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Shoulder Dystocia
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What is shoulder dystocia?
Shoulder dystocia is the condition where, after delivery of a baby's head, the baby's shoulder
gets stuck under the mother's pubic bone. This prevents the rest of the baby from emerging easily
from the birth canal. Shoulder dystocia occurs in approximately 1 in every 100 vaginal births.
The natural forces of labor and delivery and the delivery techniques necessary to resolve the shoulder
dystocia are sometimes associated with injury to the nerves in the baby's neck and shoulder that go to
the arm and hand. This is called a brachial plexus injury. It occurs in approximately 1 in 1000 vaginal
births overall.
There are other risks to your infant if you have a shoulder dystocia at delivery. The baby's arm or
collarbone may be fractured. These injuries will almost always heal completely. If recovery is not complete,
children with brachial plexus injuries may not have full use of their shoulder, arm or hand. Fortunately,
about 85-90% of brachial plexus injuries heal completely.
A more severe complication - your baby not getting enough oxygen during the resolution of the shoulder
dystocia - is extremely rare.
What are the risk factors for a large baby or shoulder dystocia?
Maternal diabetes in this pregnancy
Previous baby over 4000 g (8lbs 12oz)
Previous delivery with shoulder dystocia
Weight gain over 40 lbs (18kg) in this pregnancy and a BMI >30
BMI over 35 at the end if this pregnancy
Fundal height measurement over 40cm
Maternal height under 1.52 m (5 feet)
What can I do about shoulder dystocia?
In the last month of pregnancy, the presence of any of the risk factors listed here indicates that you may
be at greater risk for having a large baby or shoulder dystocia.
You can not change how much you weighed at the beginning of this pregnancy but you can make important and
wise decisions during the rest of the pregnancy. The goal is to eat well so that the baby gets good nutrition
and is born healthy at term. There are many valuable sources of information about what to eat during pregnancy.
You will find a selection below.
Health Canada and the Institute of Medicine in the US have published recommended amounts of weight to gain
during pregnancy. Naturally, as your weight increases in pregnancy so will your Body Mass Index (BMI). The
following table gives you an insight on the recommended total weight gain during pregnancy.
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BMI Before pregnancy
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Recommended Total Weight Gain
During Pregnancy
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kg
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lb
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Low
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<18,5
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13-18
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28-40
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Normal Healthy/weight
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18,5-24,9
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11-16
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25-35
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Overweight
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25-29,9
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7-11
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15-25
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Obese
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>30
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7
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15
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A common way of determining if your weight is appropriate for your height is with a ratio called the
Body Mass Index (BMI). Here is a table that gives you a rough idea how height and weight are related to
BMI. Find your height on the outside vertical columns and then move horizontally until you are in the column
that corresponds to your weight (before pregnancy) as shown in the outer top or bottom row. The cell where
your height-row and weight -column meet is your BMI.
There are no hard and fast rules, so these should be considered as general guidelines. These recommendations
do not apply to twin or triplet pregnancies.
If any of the risk factors listed above applies to your situation, you can opt for a new screening test
offered at PROCREA Cliniques. This new test, the CALM Shoulder ScreenTM , can give you an idea about
your own chances of having shoulder dystocia that is associated with persistent injury.
The CALM Shoulder ScreenTM program combines information about your height and weight
in addition to an estimate of the baby's weight to help your doctor assess your risk of having shoulder
dystocia with persistent brachial plexus injury.
An ultrasound examination to estimate the weight of the baby and the CALM Shoulder ScreenTM
test are available at PROCREA Cliniques with a referral from your doctor.
Understanding your results
It is important to remind you that the CALM Shoulder ScreenTM is a screening test and is
not meant to give a definitive diagnosis. The test results, sent to your treating physician, will show
your level of risk of shoulder dystocia associated with persistent injury with a vaginal delivery.
If the results show a low risk, this means that your risk of shoulder dystocia associated with persistent
injury with a vaginal delivery is less likely than the background rate. This is great news!
If the results show an intermediate risk, that means that your risk is slightly increased from the
background rate.
If the results show a high risk, you and your doctor may wish to discuss the risk of this complication
and the options of having a cesarean section, or taking special precautions during labor.
Resources
It's Your Health: Folic Acid and Birth Defects
Nutrition for a Healthy Pregnancy - National Guidelines for the Childbearing Years
Healthy Beginnings: Your handbook for pregnancy and birth. Third edition.
Society of Obstetricians and Gynecologists of Canada. January 1, 2006
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