Safer Child Birth - Prevent Shoulder Dystocia - LMS Medical

BACKGROUND:

Shoulder dystocia takes place when a baby gets stuck by the shoulders behind the mother's pelvic bone during delivery. This happens when a baby is already in the birth canal, so to ease the baby out, a doctor has to do immediate maneuvers. Shoulder dystocia is described in an American Family Physician research article as "one of the most frightening emergencies in the delivery room." Authors wrote, "Although many factors have been associated with shoulder dystocia, most cases occur with no warning." Risk factors for shoulder dystocia include having diabetes, being overweight, carrying a large baby and having a history of births with shoulder dystocia.

While some cases of shoulder dystocia are overcome without injury to the baby, 20 percent cause injury, according to shoulderdystociainfo.com. These injuries include collar bone fractures, humerus fractures, contusions, lacerations, birth asphyxia and damage to the brachial plexus nerves. The brachial plexus nerves are found at the base of the neck. When the nerves are damaged, a baby can suffer paralysis of the arm and hand.

TREATMENT:

The majority of brachial plexus injuries resolve on their own over the course of several months to a year, but physical therapy is usually recommended following birth. For permanent injuries, physical therapy can strengthen nerves that are partially damaged. Although some surgeries, like nerve grafting and muscle transposition, are carried out after these types of injuries, their effectiveness remains controversial.

IS IT PREVENTABLE?

Traditional thought is that shoulder dystocia is unpredictable and unpreventable. However, the United Brachial Plexus Network says using the proper positioning during labor will help reduce the chances of shoulder dystocia. To prevent the complication, experts recommend a mother not lie on her tailbone during delivery. This is because the position reduces the amount of space a baby has to pass through and increases the likelihood of a forceps or vacuum delivery. In some cases, a woman who presents multiple risk factors for shoulder dystocia is told a C-section is the safest option for delivery.

A NEW WAY TO PREDICT:

Dr. Emily Hamilton of Montreal has developed an algorithm that, using multiple pieces of data about a pregnant mother and her baby, can calculate a probability of shoulder dystocia with injury occurring. She took this algorithm and developed a software system called CALM Shoulder Screen, which is now being utilized by obstetricians throughout the United States. The Web-based system can be used to predict a woman's risk of shoulder dystocia during birth from 37 weeks of gestation onward. Henry Lerner, M.D., Assistant Clinical Professor of Obstetrics and Gynecology at Harvard Medical School in Boston, Mass., was involved in the testing of the software after it was first developed but no longer works for the company. He still uses it in his practice.

Category:

News & Politics

Tags:

• shoulder
• dystocia
• erbs
• palsy
• screen
• pregnancy
• birth
• defect
• injury
• medical
• malpractice
• OB
• obstetrics
• brachial
• plexus
• bpi
• diabetes
• deformity
• fetal
• large
• baby
• LMS
• Medical
• Systems

[lncooper]

Do they take into consideration that what they do to moms in the hospital is usually what causes SD? Being stuck in bed, augmentation, induction, & instrumental deliveries majorly increase the risks of SD.

Having a c-section will take away some of the worries about risks when having a baby? Really? Cesareans are far riskier for baby, mom, & any of mom's future babies. Instead, they should focus on good nutrition & maintaining mobility during birth.

[lncooper]

Around 120 years ago, there was poorer living conditions, sanitation, & overall quality of life. Yes, an OB & hospital can be beneficial for the ~5% of end up needing them, but for the rest of us & our babies, they cause more harm than good. When birth first moved to the hospital, MORE moms & babies were dying because of infection. The movement to the hospital was a social status one & driven by access to pain medications, not one based on evidence or safety.

[lncooper]

@Carabin33fr I'm done debating with someone who uses incomplete sentences and words like "learnt." It's simple to use Google or talk with a care provider who practices the midwifery model of care (not necessarily all midwives; some rare gem OBs practice this model of care as well) to learn more about how immobility impedes birth progress & can lead to complications, SD just being one of them.

[lncooper]

@Carabin33fr SDs are generally handled better at home than in hospital- less perineal trauma, less chance of the baby's clavical being broken, the lack of immobilizing medications makes mom able to be more of an active participant in freeing a stuck baby more quickly whereas at the hospital other attendants flip mom around or default to breaking baby's clavical because other positions can't be tried with an immobilized mom if the McRobert's maneuver doesn't work.

[lncooper]

@Carabin33fr Aside from symphysiotomy & the zavanelli maneuver, the "tricks" (position changes) to free up SD are available at home with a trained midwife. Trained midwives have emergency training and all of the first line of medications & assistance necessary for a mom/baby that may be in trouble that you'd find in the hospital. They are trained to know when transport is necessary or when something is out of their ability to handle.

[lncooper]

@Carabin33fr Look up lithotomy position and shoulder dystocia on any search engine. The lithotomy position decreases the pelvic outlet. It isn't rocket science to figure out that the smaller the opening of the pelvis, the more likely for a baby's shoulders to get stuck. This isn't the same as saying having a small pelvis equates being at high risk for SD, but it does mean that being immobilized in the lithotomy position increases SD for a mom/baby vs. mom being able to move.

[Carabin33fr]

@lncooper I didnt forget to mention anything..I did not want to enumerate them all but i have to say.. I have simply never heard, learnt or read anything concerning the inability to move as a risk factor. Do you have any valid source you could share? I'm sorry for calling you an ignorant but your criticism against hospital care doesnt seem founded. It isn't perfect but it enables fast intervention when necessary. Which would not be possible at home. Precisely in the case of SD.

[Carabin33fr]

@lncooper I didnt forget to mention anything..I did not want to enumerate them all but i have to say.. I have simply never heard, learnt or read anything concerning the inability to move as a risk factor. Do you have any valid source you could share? I'm sorry for calling you an ignorant but your criticism against hospital care doesnt seem founded. It isn't perfect but it enables fast intervention when necessary. Which would not be possible at home. Precisely in the case of SD.

[lncooper]

When mom is not able to move around while pushing, not only does this make shoulder dystocia more likely to occur, but it can also lead a case of sticky shoulders to become something much more serious (like full blown shoulder dystocia). The ability to move is crucial should sticky shoulders or shoulder dystocia occur. The vast majority of women birthing in hospitals are tethered to bed by monitors, impeded by medication, &/or made to birth on their backs.

[lncooper]

@Carabin33fr What makes you think I'm "completely ignorant"? (Note: corrected spelling of completely) You note that macrosomia & pelvic anomalies may be risk factors, but forget to note that inability to move while pushing is a risk factor too. Birthing in a position that closes up the pelvic outlet is a risk factor often imposed by the obstetrical model of care.

[Carabin33fr]

@lncooper Shoulder dystocia is completely unpredictable. There are certain risk factors like macrosomia and pelvic anomalies but it is definitely not favorised by hospital care. Hospital care, on the contrary, is necessary, among many other things, when dystocia actually occurs to save the baby. Please don't try to inform others when you're completly ignorant yourself.

[josigrosie]

Are you an expert "incooper"?!?!?!?