Shoulder dystocia

Shoulder dystocia occurs when a baby's head is delivered through the vagina, but his shoulders get stuck inside the mother's body. This creates risks for both mother and baby. Dystocia means "slow or difficult labor or delivery."

Shoulder dystocia can happen when:

  • A baby is unusually large. Overweight women and women with diabetes are at risk for having large babies.
  • The mother's pelvic opening is too small for the baby's shoulders to come out.

Although there are risk factors for shoulder dystocia, health care providers cannot usually predict or prevent it. They often discover it only after labor has begun.

Risk factors
A pregnant woman may be at risk for shoulder dystocia if:

  • Her baby is very large. (But in most cases of shoulder dystocia, the baby's weight is normal. And for most very large babies, shoulder dystocia doesn't occur.)
  • She has diabetes.
  • She is pregnant with more than one baby.
  • She is obese.
  • She delivers after the baby's due date.
  • She has had shoulder dystocia or a very large baby during a past delivery.

Shoulder dystocia may occur when the woman has no risk factors.

What happens in the delivery room
In most cases, the baby is delivered safely. Here are some things that may be done:

  • Pressing the mother's thighs against her belly.
  • Applying pressure to the mother's belly.
  • Rolling the mother onto all fours.
  • Turning the baby's shoulder while it is still inside the mother.
  • Gently cutting a wider opening in the woman's vagina (an episiotomy).
  • Performing a cesarean section after labor has begun. Because shoulder dystocia is hard to predict, a planned c-section is usually not recommended to prevent it.

Complications
Usually, the mother and the baby do well and have no permanent damage. But there may be some complications. For the baby, risks include:

  • Injury to the nerves of the shoulder, arms and hand. This may cause shaking or paralysis. In most cases, the problems go away in 6 to 12 months.
  • A broken arm or collarbone.
  • Lack of oxygen. In the most severe cases, which are rare, this can cause brain damage and even death.

Complications for the mother include:

  • Heavy bleeding after delivery
  • Tearing of the uterus, vagina, cervix or rectum
  • Bruising of the bladder

In most cases, complications can be treated and managed.

December 2007

Most common questions

What is mononucleosis?

Mononucleosis (also called mono) is an infection usually caused by the Epstein-Barr virus (EBV). It’s sometimes caused by another virus called cytomegalovirus (CMV). EBV and CMV are part of the herpes virus family. Mono is most common in teenagers and young adults, but anyone can get it. Mono is called the “kissing disease” because it’s usually passed from one person to another through saliva. In addition to kissing, it can also be passed through sneezing, coughing or sharing pillows, drinks, straws, and toothbrushes.

You can have mono without having any symptoms. But even if you don’t get sick, you can still pass it to others. Symptoms can include:

  • Achy muscles
  • Belly pain
  • Fatigue (feeling tired all the time)
  • Fever
  • Sore throat
  • Swollen glands in your neck

If your symptoms don’t go away or get worse, tell your health care provider. He’ll most likely do a physical exam and test your blood to find out for sure if you have mono.

There’s no vaccine to prevent mono. There’s also no specific treatment. The best care is to take it easy and get as much rest as you can. It may take a few weeks before you fully recover.

Can Rh factor affect my baby?

The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.

If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.

If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.

I had a miscarriage. How long should I wait to try again?

Before getting pregnant again, it's important that you are ready both physically and emotionally. If you don't need tests or treatments to discover the cause of the miscarriage, it's usually OK for you to become pregnant after one normal menstrual cycle. However, it may take longer for you to feel emotionally ready to be pregnant again. Everyone responds differently to a miscarriage. Only you will know when you are ready to try to get pregnant again.

Are gallstones common during pregnancy?

Not common, but they do happen. Elevated hormones during pregnancy can cause the gallbladder to function more slowly, less efficiently. The gallbladder stores and releases bile, a substance produced in the liver. Bile helps digest fat. When bile sits in the gallbladder for too long, hard, solid nuggets called gallstones can form. The stones can block the flow of bile, causing indigestion and sometimes serious pain. Staying at a healthy weight during pregnancy can help lower your risk of gallstones. Exercise and eating foods that are low in fat and high in fiber, like veggies, fruits and whole grains, can help, too. Symptoms of gallstones include nausea, vomiting and intense, continuous abdominal pain. Treatment during pregnancy may include surgery to remove the gallbladder. Gallstones in the third trimester can be managed with a strict meal plan and pain medication, followed by surgery several weeks after delivery.

©2013 March of Dimes Foundation. The March of Dimes is a non-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3).