Shoulder Dystocia: What is a Nurse’s Role?

• Hearing the words ‘shoulder dystocia’ from a physician during a delivery means the clock is on for the expecting mother and healthcare team. 
• It is of the utmost importance that labor and delivery nurses are well informed on the current practices, maneuvers, and outcomes of shoulder dystocia.  
• Want to step into a labor and delivery nurse’s shoes? Let’s break it down! 

You are about halfway through your shift and your labor patient puts her call light on.  

You perform a sterile vaginal exam and find your patient to be complete.  

Coaching with the patient and their birth partner goes smoothly so you do some practice pushes, which go great!  

The provider comes into the room for delivery, and everyone is ready to meet the newborn!  

Suddenly, your provider looks at you and says, “It looks like we have a shoulder dystocia…” 

Up to this Point

As a labor and delivery nurse, when you hear the words ‘shoulder dystocia,’ you know the clock to get the newborn out starts immediately. 

The American Family Physician Journal (AFP) defines shoulder dystocia as, “when the fetal anterior shoulder impacts against the maternal symphysis following delivery of the vertex.” 

Essentially, this delivery room emergency occurs when the fetal head is delivered but one or both shoulders are stuck behind the maternal pubic bone.  

Time is of the essence in a situation like this.  

As healthcare providers, we tend to reflect back after an emergent event has happened. You think back and wonder, why did this happen? Was there anything that stood out to anticipate a shoulder dystocia, for example?  

While there are some indicators that can heighten your awareness, ultimately, shoulder dystocia can also happen without much warning. 

Risk factors to consider

• Gestational Diabetes 
• Estimated fetal weight greater than 4500 gm for GDM 
• Estimated fetal weight greater than 500 gm for non-GDM 
• History of shoulder dystocia 

Ready, Set, and Go!

As mentioned earlier with shoulder dystocia, you are on the clock once the head is delivered.  

In these events, each healthcare provider assumes a role to help ensure patient safety.  

The nurse planning to care for the newborn will start checking her resuscitation equipment and prepare for additional assessments to identify any potential neonatal injury outcome.  

Staff members will be helping with recording or talking with the patient and their support system.  

Nursing staff and the provider will be attempting various maneuvers to work towards delivery of the compromised shoulder safely.  

Regardless of assigned roles, communication between all members of the healthcare team is crucial to engage a continuously developing treatment plan and promote a successful outcome in a timely event. 

Potential complications

Maternal

• PPH 
• Cervical/Vaginal lacerations 
• Bladder injury 
• Perineal Damage 
• Uterine Rupture 

Fetal

• Fractures 
• Brachial Plexus Injury 
• Asphyxia 
• Hypoxic Ischemic Encephalopathy 
• Death 

What Do We Do to Improve Shoulder Dystocia Awareness and Practices?

Debrief

As with any unexpected event or outcome, one of the best resources for knowledge and insight is through a post-event debrief.  

Having debriefs immediately following each event allows for a more accurate recall. 

Utilizing a standard debrief form will prevent missing an opportunity for gathering thorough information.  

Additionally, holding debriefs provides the healthcare team time to not only review each event for opportunities towards improvements, but also promotes successes within the team.

Gain individual knowledge and awareness

Knowledge of shoulder dystocia as a labor and delivery nurse is vital.  

Following, not only knowing the risk factors to be watchful for or the complications that can happen but understanding each team member’s role and responsibilities if shoulder dystocia occurs can be the difference between life or death. 

To promote successful outcomes as an individual, you can review your facility’s policies and procedures, familiarize yourself with documentation requirements, understand each role, and gain knowledge of each of the maneuvers.  

While there are limitations present for all maneuvers to be done only by a provider, knowledge of each maneuver is important to the overall event. This knowledge may come in handy when you review charts or documents as the primary nurse.  

In addition, if patients need to be in a specific position to accomplish a maneuver, you will need to understand these.  

Not to mention, there are also maneuvers that are specific for nursing staff to perform when asked to do so. These maneuvers take more foundational knowledge and an understanding of newborn positioning. 

Increase facility knowledge and awareness

There are several things a facility can do to increase its knowledge and preparedness for shoulder dystocia events.  

Mock events are a great example, as they allow for guided practice and opportunities to improve communication among team members.  

Simulations and drill scenarios have also been proven to promote success for real life emergent events.  

Additionally, ensuring that all policies and procedures of the facility are up-to-date and reflect evidence-based practices are essential in promoting positive outcomes. Using references, checklists, and order sets for emergency event efficiency will also promote more accurate and complete documentation. 

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