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September 5, 2025 14 mins

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Shoulder dystocia is a rare but significant birth complication where the baby's head is delivered but a shoulder gets stuck behind the mother's pubic bone, similar to moving furniture through a doorway. 

• Occurs in only 0.5-1% of births
• Risk factors include large babies, maternal diabetes, prior shoulder dystocia, and short maternal stature
• Providers look for the "turtle sign" where the baby's head retracts slightly after emerging
• Birth rooms typically have stools ready for this emergency
• McRoberts maneuver (hyperflexing mother's legs) is usually the first intervention
• Additional techniques include suprapubic pressure, internal maneuvers, and position changes
• All-fours position is often used as a last resort intervention
• In extreme cases, intentional clavicle fracture may be necessary
• Most babies recover well, though there may be temporary arm weakness
• Mothers may experience increased bleeding or perineal tears
• Birth teams train regularly for this scenario and have clear protocols

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Show Credits

Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker

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Transcript

Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
Welcome to the Ordinary Doula Podcast with
Angie Rozier, hosted by BirthLearning, where we help prepare
folks for labor and birth withexpertise coming from 20 years
of experience in a busy doulapractice Helping thousands of
people prepare for labor,providing essential knowledge

(00:38):
and tools for positive andempowering birth experiences.

Speaker 2 (00:48):
Hi, my name is Angie Rozier and I am glad to have you
here with us today on theOrdinary Doula podcast.
So today's subject I want totalk a little bit about
something you may have heard ofbefore, called shoulder dystocia
.
So shoulder dystocia is whatmay happen right during delivery
of the baby's head being born,if one of the shoulders gets

(01:08):
stuck after the head is born.
So I want you to imagine, likemoving a big piece of furniture
through a doorway I don't knowif you've ever done that like a
wide chair, a couch, a dresser,something like that.
Let's say, the front edge makesit through, fine, and that's
just like the baby's head beingborn.
That's coming out, just fine.
But then one of the corners ofthe furniture, some other piece

(01:29):
of the furniture kind of getsstuck, like on the doorframe.
It's not totally stuck, butthere's like a lip of doorframe
that's holding it back.
So no matter how you push, youcan't get it through right.
Just it won't just slidethrough.
So what do you do?
You are going to.
You know, we're not just goingto keep yanking and hope that it
works.
We're going to kind of changethe angle, tilt the furniture,

(01:50):
turn it sideways, see how youcan work it to get it through
more smoothly.
So that's very similar to whatthe birth team does when there
is shoulder dystocia.
They'd use different positions,maneuvers to kind of help the
baby's shoulders just like thatlip, that furniture on a lip of
a door frame to rotate and shiftand come through safely.
So shoulder dystocia is notsuper common.

(02:12):
It happens in 0.5 to 1% ofbirths.
So that's less than 1% ofbirths.
This happens in not crazycommon.
Some indicators that it happen.
They're actually pretty sketchy, like it's not easy to predict.
But if we have what's calledmacrosomia, so a baby that we
think is large, and that is alittle bit challenging to

(02:34):
determine exactly how big a babywill be, or LGA large for
gestational age.
So if we have a suspected babythat we think is large, that
increases the risk.
But it's not a for sure thingthat we're going to have
shoulder dystocia.
If the mom has diabetes, thatcould contribute to the

(02:55):
likelihood of it happening.
If there's been a priorshoulder dystocia, that actually
could contribute to ithappening.
Having an operative or thatmeans like a instrument-assisted
vaginal birth, so that's likeforceps or vacuums and if it
happens to someone once kind ofinteresting to know that you

(03:15):
have a 7% chance of reoccurrence, so it can happen again.
You know the 7% chance ifsomebody has had it before.
So bigger babies that's kind ofwhat we're looking at here is
bigger babies may sometimes getstuck and, interesting, it says
short maternal stature.
So if we've got like shortmamas sometimes that may

(03:37):
contribute to it, not all thetime for sure, right.
So what happens is, withshoulder dystocia, the head is
born and the baby's head comesout, usually like the top back
of the head.
You know, if you were to reachup and touch on top of your head
, that's the part that presentsfirst and then the face starts
to come out and if that'shappening, the head is being

(03:58):
born and your provider can kindof know that it's going to be
happening by something that wecall the turtle sign.
So the head's coming out andthen it kind of turtles back in
and that is because the anterioror the front presenting
shoulder is getting hung up onthe pubic bone.
So it's usually that topshoulder is getting hung up on

(04:20):
the pubic bone of the mom.
So the head can come out butthe shoulder can't.
So if you look around in yourbirth room, if you're at a
hospital you're going to havesome fairly standard equipment
around.
There are going to be one ortwo stools that are probably
like I don't know five, four orfive inches off the ground and

(04:42):
they're just hanging around inthe room somewhere.
Take a look for where those are.
I love to use those for allkinds of things, like helping a
mom to open her pelvis duringlabor, stand as she's standing
and put one foot up on a stool.
Sometimes I'll sit on them todo counter pressure or whatever.
But those, those stools, areactually for shoulder dystocia,

(05:03):
so the staff is all trained inwhat to do with this.
If the baby does get, theysometimes can suspect it.
Like, if you kind of know whatto listen for, you might realize
that they're suspectingshoulder dystocia and they'll
kind of get ready for it andhonestly, most of the time they
say that, um, it doesn't happen,like they're ready for it and

(05:26):
generally it won't happen.
I was at a birth recently whereit did happen and actually this
was a shorter mom.
I think she was five foot orfive, two, I think five foot,
even something like that veryshort.
There's no signs that she washaving a very large baby or
anything like that she pushedfor I don't know two hours and
ten minutes.

(05:46):
So standard, you know, and longprolonged pushing stage can
give an indication of shoulderdystocia, but certainly not
always.
So she pushed for quite a whileand it was interesting.
I was listening to the team talkand stuff.
We had a midwife who wasdelivering and nobody said
anything but a nurse walked inwith a second stool.
There was already a stool inthe room.

(06:07):
She walked in with a secondstool, a shoulder dystocia stool
, and I knew just exactly whatshe was thinking, as well as the
rest of the team.
So where I was standing I washolding the mom's leg as she
pushed and she worked so hard,was doing amazing and she kind
of pushed that put that stool ina strategic place.
So as the head was coming out,the midwife called shoulders.

(06:27):
We got shoulder dystocia.
Now sometimes there's likesticky shoulders and that sticky
is like it't get stuck but it'sa little sticky right, like it
takes a little bit of wigglingto get out.
But when they actually do call ashoulder dystocia, there's kind
of some steps they go through.
They're going to recognize theturtling sign and then the

(06:47):
shoulder won't deliver withinthe usual time and we want it to
be, you know, fairly soon afterthe head.
So they'll announce kind of ashoulder dystocia and people get
into their zone here, like thatteam is going to get into their
work zone.
They start a clock, like anurse will start the clock and
they'll call for help, keep thepatient informed as best they
can, and they kind of go througha simple sequence of events

(07:12):
where they call for help.
They may, may evaluate for anepisiotomy, like would an
episiotomy be appropriate now?
Now, episiotomy is not going tomake more space in the bones,
because that's what the baby'shead is being hung up on, but
the episiotomy makes more spacefor internal maneuvers and they
don't jump to internal maneuversfirst of all.
That becomes later.

(07:33):
But what happens?
One of the first things they'lldo, it's called the McRoberts.
So a nurse will get on eitherside and they'll push anyone out
of the way who's in the way.
But they'll get on either sideon those stools and they'll take
the mom's legs kind of way back, so hyperflex her hips and then
they will add super pubicpressure to that.
So another nurse, or one ofthose two nurses doing that,

(07:55):
will get right on top of thepubic bone and like with the
flat of her hand gives somepretty good pressure there.
They used to do and thankgoodness they don't, I haven't
seen it for a really long timethey used to do fundal pressure,
so they'd go to the top of theuterus, the top of the mom's
belly, and just like push downthere.
So we'd have somebody pushingon the pubic bone, someone
cranking on the uterus, bothhips or back, as they're trying
to get that baby out.

(08:16):
But they don't do any funnelpressure anymore, which is
awesome.
And then internal maneuversthey'll kind of do some
corkscrew to deliver that backshoulder and arm to kind of to
reduce the diameter of thebaby's shoulders that are trying
to come through, and then kindof a last resort is getting on
all fours.
So they'll help that mom turnover epidural or no epidural and

(08:39):
get on all fours, because thatchanges the angle of the pelvis
as well.
Now, kind of interesting tonote.
You know I'm all about movementand position and how helpful
that is.
If we were pushing on all fourswe would already be doing the,
you know, like the very mostheroic thing we can do in a
shoulder dystocia.
So we can in effect have a lesslikelihood of shoulder dystocia

(09:03):
by simply delivering indifferent positions, which can
be good.
So last last resort would be andthis is, you know, if we're not
able to get this baby out andwe want the baby to come out
because it's Baby's gettingsqueezed like on their neck and
things, at this point Maybetheir cord is getting compressed
and they're not getting greatoxygenation.

(09:23):
It's okay to sit at theperineum for a little bit, but
certainly not very long.
So last last resort, if they'renot able to resolve this with
all the maneuvers of mom's bodyand internally, then they'll do
a clavicle fracture, like anintentional clavicle fracture of
that baby, and the provider canjust reach in and kind of pop
their collarbone and it does.

(09:44):
It's sad like it does break it,but that helps the baby to be
born much more quickly becausethat gives of course a little
bit more room.
So I shudder to think of that.
But I have seen a couple ofbabies not intentional, let me
think, if I have.
I have seen one get anintentional break with the
shoulder, dystocia.
But I have seen a couple breakunintentionally and we're not

(10:06):
quite aware of that for a littlebit.
But there's some pretty acutecoaching going on at this point.
There's some pretty steadynarration.
Someone will take charge withshoulder dystocia.
The maneuvers take 30 to 60seconds.
The nurses, everyone in theirrole, knows exactly what they're
doing.
They document it very well andthey're trained.
They're trained to do this.

(10:26):
So incredibly rare.
You know 0.5 to 1% of babies ordeliveries is this going to be
happening and it's not reallyvery predictable.
So it's not predictable.
Like I told you, I've seen many, many times they prepare for it
and then we just didn't evenneed it.
They were like already there onthe stools and the baby just
slides right out.
So maybe anticipate some quickmovement and quick working and

(10:50):
talking if that is the case.
But just want you to know alittle bit about shoulder
dystocia and you know why it's.
A problem for the baby is it can.
Being stuck can kind of meanpressure on the neck and nerves
May lead to injuries, brokencollarbone or temporary weakness
in an arm or something.
Babies can't tell us about that, but you can kind of notice in

(11:12):
some of their behaviors.
Most heal well, of course.
And then for the mom, for thebirthing person, it can increase
the chance of heavy bleedingafter the birthing person.
It can increase the chance ofheavy bleeding after and it can
also cause more tear vaginal orperineal tears, as you can
imagine, as they're doing umwork with the maneuvering.
So and the one you know, that'spretty true to form the birth I
was at a few days ago with theshoulder dystocia, um, there was

(11:35):
extra bleeding afterwards.
They watched that mom prettyclosely, um, for a little while.
But realize that your birth team, whether you're at a birth
center, they can handle this,you know, in almost all cases
and they're amazing at doingdifferent positions and avoiding
it in many instances.
But your providers are going tobe trained with steps to help

(11:57):
free the shoulder quickly andsafely.
So that's adjusting legs.
That'll often solve the problemright there and moving the
mom's body as needed.
So most people you know arejust fine.
They recover well when this isthe case and it's actually
pretty rare, which is kind ofnice to know.
So, just like that couch, thatkind of gets stuck if you have a

(12:21):
piece of furniture that'sgetting stuck in a doorframe.
This is very similar, right,change the angle.
In birth we use the sameprinciples Adjusting the angle
so that that shoulder can getout.
Hopefully that answers anyquestions you may have about
shoulder dystocia.
Sometimes, yeah, they say getready for a shoulder or you know

(12:45):
suspected shoulders.
Hopefully you're not going torun into that, but I want you to
kind of know and be aware ofwhat happens.
It gets a little tense for aminute, but know everybody's
doing their job and they'redoing their job they're trained
to do.
Like I said, I've only seen ita very handful of times, small
handful of times in the 20 yearsthat I've been 20.
Some odd I've been doing this,so hopefully you'll never see it

(13:07):
.
It's a pretty rare thingactually to occur.
Thank you again for being herewith us on the Ordinary Doula
podcast.
We sure do enjoy our audienceand love to see the lessons that
we're getting and the downloads.
We appreciate that and we hopeagain, like always, that you

(13:28):
will go out and make a humanconnection with someone today.
Please, please, reach out andmake a human connection, maybe
somebody you've seen recently orsomebody you haven't.
Make a connection and make adifference in someone's life.
Thanks for being here and we'llsee you next time.

Speaker 1 (13:54):
Thank you for listening to the Ordinary Doula
podcast with Angie Rozier,hosted by Birth Learning.
Episode credits will be in theshow notes Tune in next time as
we continue to explore the manyaspects of giving birth you.
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