Shoulder dystocia is a relatively uncommon obstetric emergency. Despite this, care providers, particularly at Sunshine Hospital, must still be aware of the steps to take to address dystocia in the event obstetric support is unavailable.

Shoulder Dystocia guideline (WH – last review 2013)

Watch a short video filmed by Dr Neil Long FACEM, in collaboration with the midwifery education team of Sunshine hospital (5min)

Mechanically, shoulder dystocia occurs due to a mismatch between the antero-posterior width of the baby’s shoulders relative to the mother’s pelvis, causing obstructed labour. All techniques seek to manipulate these dimensions and correct this mismatch.

Key points:

1. call for help early (obstetric as a given but remember paediatric/neonatal support and anaesthetic support)
2. manipulate (widen) pelvis: McRoberts position (hips flexed)
3. manipulate (relatively reduce) shoulders: suprapubic pressure / shoulder rotation / deliver arms
4. consider episiotomy
5. try on all fours position if safe
6. consider salvage manuevers

Additional resources

watch: longer video also describing salvage techniques (10min)

watch: a dramatisation, solely to stimulate your adrenaline response (4min)