1 of 9

Shoulder Dystocia

Deb Phillips, CPM

2 of 9

Stuck or not stuck?

  • Shoulder dystocia
  • Sticky shoulders
  • Soft tissue dystocia
  • Bed dystocia
  • No such thing as “mild” shoulder dystocia
  • It either is or it isn’t!

3 of 9

When to expect

  • Baby one pound larger than previous babies
  • Gestational Diabetes or diabetes
  • History of large babies
  • Maternal obesity
  • Postdates
  • Large baby
  • History of difficult deliveries
  • Contracted pelvis
  • Slow labor
  • Long pushing
  • Turtle sign

4 of 9

  • The best preparation for management of shoulder dystocia is to have anticipated it.

5 of 9

WRONG!

  • Exaggerated lithotomy (McRoberts)
  • Hang off edge of bed
  • Inverted bed pan
  • Spread eagle
  • Reach in with both hands and turn shoulders
  • Suprapubic pressure
  • Catherize
  • Cut large episiotomy
  • Vag check to rule out
    • Short cord
    • Enlargement of baby from tumors, etc
    • Locked twins
    • Conjoined twins
    • Bandl’s retraction ring
  • Screw Maneuver of Woods
  • Deliver posterior arm
  • Rotate baby again
  • More suprapubic pressure
  • Break baby’s clavicle
  • Zavanelli maneuver

​

6 of 9

Sticky Shoulders

  • Squat first
    • Opens pelvis 20%
  • Encourage mother to push hard
  • Give rectal pressure
    • She has no urge to push with the shoulder’s still behind the pubic bone and the head out
  • Stay calm

​

7 of 9

Gaskin Maneuver

  • Move to hands and knees
  • Move to lithotomy
  • Exaggerated lithotomy
  • Suprapubic pressure
  • Hook an arm
  • Back to squat
  • Repeat if need be

8 of 9

Screw Manuever of Woods

  • Pelvis is so full
  • Hard to tell which way to turn
  • Remember where the heart tones were.
  • Turn one way
  • Turn the other way

​

9 of 9

Case Study

  • Darlene W, 1993
    • 11 pound baby with hand on back
    • Full set of Gaskin maneuver twice
  • Martha W, 1986 & 1994
    • Screw Manuever of Woods twice
  • Lin F, 2000
    • Cramped quarters