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Understanding Shoulder Dystocia and Delivery Complications

While most deliveries happen without serious complications, labor and delivery can be unpredictable, and unexpected problems may develop quickly and require immediate medical attention. Shoulder dystocia is one such complication. It occurs when a baby’s head is delivered but one or both shoulders become stuck behind the mother’s pubic bone, and it may require immediate intervention to protect the mother and baby and to reduce the risk of birth injury.

Shoulder dystocia cannot always be predicted or prevented. However, understanding the condition, the factors that may increase its likelihood, and how medical providers should respond can help parents better understand what happened during a difficult delivery.

What is shoulder dystocia?

During vaginal delivery, the baby’s head and shoulders pass through the birth canal one after another. When a shoulder becomes lodged behind the mother’s pubic bone, the rest of the body cannot be delivered normally. Shoulder dystocia is considered an obstetric emergency because the baby may have difficulty receiving enough oxygen while the delivery is delayed. The longer the delivery takes, the greater the potential for complications.

What causes shoulder dystocia?

Shoulder dystocia does not always have an obvious cause. It can happen even when a pregnancy has appeared to be progressing normally and no known risk factors are present.

Certain circumstances may increase the likelihood of shoulder dystocia, including:

A larger-than-average baby (a condition known as fetal macrosomia, which can make vaginal delivery more difficult)
Maternal diabetes
Excessive weight gain during pregnancy
A pregnancy that continues beyond the due date
A previous delivery involving shoulder dystocia

Having one or more risk factors does not mean shoulder dystocia will occur.

How Is Shoulder Dystocia Recognized?

Some cases of shoulder dystocia occur without any obvious warning signs. Doctors may consider known risk factors during prenatal care, such as the mother’s health, fetal growth, and prior delivery history. However, even when risk factors are present, shoulder dystocia can still occur unexpectedly during delivery.

Doctors recognize shoulder dystocia when the baby’s head delivers but the shoulders do not follow with normal, gentle traction. Signs may include:

The “turtle sign”: the baby’s head pulls back slightly against the perineum after delivery.
Difficulty delivering the face and chin, despite normal pushing efforts.
The shoulders do not follow the baby’s head with gentle traction.

When these signs occur, the medical team must recognize shoulder dystocia immediately, respond quickly with appropriate delivery maneuvers, and closely monitor the baby’s heart rate for signs of distress.

How Is Shoulder Dystocia Treated During Delivery?

When shoulder dystocia occurs, doctors and other members of the delivery team may take specific steps to help release the baby’s shoulders. These can include repositioning the mother’s legs, applying pressure above the pubic bone, or rotating the baby’s shoulders to a different position. If those steps do not resolve the impaction, the team may attempt to deliver the baby’s posterior arm or reposition the mother onto her hands and knees.

Throughout, the medical team may call for additional assistance and should continue monitoring the baby’s heart rate and condition. The steps taken and the time elapsed should be documented as the delivery proceeds.

What Injuries Can Shoulder Dystocia Cause?

While many babies born after shoulder dystocia do not experience lasting injuries, complications can occur, particularly when the delivery is prolonged or excessive force is used. Potential injuries include:

Brachial plexus (sometimes called Erb’s palsy): nerve damage that can cause weakness, limited movement, or paralysis in the affected arm.
Fractures, particularly in the baby’s collarbone or upper arm.
Hypoxic-Ischemic Encephalopathy (HIE): A brain injury that can occur when a baby does not receive enough oxygen during a prolonged delivery.

HIE is one of the most serious concerns during a prolonged shoulder dystocia delivery. Not every baby who experiences shoulder dystocia will suffer oxygen deprivation or brain injury, but if a baby shows signs of distress during delivery, the medical team should recognize those warning signs and take appropriate action. A failure to recognize prolonged oxygen deprivation may contribute to HIE and other forms of birth injury. The potential effects depend on the severity and duration of the oxygen deprivation and can include developmental delays, movement disorders, seizures, and other neurological complications.

What Happens If Shoulder Dystocia Is Not Recognized or Managed Properly?

Since shoulder dystocia can become an emergency, delays in recognizing or responding to the complication may increase the risk of injury. If the baby’s shoulders remain stuck, the baby may experience prolonged compression or oxygen deprivation.

If a delivery team does not appropriately monitor the baby’s condition, uses excessive force, or fails to take appropriate steps when the baby shows signs of distress, the baby may be at increased risk of injury. In some cases, a delayed intervention or delayed C-section may raise questions about whether the injury could have been prevented. Whether a medical error occurred depends on the specific circumstances and requires a careful review of the medical records.

What Are the Signs of a Birth Injury After Shoulder Dystocia?

Some injuries are identified immediately after delivery, while others may become more apparent as the baby grows. Parents may notice that a baby is not moving one arm normally, has weakness in an arm or shoulder, or appears to have difficulty using one side of the body.

Other concerns may include seizures, unusual muscle tone, difficulty feeding, developmental delays, or other changes identified during pediatric appointments.

A baby who experienced shoulder dystocia may require follow-up care to monitor movement, development, and recovery. If an injury is diagnosed, parents may also want to understand how it occurred and whether it could have been prevented.

What Should Parents Do If Their Baby Was Injured During Delivery?

If your baby experienced a birth injury following shoulder dystocia, you may have questions about whether the complication was recognized and managed appropriately.

Medical records can provide important details about the delivery, including fetal heart rate monitoring, the timing of delivery, techniques used to manage shoulder dystocia, medications given during labor, and your baby’s condition after birth.

Reviewing these records can help families better understand what happened and whether the care provided was appropriate. A birth injury does not automatically mean medical malpractice occurred, but if you have concerns about your baby’s injury or how shoulder dystocia was managed, a professional review of the medical records may help provide clarity.

Do Not Wait. Get Answers Now.

At Wais, Vogelstein, Forman, Koch & Norman, LLC, our birth injury attorneys help families understand what happened during pregnancy, labor, and delivery. If your child experienced a birth injury following shoulder dystocia and you have questions about whether something went wrong during delivery, we are here to help you get answers.