Shoulder dystocia is basically the baby’s shoulder/s get caught in the pelvis. According to RCOG Greentop guidelines on Shoulder dystocia (2012) (1) Shoulder dystocia occurs in 0.58% to 0.7% of births.
Within these numbers there is an increased incidence of postpartum haemorrhaging at 11% along with third- or fourth-degree tears at 3.8%. These number are inclusive of the 0.58 to 0.7%.
There is a relationship between larger babies and shoulder dystocia however it is important to know that 48% of the shoulder dystocia births reported are babies less than 4kg (smaller/average babies).
Factors that are associated with shoulder dystocia:
Pre-labour
· Previous Shoulder Dystocia
· Large baby
· Gestational Diabetes
· Higher BMI
· Induction of Labour
During Labour and birth
· Prolonged first stage
· Prolonged second stage
· Paused dilation
· Oxytocin Augmentation
· Assisted birth
You can see here that induction of labour increases chances of shoulder dystocia before and during labour.
There are a lot of medical professionals keen to focus on the management of shoulder dystocia rather than prevent it. (2)
Undisturbed, movement and patience with labour can hugely impact if baby is in an awkward position. As we can see from the RCOG green top guidelines the risk factors include speeding up and inducing labour.
We know that with inductions we are more likely to use Analgesics (vs spontaneous labour (71% vs 41%)(3)) such as the epidural which can mean birthers are more likely to be in positions such as on the bed or on their back for longer periods of time.
We have to remember that the risk factors listed above mean that birthers are more likely to experience interventions and inductions which can increase the risk of shoulder dystocia. We don't always need to rush straight to forceps, episiotomy or c-sections. There are other methods such as changing birther position and getting movement involved.
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