Shoulder Dystocia

[mghmom]

Can you give a definition of true shoulder dystocia and what, if any, implications are there for future births of a mother who has had a true case?

TIA

[mwherbs]

here is one article about shoulder dystocia-
http://www.aafp.org/afp/20040401/1707.html

and another which is a fairly good article with several illustrations
http://www.shoulderdystociainfo.com/introduction.htm

[MsBlack]

Thanks for the great links!

It comes as no surprise to me that the incidence of SD, and the % of recurrence of SD in any one mother, are as high as stated in these articles--which of course are based upon medical practices and hospital birth. SD certainly can and does occur at homebirths, even in the most experienced of care--but the differences in birth care, I believe, do impact the occurrence and recurrence of SD. One of the factors noted in one of these articles is the use of vacuum extraction/forceps--and very few mws make use of these, for one example. Delivery positioning is another factor, since most mws do not have moms deliver on their backs--and many will urge mothers to choose positions for delivery that feel right to the mom. In my own practice, knowing that a large baby is on the way (or, a very small mother, whatever the baby's size) will prompt me not just encourage moms to choose their own pushing positions, but also to suggest avoiding certain ones (some women do choose lying on their back, or sitting semi-reclined with butt on the bed or floor--their weight on sacrum, thus inhibiting the potential for pelvis to open as wide as possible at the sacral joints).

Both place of birth and tendencies of care provider make a difference in incidence and recurrence of SD. SD is not just about baby's size or mom's pelvis, it is about the 'dance' that mom and baby do during baby's descent. This dance, when allowed to unfold in it's own time and with mom's pelvis able to move and open in all possible ways, helps to create the baby's positional attitude: so, even broad shoulders might pass through a small (comparitively) pelvis, IF those shoulders are arranged so as to present the smallest possible diameter. And IF mom's pelvis is able to maximally open wide, and she is otherwise able to freely move her pelvis during delivery.

In any place of birth, the provider's understanding of SD and their ability to remain calm--NOT jumping too soon into forcible manuevers--and attend to timing of events is pretty important. Tho most babies' shoulders rotate soon after delivery of head, it's ok to wait a few minutes before 'helping' and possibly only making matters worse...baby's head going purple is not an emergency signal before 3-4 minutes is up (tho it will feel like an eternity). Even without forceps/vacuum, care providers of any kind can make matters worse by things such as pushing the perineum past the baby's chin if the chin does not readily emerge. But once the chin is past the perineum, you have potentially locked the head and shoulders into nigh-immovable positions with respect to perineum and pubic bone. If the baby's head is not trapped outside of the perineum, manuevers of shoulders are easier for both baby itself and the care provider if her help is needed.

Anyway, a lot has been written on the topic--don't mean to try to say it all here! Just to indicate some of the variety of factors involved, from POV of motherbaby, and care providers. If I were to meet a pregnant woman with a history of shoulder dystocia, I would not worry about future SD before I knew all the factors involved in the first one. When I know that a baby is fairly large, and/or mom is unusually small, I am aware of the possibility for SD and do prepare all concerned in certain ways (such as telling mom/her helpers that we might have to help mom change positions during delivery). What I was taught is that 'if the head can emerge, then the shoulders can, too'--and that it's a matter of how birth is handled that makes the difference.