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Shoulder dystocia: what is it, how is it caused, and what are the long-term effects?

Posted: 30/06/2022

This article is a continuation of our new series covering topics relating to birth injuries. The previous article discussed cerebral palsy.

What is shoulder dystocia?

Shoulder dystocia is a rare birth complication, where the baby’s shoulders become lodged against the mother’s pelvis during birth through vaginal delivery. Generally, this can be resolved and both mother and baby will recover well, but shoulder dystocia has been known to cause significant injury and can result in death in some cases.

What are the causes of shoulder dystocia?

Shoulder dystocia is more common in cases of multiple births (twins/triplets etc), and also where the mother has diabetes, is overweight, or the labour is induced. If you have suffered shoulder dystocia in a previous birth, you are also at risk of it happening again, so your doctor will often recommend a caesarean birth for any future deliveries.

Shoulder dystocia can also arise where none of these factors are present, which makes it hard to predict.

What can be done to help when shoulder dystocia arises?

There is a helpful mnemonic used by doctors to assist in treating shoulder dystocia when the complication arises - HELPERR. Some of these techniques may be used by your doctor:

H- Help: Your doctor should send an alert for further assistance immediately.
E- Episiotomy: An incision may be made in the perineum (between the vagina and anus). While this will not be sufficient in itself to create room for the baby, it can be helpful in some cases.
L- Legs:    You may be asked to bring your legs towards your stomach, which in turn re-positions the pelvis, and can help the baby pass through.
P- Suprapubic pressure:    Your doctor may apply external pressure on your pelvis to encourage rotation of the baby’s shoulders.
E- Enter manoeuvres:  Otherwise known as internal rotation, your doctor may manually rotate the baby.
R- Remove posterior arm:  Your doctor may attempt to remove one of the baby’s arms from the pelvis, to provide further room for the baby to pass through.
R- Roll the patient: You may be asked to change your position onto your hands and knees, to assist in allowing the baby to pass through.

What are the long-term effects of shoulder dystocia?

In most cases of shoulder dystocia, the mother and baby will recover well, but it is possible that injuries can be sustained.

Mothers are at risk of infection from tears and ruptures to the cervix, rectum, uterus or vagina, as well as haemorrhaging, and nerve damage which can lead to incontinence. Shoulder dystocia can also be a very traumatic experience.

For the baby, shoulder dystocia can cause a lack of oxygen which can lead to brain damage and, in the worst cases, death. The baby can also sustain serious injuries, including a broken collar bone, broken arms, and nerve damage. Nerve damage can, in turn, cause Erb’s Palsy. The next article in this series will explore this condition further.

Shoulder dystocia occurs very rarely, and its occurrence does not necessarily mean that the medical treatment given was negligent. Nevertheless, if you do have any concerns following the birth of your child, we have a specialist birth injury team who are able to provide a no-obligation discussion. Please do not hesitate to get in touch.

This article was co-written with Jessica Earley, trainee solicitor in the personal injury and clinical negligence team.

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