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Shoulder dystocia

Within this information, we may use the terms "woman" and "women". However, we recognise that not only people who identify as women may want to access this content. Your care should be personalised, inclusive and sensitive to your needs, whatever your gender identity.

You may find this information useful if:

  • the birth of your baby was complicated by shoulder dystocia
  • if you are a partner, relative or friend of someone who has experienced shoulder dystocia
  • if a doctor has mentioned this term to you, for example because you're expecting a large baby

What is shoulder dystocia?

Shoulder dystocia is when the baby’s head has been born but one of its shoulders becomes stuck behind the mother’s pubic bone, delaying the birth of the baby’s body. If this happens, extra help is usually needed to release the baby’s shoulder. In the majority of cases, the baby will be born promptly and safely.

How common is shoulder dystocia and can it be predicted?

Shoulder dystocia usually occurs unexpectedly during childbirth and most of the time it is not possible to predict when it will happen. However, it is more likely to occur if:

  • you have had a previous birth where shoulder dystocia occurred
  • you have diabetes
  • your body mass index (BMI) is 30 or higher
  • your labour is induced
  • you have a long labour
  • you have an assisted vaginal birth, e.g. using forceps or vacuum cup (ventouse)

While shoulder dystocia is more likely with large babies, there is no difficulty delivering the shoulders in the majority of babies over 4.5kg (10lb). Half of all instances of shoulder dystocia occur in babies weighing less than 4kg (approximately 9lb).

Ultrasound scans are not good at telling whether you are likely to have a large baby. Therefore they are not recommended for predicting shoulder dystocia if you have no other risk factors. As with all maternity scans, we have a 20% margin of error.

Can shoulder dystocia be prevented?

In most instances, shoulder dystocia cannot be prevented because it cannot be predicted.

If you have diabetes or have developed diabetes in pregnancy, you will usually be offered early induction of labour or planned caesarean section. This will reduce the risk of shoulder dystocia.

If you don’t have diabetes, early induction of labour does not prevent shoulder dystocia, even if your baby is suspected to be large. Caesarean section is also not routinely recommended in this situation.

What happens if shoulder dystocia occurs?

Your midwife and obstetrician will be aware that in every birth there is a possibility of shoulder dystocia.

Shoulder dystocia is an emergency. Therefore, if it does occur, it's important that we act quickly.

The baby’s shoulder needs to be released quickly so the body can be born and he or she can start breathing. Your midwife will pull the emergency buzzer and other members of staff, including obstetricians, midwives and a doctor for the baby (paediatrician), are likely to come into the delivery room to help. These are extra pairs of hands to help you and your baby.

Because it happens so quickly and lots of people come into the room, it may be frightening for you and your birth partner. However, it is important to remember that the obstetricians and midwives are highly trained in how to release the shoulders. In the majority of cases your baby will be delivered promptly and safely.

The obstetrician or midwife will usually:

  • ask you to stop pushing
  • reposition you to give your baby more room inside the vagina
    • You will be asked to lie on your back with your legs pushed outwards and up towards your chest (this is known as the McRoberts manoeuvre)
  • press on your abdomen just above the pubic bone to try to release your baby’s shoulder
  • consider making a cut (episiotomy) to enlarge the vaginal opening

If the shoulder is not released easily with the above measures, either your obstetrician or midwife will put his or her hand within the vagina to try to free your baby’s shoulder, or you may be helped to roll over onto all fours, which can also help to release the shoulder.

Once the shoulders are free, your baby will be born, and a paediatrician will examine him or her. Your midwife and obstetrician will talk to you about what happened. If you wish to talk at a later date about your experience, ask to talk to your obstetrician, midwife, health visitor and/or GP.

What happens if I give birth at home or in a midwife-led unit?

Wherever you give birth, your midwife is trained to deal with shoulder dystocia. If your baby is not born with the simple measures described above or by rolling over onto all fours, your midwife will call an ambulance to transfer you to hospital. If your baby is born before the ambulance arrives, your midwife may still suggest taking you and your baby to hospital to be checked over.

What if I have chosen to have a water birth?

If you are having a water birth, you will be asked to get out of the pool so that your midwife can assist you.

What could shoulder dystocia mean for me and my baby?

For you

Vaginal tears are more common after shoulder dystocia and may extend to the back passage. Heavier bleeding than normal after birth (postpartum haemorrhage) is also more common and you may require additional treatment and/or a blood transfusion.

Information on vaginal tears is available on the Royal College of Obstetricians and Gynaecologists website.

For your baby

About 1 in 10 (10%) babies who have shoulder dystocia will have some stretching of the nerves in the neck, called brachial plexus injury (BPI), which may cause loss of movement to the arm. The most common type of BPI is called Erb’s palsy. It is usually temporary and movement will return within hours or days. Permanent damage is rare.

It is important to remember that BPI can occur without shoulder dystocia. BPI can also occur in babies born by caesarean section.

Sometimes shoulder dystocia can cause other injuries, including fractures of the baby’s arm or shoulder. In the majority of cases, these heal extremely well.

Even with the best care, in very few cases, a baby can suffer brain damage if he or she did not get enough oxygen because the delivery was delayed by shoulder dystocia.

What about future deliveries?

If your baby’s birth was complicated by shoulder dystocia, there is an increased risk of shoulder dystocia in future pregnancies; around one in ten women will experience shoulder dystocia again. In view of this, your obstetrician or midwife will discuss your options for next time, taking into account your individual circumstances and preferences.

You may wish to consider a vaginal delivery if it was easy to release your baby’s shoulders, your baby was fine and you have no other risk factors. If it was difficult to release your baby’s shoulders, your baby had any injuries or the experience has affected you and your family, you may wish to consider a planned caesarean section.

Please talk to your doctor or midwife if you have any concerns and they can discuss these with you.

Last reviewed: 26 January 2023