Preventing Shoulder Dystocia Complications

Two little words -- shoulder dystocia -- can bring fear into the delivery room.

Shoulder dystocia describes the condition when the baby's shoulders are not entering the mother's pelvic area the right way. Although not that common, shoulder dystocia can lead to mild to serious complications and lawsuits.

Your doctor or healthcare professional should be paying attention prior to delivery about the possibility of shoulder dystocia occuring. The positioning of the baby inside the mother's womb can provide a head's up that shoulder dystocia may be a problem during delivery.

The delivery team should be experienced in shoulder dystocia. Other recommendations include being prepared for the succession of several solutions such as putting pressure at the public bone to possibly allow the shoulder enough room to move through the birth canal; get the patient on her hands and knees which is easier said than done under anesthesia; performing a Cesarian section birth; plus other complex procedures.

After delivery, babies should be closely monitored for breathing, fractures, and other problems associated with shoulder dystocia.

Erb's Palsy - Importance of Therapy and Treatment

Erb's Palsy is a condition that often affects very young children. The condition falls under a category of injuries known as Brachial Plexus Injuries. These are a network of nerves that service the shoulders, arms and hands. Erb's Palsy occurs when these nerves are damaged in some way - usually they are pulled or torn when the shoulder is injured. The reason why this condition affects children so often is because this damage often occurs during childbirth. Studies show that about 2 in every 1,000 babies have this condition.

The severity of this condition varies according to the damage. In some cases, the nerve gets completely cut off from the spinal cord - this is the worst kind of brachial plexus injury. The good news is that in a number of cases, particularly among children, the damage heals on its own. Infants who sustain this injury at birth often take about 4 months to heal completely. If the injury is more severe then physical therapy, and in some cases, surgery is recommended.

It's important to note that nerve surgery should occur within the first three months of the child's life. Surgery performed after the baby's first year will not be effective. It's also important to do physical therapy with your child, starting when they are about three weeks old. These should be done at least twice a day - your doctor will give you a range of exercises to do.

Remember that children who are affected by Erb's Palsy may continue to experience weakness in the affected arm. This is why physical therapy and continued treatment at the right time is so important.

Home Births vs Hospital Births: Who's at Risk?

Should you have your baby at home or in a hospital?

That is a very personal question and how that question is answered is in part dependent on whom you are asking. If you are asking the American Medical Association or the American College of Obstetricians and Gynecologists then the answer is a hospital. It is the feeling of both organizations that home births are not safe and should be discouraged in the United States.

In fact the American Medical Association went as far as to endorse a resolution highlighting the risks of at home births after former talk show host Ricki Lake made a documentary movie advocating home births. According to Ricki Lake, the documentary “The Business of Being Born” was intended to inform women about their choices regarding childbirth and to give women access to all of the facts when making their decision.

The resolution adopted by the American College of Obstetricians and Gynecologists and endorsed by the American Medical Association declares hospitals to be the safest place for women to have babies. It goes on to warn women about the potential dangers of shoulder dystocia and other complications.

The story reported in the June 18, 2008 NY Daily News does not consider whether certified midwives would be able to safely birth babies who suffer from the unpredictable condition of shoulder dystocia. However, reader comments on this story seem to focus on that very point.

Several women discuss their experiences of having a baby who experiences shoulder dystocia.

Some discuss their hospital experiences and others discuss their home birth experiences. If you would like to read the story and accompanying comments, please click here.

Please leave a comment and tell us what you think: Are home births inherently unsafe because of unpredictable complications such as shoulder dystocia or do they provide a viable and important alternative for women?

Erb's Palsy: Can a New Tool Predict Complications?

Regional Women’s Health Management is one of the largest providers of obstetrical and gynecological care for New Jersey women. The group treats over 200,000 women annually and delivers approximately 5,000 babies.

In May 2008 Regional Women’s Health Management entered into an agreement with LMS Medical Systems to provide a new and innovative tool to help predict shoulder dystocia and prevents its potentially horrible effects. Shoulder dystocia occurs when the baby’s shoulder gets stuck during birth. The potential effects include nerve damage, Erb’s palsy, brain damage and even death.

The new tool developed by LMS Medical Systems is called the CALM Shoulder Screen. CALM Shoulder Screen will help doctors manage shoulder dystocia.

Dr. Kay, the Chairman of Regional Women’s Health Management, says that “Shoulder dystocia is one of the scariest crises to occur in obstetrics…We believe the CALM Shoulder Screen will not only help us to identify the higher risk mothers and take action to avoid a significant number of persistent injuries, but also help us to properly identify those lower risk mothers who have a chance of delivering without unnecessary intervention."
While it is too early to tell if Dr. Kay’s predictions will turn out to be true, it is safe to say that this will be a major breakthrough in medical care if they do. It is important to both minimize the cases when shoulder dystocia occurs and to minimize medical interventions. The CALM Shoulder Screen is designed to do both of those things.

Childbirth is a very uncertain undertaking and mothers who develop complications are very dependent on their medical providers to help them through childbirth safely. Any tool that can help doctors anticipate the medical emergency that is shoulder dystocia is a welcome development that could benefit many mothers and newborns every year in New Jersey and around the country.

Complications of Labor: Shoulder Dystocia

Shoulder dystocia is a complication of labor that is not only dangerous to the baby but also to the mother. It is a hard condition to predict and while there are conditions that make it more likely to occur there is not an accurate way to diagnose it prior to delivery.

What are the risks to the mother?
There are several risks to the mother. Some merely add to the already painful experience of childbirth and others are more serious and may require further medical interventions in order or prevent serious injury or death for the mother. The risks include:
· Rupture or significant tearing to the mother’s uterus;
· Hemorrhaging after delivering the baby;
· Bruises or tears;
· Tearing;
· Damage to the bladder.

There is a lot of discussion, research, and attention paid to the complications of shoulder dystocia on newborns. Doctors should have the responsibility to inform parents-to be about the risks of shoulder dystocia to both newborns and mothers.

If you are a pregnant mother and your doctor tells you that your baby is large, you suffer from diabetes, or you are obese or very small then do not hesitate to ask your doctor what his or her professional opinion is about the likelihood of shoulder dystocia.

Also, ask about how your doctor will handle shoulder dystocia if it presents during delivery. Will you be given an episiotomy? Will the doctor use a vacuum or forceps? Or, will the doctor opt for an emergency C– Section?

For more information about the potential risks to the mother, as well as the baby, please visit the University of Michigan’s Health System web page on shoulder dystocia.

Should Dystocia: Birth Injury Risk Factors

If you are pregnant and your unborn child is estimated to weigh more than 8 pounds, 13 ounces, then you may be concerned about potential birth injuries including shoulder dystocia and Erb’s palsy. While neither condition is able to be predicted prior to your child’s birth, there are number of factors that put you and your baby at risk.

Your risk for those conditions is elevated if you are over the age of 35, obese, significantly past your due date, diabetic or if you have previously given birth to a large baby or one who suffered from shoulder dystocia.

Being at risk does not render you helpless. Depending on how large your baby is estimated to be and the number of risk factors, you may decide to speak with your doctor about delivering the baby via a Cesarean Section (C – Section).

Yet, it is important to know that a C – Section is major surgery and it not without risk. C – Sections carry many of the same risks as other major surgeries including the risk of infection, blood loss and respiratory complications from anesthesia. Other complications include risk of changes in bladder or bowel function that may require further surgeries. C- Sections require longer hospital stays and recovery times than vaginal births and carry a higher risk of maternal death at about 1 in 2,500 as compared to 1 in 10,000 vaginal births.

For more information about the pros and cons of C – Sections please visit the NYU Langone Medical Center website.

When the time comes to make a decision, most women are dependent on the knowledge and expertise of their doctors to help them come to the right decision. It's important that you work with a doctor whom you trust to exercise the right standard of care.

Shoulder Dystocia, Pregnancy, and Diabetes

Shoulder dystocia is one of the most common birth injuries. The degree of severity varies significantly within the .3 -2 births per 1,000 that are affected by this complication. The likelihood of shoulder dystocia increases if you are a mother with diabetes.

It is often said that is not possible to predict shoulder dystocia until the mother is actually delivering the baby. While that is technically true, there are risk factors such as maternal diabetes that increase the chances of shoulder dystocia and there are ways to minimize the risk.

Can Shoulder Dystocia be Prevented?
No, shoulder dystocia cannot be prevented because it cannot be accurately predicted. However, if you have Type I, Type II or Gestational Diabetes then there are things that you can do to lower your risk of delivering a baby that suffers the trauma of shoulder dystocia.

The best way to prevent shoulder dystocia is to keep your baby within an ideal birth weight of approximately 6 pounds to 8 pounds 13 ounces. Of course, this is not always possible and there are many factors that are not within the control of either the mother or her doctor.

Here are some things that you can do to keep your diabetes under control and maximize the odds of having a baby that is less than 8 lbs 13 oz:
· Allow your doctor to perform the recommended tests to determine if you have diabetes;
· Follow the diet prescribed by your doctor, nurse or nutritionist;
· Exercise regularly, as discussed with your doctor;
· Take oral medications or insulin as prescribed by your doctor;
· Test your blood sugar several times a day, as directed by your doctor, to make sure that your blood sugar levels are staying within your targeted range. Whenever you get a reading that is outside of the targeted range, contact your doctor.

It is hard to be diabetic and pregnant. However, it is well worth the effort that it takes to effectively manage your diabetes so that you may be able to prevent your baby from suffering a birth injury.