Infant Shoulder Dystocia

Although it is a natural process with hundreds of thousands of years of evolution behind it, giving birth is still riddled with challenges. Even if you make it all the way through the pregnancy without an issue, actually giving birth is the final stretch where a problem could come up. Often they involve the baby’s shoulders making it out of the womb. One example of this is known as infant should dystocia.

What Is Infant Shoulder Dystocia?

Infant shoulder dystocia is an injury that occurs during the delivery phase of the birthing process when the baby’s shoulders keep it from exiting the mother’s pelvic region. The complication is often because the baby is simply too large for the birth canal.

However, other causes may be in play as well. For example, the baby might be born face first. This is sometimes referred to as turtle syndrome. If the baby is pulled out by their face, undue stress can be placed on their neck. On the other hand, if the baby is born feet first, excessive stress may be put on their shoulders or neck.

Symptoms of Infant Shoulder Dystocia

The first sign that infant shoulder dystocia is occurring is when the baby is able to get their head out, but the rest of the transition then comes to an immediate halt. This is a good sign that the shoulders are stuck.

In an attempt to free the baby, physicians could accidentally injure the infant’s brachial plexus, causing palsy. Bones can be broken and various facial injuries might occur.

Common injuries that are associated with infant shoulder dystocia include:

  • Nerve damage and general pain in the injured area
  • The child’s hand is held like a “claw”
  • Minor paralysis in the affected limb

Unfortunately, the mother is also put at risk when this complication happens. They could suffer from hemorrhaging, lacerations or even uterine rupture.

What Is Brachial Plexus Palsy?

Brachial plexus palsy can occur as a result of a physician poorly trying to treat infant shoulder dystocia. In brachial plexus palsy, damage is done to the brachial plexus system of nerves. This can include Klumpke’s palsy and Erb’s palsy.

These two forms of palsy and other types involved with brachial plexus palsy happen because the nerves have been moved, torn or even completely detached. As a result, nerve signals are interrupted or otherwise altered.

Risk Factors to Watch Out For

There are a number of risk factors associated with this condition that you should be aware of. They include:

  • Fetal macrosomia
  • Maternal diabetes
  • Prior cases during delivery
  • Late labor and delivery
  • Pregnant with twins, triplets, quadruplets, etc.
  • Epidural use
  • Induced labor
  • Maternal obesity

Preventing Infant Shoulder Dystocia

The good news is that, in most cases, infant shoulder dystocia is preventable. A physician, who is constantly monitoring the infant, will be able to tell if the baby is in distress. If so, they can schedule an emergency C-section to preempt any injuries that would otherwise occur.

Also, if an infant is already going to have a high birth weight and has cephalopelvic disorder (CPD), they will most likely need to be delivered via C-section to alleviate any risks of shoulder dystocia. However, the physician will need to decide which one is more dangerous.

Treating Infant Shoulder Dystocia

If the injury occurs, treating it will depend on its severity. Often, infant shoulder dystocia does not stop a successful delivery from occurring, so only the injured area needs to be addressed. In such a case, physical therapy should be sufficient.

Usually, though, doctors will try things like suprapubic pressure, the McRoberts maneuver, internal rotation or the Zavanelli maneuver to help the baby leave the birth canal with little to no injuries.

Infant shoulder dystocia is, fortunately, fairly easy to prevent. However, even if it occurs, the complication does not need to be major threat to the health of the baby or its mother.

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