Shoulder dystocia – When baby’s shoulders take time to be born
I had just begun my evening duty when Alice came into the hospital in labour. She was about to have her second baby. Having delivered her first through a normal delivery, she was calm and confident, anticipating a smooth delivery. Being a 30 year old mum, she was glowing and full of joy to see the end of her pregnancy.
On admission, which did not lake long as she had done the necessary booking arrangements earlier on, we set her up for an examination. She was about 5cm dilated. The doctor and I monitored her closely through her labour process. Her waters broke and after about four hours she was in second stage of labour.
We took her to the delivery room and encouraged her to bear down so as to aid in the delivery of the baby. She cooperated and after about fifteen minutes the baby’s head could be seen. We encouraged her to push and in a little while the baby’s head was born.
We were anticipating the rest of the baby’s body to closely follow: soon she would be holding her bouncing baby boy. The neck was out but retracted against the mother’s perineum, causing the cheeks to puff out. Alice was still pushing with all her might, but her baby’s shoulders were stuck in the birth canal. This condition whereby the shoulders fail to deliver shortly after the head is known as shoulder dystocia.
A smooth delivery is determined by sizes of the foetal head, shoulders and chest, compared to the shape and size of the maternal pelvis. Usually it is the foetal head that has the largest dimensions. However, the soft, mobile bones of the foetal head can alter their shape and slightly overlap. This facilitates the foetal head fitting through the maternal pelvis. The baby’s shoulders, likewise being flexible, usually follow the delivery of the baby’s head quickly and easily. For this to happen, foetal shoulders must descend into the maternal pelvis at an angle tilted to the anterior-posterior dimension of the pelvis. This position gives the shoulders room for their passage. If instead the shoulders line up in a straight front-to-back orientation as they are about to emerge from the mother’s pelvis, there will often be insufficient room for them to squeeze through. The basis of the mother’s pubic bone then forms a shelf on which the baby’s anterior shoulder can get caught. If this happens, the shoulders cannot deliver and a shoulder dystocia results. Babies who have shoulder dsytocia usually have disproportionately larger dimensions of the shoulders and chest than those of the head.
In Alice’s case, we had to summon a team of medical specialists that included a gynaecologist, a physiotherapist and a paediatrician to intervene because any delay at this point could have caused adverse effects on both the mother and the baby. We. however, were nearby to assist and advice on earlier progress.
The efficient medical intervention paid off. After five minutes of special manoeuvres the baby was delivered, weighing a tidy 4.3kgs. However, he had to be resuscitated and one of his shoulders was injured. The physiotherapist advised for various visits to the physiotherapy clinic. The baby is now nine months old and thankfully healed of the shoulder injury.
END: PG25/17