Shoulder dystocia is a complication of labor and delivery in which one or both of the baby’s shoulders get stuck behind the mother’s pelvic bone as the baby works his or her way down the birth canal. Only one percent of babies weighing six pounds have shoulder dystocia but five to nine percent of babies that weigh more than nine pounds have shoulder dystocia.
It is more likely to occur in larger babies. Mothers who have gestational diabetes or have previously delivered a baby with shoulder dystocia are more at risk. The risk of shoulder dystocia also increases if a mother goes past her due date or needs to be assisted in delivery by forceps or vacuum. There are also many cases of shoulder dystocia when none of these risk factors are present.
Shoulder Dystocia Delivery
Medical professionals must be comfortable and experienced in the maneuvers required to dislodge a “shoulder dystocia” baby from the birth canal. Without the proper handling of the situation, there can be nerve injury, breaks or fractures in the baby’s collarbone or arms. In addition the mother may experience hemorrhage, tearing of the perineum, uterine rupture or other pelvic injuries.
OB emergency simulations offer many students the opportunity to be prepared. Just ask the nurses at Saint Clare’s Health System in Denville, N.J. how they have become so adept at handling shoulder dystocia emergencies. They are using our high fidelity birthing simulator named Noelle to prepare for emergencies such as shoulder dystocia.
“Shoulder dystocia is an obstetrical emergency,” said Jennifer Waters, RN, MSN, NE-BC, director of maternal-child nursing. “And because we have 1% incidence of shoulder dystocia each year, it was important to prepare the team with simulation drills.”
“The drills were lifelike and realistic,” team member Gina Schoch, RNC-OB, said. “The stress and energy in the room was real. A few days after the drill, we had an actual shoulder dystocia. Thanks to the simulation drills, everything went smoothly and everyone in the room knew their role.”
Once the baby is delivered at the drill, it is taken to the warmer and resuscitated as needed, which adds to the reality of the scenario for nurses.Team members said an additional skill that has emerged is the emotional care for the mother during the emergency delivery.
The simulations, according to team members, have resulted in improved communication, delineation of roles in emergency situations, optimal use of resources and improved outcomes for patients.
“I am impressed with simulation because it allows hands-on experience with the emergency situation before you encounter it in an actual patient situation,” said Kathy Machuga, RN, a mother-baby staff nurse.