“Shoulder Dystocia” – with Dr. Caroline Friedman

Shoulder dystocia is a delivery complication that occurs when a baby’s shoulders do not emerge within approximately 60 seconds after the head is delivered. On the Healthful Woman podcast, Dr. Caroline Friedman joined Dr. Fox to discuss what shoulder dystocia is, why it happens, and how obstetricians respond when it occurs. If you are navigating a high-risk pregnancy or simply want to understand potential delivery complications, this resource is designed to give you clear, factual information. To speak with a specialist, call us today.

What Is Shoulder Dystocia and Why Does It Happen?

Shoulder dystocia occurs during vaginal delivery when the baby’s anterior shoulder becomes impacted behind the mother’s pubic bone after the head has already been delivered. Under normal circumstances, the shoulders follow the head within about 60 seconds. When that does not happen, the obstetrician must act quickly to safely complete the delivery.

Factors That May Increase the Likelihood of Shoulder Dystocia

According to Dr. Friedman’s discussion on the Healthful Woman podcast, several factors may be associated with shoulder dystocia, including:

• Fetal macrosomia, meaning a larger-than-average baby
• Maternal diabetes, including gestational diabetes, which can influence fetal size and fat distribution
• Operative vaginal delivery, such as the use of forceps or vacuum
• A history of shoulder dystocia in a prior delivery
• Prolonged labor or prolonged second stage of labor

It is important to note that shoulder dystocia can also occur without any identifiable risk factors. Dr. Friedman emphasized on the podcast that predicting shoulder dystocia before delivery remains difficult, even with ultrasound estimates of fetal weight. Ultrasound measurements of fetal size carry a margin of error, which means that estimated fetal weight alone is not a reliable predictor. This is one reason why obstetric teams maintain preparedness for shoulder dystocia in all vaginal deliveries. Individual circumstances vary, and your care team is best positioned to discuss your specific situation.

Understanding these risk factors is one reason comprehensive high-risk obstetrics care includes ongoing monitoring throughout pregnancy, not only at delivery.

How Obstetricians Manage Shoulder Dystocia During Delivery

When shoulder dystocia is identified, the obstetric team responds with a defined set of maneuvers intended to help release the impacted shoulder safely. Time is a critical factor because the baby’s oxygen supply may be affected during this interval.

Common Obstetric Maneuvers

Dr. Friedman described several techniques that providers are trained to use in sequence. The McRoberts maneuver is typically the first step and involves sharply flexing the mother’s thighs against her abdomen to widen the pelvic outlet. Suprapubic pressure, applied by a nurse or additional provider, is often used alongside McRoberts to help dislodge the shoulder from behind the pubic bone.

If those initial steps are not sufficient, the care team may move on to rotational maneuvers, such as the Rubin II or Woods screw maneuver, which are designed to rotate the baby’s shoulders into a more favorable position for delivery. In some cases, delivery of the posterior arm may be attempted to reduce the diameter that needs to pass through the pelvis.

These maneuvers require hands-on training and regular obstetric drills. Dr. Friedman noted on the podcast that simulation training plays an important role in preparing obstetric teams to respond efficiently under pressure. The goal throughout is to deliver the baby as safely and quickly as possible while minimizing risk to both mother and infant.

Patients with additional complexity may benefit from a consultation through high-risk pregnancy care services, where delivery planning can be discussed in greater detail with a maternal-fetal medicine specialist.

Understanding Risk, Preparation, and Delivery Planning for Shoulder Dystocia

One of the most important points Dr. Friedman made during the podcast is that shoulder dystocia, while serious, is a complication that obstetric teams train specifically to manage. The incidence is estimated at roughly 0.2 to 3 percent of vaginal deliveries, and the majority of cases are resolved with the maneuvers described above.

Conversations Worth Having Before Delivery

For patients with identifiable risk factors, such as gestational diabetes, a history of macrosomic infants, or a prior shoulder dystocia, a delivery planning conversation with your provider is worthwhile. This may include a discussion of estimated fetal weight using ultrasound services, the role of induction of labor, and in some cases, whether cesarean delivery is appropriate.

It is worth noting that elective cesarean delivery is not automatically recommended for all patients with risk factors. Dr. Friedman’s discussion reflects the nuanced, individualized approach that maternal-fetal medicine specialists bring to these decisions. The data do not support universal cesarean delivery based on estimated fetal weight alone, and each patient’s full clinical picture guides the plan.

Potential complications of shoulder dystocia include brachial plexus injury in the newborn and postpartum hemorrhage or perineal lacerations in the mother, though many deliveries complicated by shoulder dystocia result in good outcomes for both. Individual results may vary, and outcomes depend on a range of clinical factors.

Why Choose Our Practice for High-Risk Obstetrics Care?

Our providers bring a depth of clinical experience that reflects both academic rigor and patient-centered private practice. Our team has been recognized among “Best Doctors,” “New York Best Doctors,” Castle Connolly Top Doctors, and Super Doctors, and our hospital partner has been recognized by U.S. News and World Report as a High Performing Hospital for Maternity Care. These recognitions reflect a sustained commitment to clinical excellence.

As a member of the U.S. Women’s Health Alliance and a Rainbow Practice, we are committed to comprehensive, inclusive care for all patients. We offer high-risk obstetrics, genetic carrier screening, and detailed ultrasound services, all under one coordinated practice model that blends the strengths of academic medicine and private care. If you are researching shoulder dystocia or delivery planning, our team welcomes your questions.

Frequently Asked Questions About Shoulder Dystocia

Can shoulder dystocia be predicted before labor begins?

Predicting shoulder dystocia before delivery is difficult. Ultrasound estimates of fetal weight carry a margin of error and are not reliably predictive on their own. Certain risk factors, such as gestational diabetes or a prior shoulder dystocia, may increase likelihood, but many cases occur in patients with no identified risk factors. Your provider can help assess your individual circumstances and discuss your delivery plan accordingly.

Is shoulder dystocia considered a medical emergency?

Shoulder dystocia is considered an obstetric emergency because it requires prompt intervention after the baby’s head is delivered. The obstetric team responds with trained maneuvers to release the impacted shoulder. Most hospitals and birth centers conduct regular simulation drills so that staff are prepared to respond efficiently. The majority of shoulder dystocia cases are resolved successfully with standard obstetric techniques.

What are the potential complications for the baby?

The most commonly discussed complication is brachial plexus injury, which affects the nerve network in the shoulder and arm. In many cases, these injuries resolve over time, though outcomes vary by individual. Other possible complications include fracture of the clavicle or humerus, and in rare cases, oxygen deprivation during the delivery interval. Your provider can speak with you about potential outcomes specific to your situation.

Should I consider a cesarean delivery if I have risk factors for shoulder dystocia?

Cesarean delivery is not automatically recommended for all patients with shoulder dystocia risk factors. The decision depends on your full clinical picture, including estimated fetal weight, your obstetric history, and other individual factors. This is a conversation best had with a maternal-fetal medicine specialist or your obstetrician, who can weigh the benefits and risks of each delivery approach for your specific case. Individual results may vary.

Can shoulder dystocia happen more than once?

A prior shoulder dystocia is recognized as a risk factor for recurrence in subsequent vaginal deliveries. However, many patients who have experienced shoulder dystocia go on to have uncomplicated deliveries. If you have a prior history, your provider will likely discuss delivery planning with you early in your pregnancy to determine the most appropriate approach for your next birth. Consultation with a maternal-fetal medicine specialist may be recommended.

If you have questions about shoulder dystocia or would like to discuss your delivery plan with a specialist in high-risk obstetrics, our team is here to help. Call us today to schedule a consultation and get the expert, individualized care you deserve.

Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!