Is your baby's shoulder stuck? Let's learn about Shoulder Dystocia, which can occur during childbirth!

For those of you who are going to be a mother, giving birth is one of the greatest joys of your life, but sometimes it can also be a little scary. Most of the time, everything goes well and smoothly, but sometimes unexpected problems can arise. That's right, this is a rare condition that we all need to be aware of during childbirth (Shoulder Dystocia) . Let's talk about this in a little more detail, but very simply, okay?

What is this (Shoulder Dystocia), doctor?

Simply put, Shoulder Dystocia is when one or both shoulders, or both shoulders, get stuck in the pelvis, the bone frame around the waist, after the baby's head comes out of the vagina. Imagine that when the baby is trying to come out, the shoulders get stuck somewhere, making it difficult to get the rest of the body out. The Greek word "dystocia" means "difficult birth."

This is actually considered a medical emergency by doctors. Because if not treated quickly, both the mother and the baby can have some problems. But the most important thing is that most of the time, doctors and medical teams manage this situation very skillfully and keep the mother and baby safe. So don't be unnecessarily afraid.

How visible is this?

Shoulder Dystocia is actually a relatively rare condition . It's hard to give exact statistics, as it can sometimes be over-diagnosed or under-diagnosed. And the number varies with the baby's birth weight.

On average, this condition affects between 0.6% and 1.4% of babies weighing between 2.5 and 4 kilograms (5 pounds 8 ounces - 8 pounds 13 ounces). However, if the baby weighs more than 4 kilograms (8 pounds 13 ounces), this risk increases to 5% and 9%.

Can we recognize this early? What are the symptoms?

Here's the important thing, Shoulder Dystocia doesn't show any specific symptoms . That is, there are no signs before labor that make you think, "Oh, this is going to happen to me." Although there are some risk factors, this condition can occur in anyone.

The doctor realizes this only after the baby's head comes out. The baby's head appears to come out and then retract back in a little. It's like a turtle sticking its head out and then pulling it back in when it's scared. Doctors call this the "turtle sign." That's when the doctors realize that the baby's shoulder is stuck.

Why is this happening? What are the reasons?

The main cause of Shoulder Dystocia is when the baby's shoulder gets stuck behind the pubic bone, which is located in the front of the mother's pelvis. There are several factors that can contribute to this:

• Fetal Macrosomia: This is likely to happen if the baby weighs more than 4 kilograms (8 pounds and 13 ounces).
• Incorrect position of the baby: The baby's position in the womb can also be a problem.
• Mother's pelvic opening is small: Some mothers' pelvis may be naturally a little narrow.
• The mother's position during childbirth: Some positions can limit the space available to the pelvis.

How do doctors recognize this?

A doctor will conclude that you have Shoulder Dystocia if three main factors are met:

1. The baby's head has come out, but the mother cannot push the baby's shoulders out.

2. It's been less than a minute since the baby's head came out, but the body hasn't come out yet.

3. Medical intervention is required to successfully deliver the baby.

What are the treatments for this?

If the doctor thinks in advance that you are at risk, either because you have diabetes or because the baby is very large, he may suggest an early cesarean section (C-section) .

However, if someone who is having a vaginal delivery feels that this is a risk, doctors have a safety checklist . That is, they have a list of things to do in case of an emergency like this.

Once shoulder dystocia is diagnosed, the work in the delivery room gets a little more hectic . The doctor and nursing team will work together to use various maneuvers to get the baby out. They may try to change your position to make more room for your pelvis, or they may try to change the baby's position to free up your shoulders.

The HELPERR method

An easy-to-remember method that doctors use in times like these is HELPERR . Each letter in it says something to do.

• H — Help: The doctor immediately asks for help from others. He uses the safety list mentioned earlier. He enlists the help of an anesthesiologist, a neonatologist, and additional nurses. He quickly brings the necessary equipment into the room.
• E — Evaluate for episiotomy: The doctor will decide whether to make an episiotomy , a small cut between the vaginal opening and the perineum, to enlarge the vaginal opening to help deliver the baby. This is only done if more room is needed for rotation maneuvers.
• L — Legs: Your doctor may use the McRoberts maneuver . This involves pressing your thighs together against your stomach. This flattens the pelvis and slightly rotates it, increasing space.
• P — Pressure: The doctor may apply suprapubic pressure . This means pressing on your lower abdomen, above the pubic bone. This puts pressure on the baby's shoulder, trying to rotate it and push it out.
• E — Enter maneuvers: The doctor may perform internal rotations . This means that he or she will try to turn the baby by inserting his or her hand into the vagina.
• R — Remove posterior arm: The doctor may use the Jacquemier maneuver . This involves removing one of the baby's arms from the birth canal. This will make it easier for the shoulders to come out.
• R — Roll the patient: The doctor may use the Gaskin maneuver , which involves rolling you onto your hands and knees.

In slightly more complicated cases

In very severe cases where the above methods are not successful, the doctor may also use these methods:

• Clavicle fracture: The baby's collarbone is intentionally broken to free the shoulder.
• Zavanelli maneuver: The baby's head is pushed back into the uterus and an immediate cesarean section (C-section) is performed.
• Symphysiotomy: This is a procedure that widens the pelvic opening by cutting the cartilage between the two pubic bones. These are very rare procedures these days.

What complications can this cause for the mother and baby?

Shoulder Dystocia can cause complications for both mother and baby during childbirth. Remember, these don't happen to everyone , but it's good to be aware.

Effects on the mother:

• Excessive bleeding after childbirth (Postpartum hemorrhage) .
• Severe tearing of the area between the vagina and anus (perineum).
• Rectovaginal fistula: This is an unnatural connection between the vagina and the anus.
• Uterine rupture .
• Separation of the pubic bones in the pelvis.

Effects on the baby:

The most common complication of shoulder dystocia in babies is a condition called brachial plexus palsy . The brachial plexus is a group of nerves that run from the baby's spinal cord in the neck to the arm. These nerves provide sensation and movement to the shoulder, arm, and hand. If these nerves are damaged, the arm on that side can become weak or even paralyzed.

Other complications:

• Fracture of the baby's collarbone (clavicle) and/or upper arm bone (humerus).
• Horner's syndrome: A rare condition that affects a baby's eyes and face.
• Compressed umbilical cord: The umbilical cord can become trapped between the baby's arm and the mother's pelvic bone. This can cause the baby to lose oxygen and blood, leading to brain damage or even death. This is a very rare occurrence.

Who is more at risk?

Shoulder Dystocia can happen to anyone . It is most often seen in babies with normal birth weight. However, there are certain risk factors that increase the likelihood of this condition. Let's see what they are:

• Diabetes: Whether you have pre-existing diabetes or gestational diabetes, your baby may be slightly larger. About 20% of mothers with diabetes have babies weighing more than 4 kilograms (8 pounds, 13 ounces).
• Macrosomia: This means that the baby weighs more than 4 kilograms (8 pounds, 13 ounces) at birth. If the baby is very large, the doctor may recommend a cesarean section.
• Shoulder Dystocia (sudden birth)
• Carrying twins or more children in the womb.
• Excessive weight gain or obesity during pregnancy.
• Short stature of the mother.
• Having an abnormal structure in the pelvis.
• Being over 35 years of age.
• Childbirth occurs after the due date.

Some conditions during labor and delivery can also increase this risk. One of the most important of these is assisted vaginal delivery , which means that the doctor has to use a vacuum extractor or forceps to remove the baby.

Other risk factors:

• Giving a drug called Oxytocin to start labor.
• Getting an epidural .
• The first stage of labor (contraction phase) is very long.
• The second stage of labor (pushing phase) is either too short or too long.
• Using inappropriate pressure or methods to push the baby out.

Can we do anything to prevent this?

To be honest, it's often difficult to prevent shoulder dystocia, especially if the baby is of normal weight. It happens so unexpectedly. However, there are a few things you can do to reduce your risk:

• If you have diabetes, control it well .
• Maintain a healthy weight throughout pregnancy.
• Talk to your doctor and see if you can induce labor early if necessary.
• If the due date has passed, inform your doctor immediately.
• Discuss a cesarean section (C-section) with your doctor (especially if there are risk factors).
• Think twice about some painkillers given during labor, such as epidurals (talk to your doctor about this too).

What happens after this situation? What is the future?

You may be a little scared to hear this, but there is good news .

Research shows that half of babies born with Shoulder Dystocia are completely normal by three months of age. By 18 months, 82% of babies are completely healthy.

If your baby has a brachial plexus injury , the outcome is usually good. However, some interventions can affect the baby's long-term condition. They may have some difficulty with fine motor skills and using the affected arm. However, more than 90% of these injuries resolve within 6 to 12 months . Less than 10% of cases result in permanent disability.

If you have had a baby with Shoulder Dystocia, the chance of it happening again is about 15%. So if you are thinking about having more babies, talk to your doctor about this. If you had a cesarean section due to Shoulder Dystocia, vaginal birth after cesarean (VBAC) is not usually recommended .

Shoulder Dystocia is a complication that can occur during childbirth. It's normal to feel anxious about what could go wrong during labor and delivery. However, it's important to remember that these situations are rare and that your medical team is well-trained to deal with them. If this rare complication does occur, don't panic and trust your doctors. They will do everything they can to keep you and your baby safe and to get your baby out without any long-term complications.

The most important thing we need to remember (Take-Home Message)

I hope you now have a better understanding of the condition we discussed today (Shoulder Dystocia). The main things to remember are:

• This is an emergency, although it is rare .
• Most of the time, medical teams manage this well .
• Even if there are no early warning signs, it is important to be aware of the risk factors .
• Things like controlling diabetes and maintaining a healthy weight can reduce the risk somewhat .
• Most babies recover completely .

Childbirth is an amazing experience. We hope this information will be helpful as you prepare for that journey. Never be afraid to talk to your doctor about any questions or concerns you may have. We wish you and your baby all the best!

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