you (Wait for the urge to push or the Fetal Ejection Reflex)

  
  

• Chiropractic care throughout pregnancy can help keep everything well aligned in the pelvis

  
  

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What to look for 

Usually baby's head crowns, and within a few contractions, the whole head is born. Then in most cases there's a slight break and again in the next contraction or two the rest of the baby is born.

But dystocia is when

• 2 or 3 contractions with head crowned or out, and baby not born yet

  
  

• Head out but neck not visible at all

  
  

• Head out or crowning, but retreating or "turtling" so you can't see the neck or face

  
  

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How to resolve Shoulder Dystocia/ "Unstick" baby

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   Position changes

   
   

 If you notice the "turtling", or it has been 2-3 contractions, immediately change positions to attempt Gaskin Manuever 1st part of "Flip FLOP"

Flip - turn over (the movement may dislodge baby's shoulder)

L - lift the legs and get into Running Start with knees close to chest

You can also try going through a cycle of: Runners start, switch both legs, stand up, slowly squat, all fours, runner start, switch both legs... repeat as necessary.

While true shoulder dystocia is highly uncommon with homebirthing mamas, sticky shoulders are a thing and these positions help with that. In the event that you need to help the shoulders out you likely won’t even have to complete one entire cycle for the baby to dislodge.

You can also try McRoberts Manuever

- Bring knees to chest

- Apply suprapubic pressure in rocking motion to dislodge shoulder.

(Please note: this method only works if mother is on her back. It's more commonly used in a medical setting or with a partner. I suggest trying Flip FLOP first)

2. Manual dislodgement

If changing position doesn't effect baby's release, attempt the second part of Gaskins Manuever "Flip FLOP"

O - Oblique - hook finger under lower arm and rotate towards baby's face

P - Posterior- Bring out the posterior arm, bending the elbow first. If needed, rotate, and bring out the second arm.

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What Not to Do

• Do NOT apply Fundal Pressure

  
  

• Do NOT pull on baby's neck or head, or try to twist the head at all. This can cause injury to baby

  
  

• Do NOT push harder, as this can impact the shoulder further.

  
  

• Do NOT cut the cord if it is around baby's neck.

  Nuchal cord

  is not usually an issue, and the cord is providing crucial oxygen to baby

  
  

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Final Note

A baby who has been stuck for some time may almost definitely need a little extra help and stimulation once born. Be gentle and reassuring with baby, rubbing their back, speaking to them calmly, and welcoming them into the world. Then initiate neonatal resuscitation as required.

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Reminder: Most cases of dystocia or "sticky shoulders" are resolved quickly with a simple change in position.

Allow yourself to move instinctively in labour to help prevent the need for specific maneuvers.