What it Means if Your Baby Was Delivered With a Shoulder Dystocia Complication

1. 1. In uncomplicated cases, shoulder dystocia can be caused by the baby's body and shoulders being turned the wrong way. In most cases the infant's shoulder can be gently turned in the right direction by the obstetrician using his hands.
2. 2. The mother's pelvis may be naturally small or misshapen. This may limit the extent that an obstetrician can help with a "natural" delivery. A C-section may be necessary.
3. 3. The unborn baby may be considered very large for a vaginal delivery. The medical term for this condition is fetal macrosomia. This reason, too, may limit the extent that an obstetrician can help with a "natural" delivery and a C-section may be necessary.

• Temporary brachial plexus injuries or injury to the nerves of the arm and shoulder.
• Temporary skeletal fractures to the clavicle or shoulder blade can occur in up to 15 percent of shoulder dystocia cases.
• Temporary skeletal fractures to the upper bone -- the humerus -- of the affected arm.
• Permanent nerve injuries, such as Erb's Palsy, affecting the arms and shoulders.
• Permanent nerve injuries to the spinal cord in the neck, usually at the C4 level and presented as partial or hemidiaphragm paralysis.
• Permanent nerve injuries to the spinal cord in the lower neck, usually at the C8 to T1 level, known as Klumpke's paralysis.
• Permanent neurological injuries -- such as cerebral palsy or intellectual disabilities caused by a lack of oxygen, hypoxia, as the head is delivered but the remainder of the infant's body remains in the birth canal and compressing the umbilical cord.
• Fetal death or the death of the baby.
• Uterine rupture or tearing of the mother's uterus.
• Lacerations or tears to the mother's cervix and birth canal due to the prolonged labor are said to occur in almost four percent of shoulder dystocia situations.
• Maternal post-partum hemorrhage, or the mother's blood loss of over 1,000 mL, occurs in up to 11 percent of mothers.
• Maternal death due to shock from uncontrolled blood loss.

• The unborn baby is considered very large for a vaginal delivery or greater than 9.9 pounds. As noted earlier in this paper, the medical term for this condition is fetal macrosomia. Unfortunately, ultrasound screening for fetal macrosomia has a very poor accuracy rate, alerting the referring doctor or obstetrician in only 20 percent of cases.
• The mother has a history of one or more pregnancies with shoulder dystocia complications during labor and delivery. A previous history of this complication can increase the chance it will occur in later pregnancies by as much as 15 percent.
• The mother is obese or overweight with a body mass index (BMI) of greater than 25. A mother weighing more than 176 pounds or 80 kilograms increases the risk of shoulder dystocia by almost eight times! Another risk factor associated with maternal weight is excessive weight gain -- anything over 35 pounds -- during pregnancy. Most overweight mothers tend to give birth to larger babies. Maternal obesity had such a large effect on shoulder dystocia because of multiple relationships between the condition and other factors that can lead to shoulder dystocia.
• The mother has diabetes mellitus. This condition can be pre-existing or gestational, occurring during the pregnancy itself. Not only do diabetic mothers give birth to larger babies, their babies have larger heads and shoulders out of proportion to the babies' weights and heights. A pregnant woman who strictly controls her blood sugar levels can decrease the chance that her fetus will weight more than 8.8 pounds (or 4 kilograms) and thus have a decreased change of experiencing shoulder dystocia.
• She is pregnant with more than one baby.
• She has passed her baby's estimated due date, also known as a post term pregnancy. This situation can double a mother's chance of experiencing shoulder dystocia.

• The average size and weight of newborn babies has increased "significantly" between 1970 and 1988. One study indicated that the percentage of baby's considered "very large" increased 300 percent during these 18 years.
• A mother's average weight and the amount of weight gained during pregnancy have continued to increase over the last few decades. Both of these factors are strongly related to an increased incidence of shoulder dystocia.
• An increased amount of news about this condition might have lead to "heightened awareness and increased reporting."
• Some may suggest that babies are delivered by vaginal birth when they should have been delivered by C-Section, but were not because of the added cost to insurance companies when a surgery is performed.