If you’re physically small and your baby is physically big, you could be at risk for shoulder dystocia (dis·tow·shuh) while giving birth. Shoulder dystocia occurs when a baby's shoulder gets hung up on their mother's pubic bone, potentially resulting in injury to both the baby and the mother.
What can be done?
Dr. Alan Lindemann is an obstetrician from North Dakota nicknamed the “Rural Doc.” Dr. Lindemann has over 40 years of experience delivering over 6,000 babies, and has made it his mission to support women in taking charge of their health and pregnancies. Dr. Lindemann is available to provide his solutions for deliveries when shoulder dystocia occurs:
1) The McRoberts Maneuver — “With this technique, the physician needs to flex (bend) the mother’s knees and hips with the help of the nurses. The nurses need to be well-trained, knowledgeable, confident, and above all, calm. There should be two nurses, one managing each leg. The goal is to use the flexion of the legs and hips to increase the room in the pelvis of the mother so the baby can move beyond the pubic bone.”
2) Delivery of the Back Arm — “Sometimes the McRoberts maneuver is enough to allow the baby to move beyond the pubic bone, but occasionally there is still not enough room. In these cases, delivery of the back arm is my favorite way to manage shoulder dystocia, and it works. When I was a resident in Minneapolis, we had many Hmong patients, many of whom were small, often less than five feet tall. One of my Hmong patients had a 10-pound, 3-ounce baby, and she had shoulder dystocia. With this patient, I had to deliver the back arm to reduce the circumference of the shoulders, but the front shoulder was still hung up on the patient’s pelvic bone. So I turned the baby to bring the front arm to the back of the mother so I could deliver the second arm from the back. With both arms past the pubic bone, the remainder of the baby could move on into the birth canal.”
3) Alternative Birthing Positions — “In the U.S., most mothers deliver on their backs. Having the mother on her hands and knees, or even on her side, are good alternative options to help manage shoulder dystocia. Again, the most important safety precaution is for the physician and nurses to remain calm and not lose their composure.”
4) Other Methods — “There are other ways to manage shoulder dystocia, but in my experience, they are not as safe and effective as delivering the two arms first:
- One Arm — In my experience this puts too much traction on the shoulder to pull the baby beyond the mother’s pubic bone, which risks breaking the baby’s shoulder and causing palsy or paralysis in the affected arm.
- C-Section — Another approach is to push the baby’s head back into the vagina and uterus and do a c-section. My feeling is this places too much pressure on the baby’s head and neck. I’ve never done it.
- Episiotomy —This will make the opening of the vagina wider, but at the end of the day the vulva and vagina are not the cause of the shoulder dystocia.”
About Dr. Lindemann:
An obstetrician and maternal mortality expert, “Rural Doc” Alan Lindemann, M.D., teaches women and their families how to create the outcomes they want for their own personal health and pregnancy. A former Clinical Associate Professor at the University of North Dakota, he served as a clinical faculty member and preceptor with medical students in rural rotations. In his nearly 40 years of practice, he has delivered around 6,000 babies and achieved a maternal mortality rate of zero! Learn more at PregnancyYourWay.com.
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