Shoulder Dystocia Injury

When shoulder dystocia occurs during childbirth, it can be a frightening and confusing experience for families. This complication happens suddenly, often without warning, and requires immediate medical response. While most babies affected by shoulder dystocia recover fully, some may experience temporary or lasting injuries that require ongoing care and support.

Understanding what shoulder dystocia is, why it happens, and what treatment options are available can help families navigate the days and months following birth. This page provides clear, medically accurate information to help you understand this birth complication and know what steps to take if your child has been affected.

What Shoulder Dystocia Means

Shoulder dystocia is a birth complication that occurs when a baby’s head delivers, but one or both shoulders become trapped behind the mother’s pelvic bone. The baby cannot move through the birth canal without help, creating an urgent situation that requires the medical team to act quickly.

This is not simply a difficult delivery. In shoulder dystocia, the normal delivery process stops. The baby’s head may emerge and then appear to pull back against the mother’s body, a sign medical professionals call the “turtle sign.” At this point, standard delivery techniques will not work, and the obstetric team must use specialized maneuvers to safely deliver the baby’s shoulders and body.

The complication typically unfolds within minutes. During that time, the baby may be deprived of oxygen, and both mother and baby face risk of injury. Quick recognition and skilled intervention are essential to minimize harm.

How Often Shoulder Dystocia Happens

Shoulder dystocia is uncommon but not rare. It occurs in approximately 0.7% to 2% of all vaginal deliveries. That means in most delivery rooms, medical teams will encounter this situation occasionally, making preparedness and training critical.

The likelihood increases when certain risk factors are present. For mothers with diabetes, the incidence rises to around 3% to 4%. For babies weighing more than 4,000 grams (about 8 pounds, 13 ounces), the risk also increases significantly.

Despite these statistics, most cases of shoulder dystocia happen in pregnancies with no identified risk factors. Many babies who experience shoulder dystocia weigh less than the typical threshold for concern. This unpredictability is one reason why all delivery teams must be prepared to respond.

Who Is at Higher Risk

While shoulder dystocia can happen to anyone, certain factors increase the likelihood:

Factors related to the baby

• Large birth weight, especially over 4,000 grams
• Babies born to mothers with gestational or preexisting diabetes, who may have increased body fat and shoulder width even at normal weights

Factors related to labor and delivery

• Prolonged labor, especially a long second stage when the mother is pushing
• Use of vacuum extraction or forceps during delivery
• Induced labor

Factors related to the mother

• History of shoulder dystocia in a previous birth
• History of delivering a large baby
• Maternal obesity
• Advanced maternal age

It’s important to understand that having one or more risk factors does not mean shoulder dystocia will occur. Most deliveries with these factors proceed without complication. Conversely, shoulder dystocia sometimes occurs in pregnancies with none of these risk factors present.

Recognizing Shoulder Dystocia During Delivery

Shoulder dystocia is diagnosed in the delivery room when the baby’s head has been born but the shoulders do not follow with gentle downward traction. The medical team will notice that normal delivery techniques are not working.

The clearest sign is the turtle sign, when the baby’s head appears to retract slightly back toward the mother’s body after delivery. This happens because the shoulder is pressed tightly against the pelvic bone.

At this point, the delivering provider will immediately call for help and begin using emergency maneuvers. Time becomes critical because the umbilical cord is compressed, and the baby is not yet able to breathe.

Medical Response and Treatment During Delivery

Once shoulder dystocia is recognized, the medical team follows a sequence of maneuvers designed to rotate the baby’s shoulders and create enough space for delivery. These techniques are taught and practiced regularly by obstetric providers.

Common maneuvers include

• McRoberts maneuver, where the mother’s legs are flexed sharply up toward her abdomen to widen the pelvis and change the angle
• Suprapubic pressure applied just above the pubic bone to help dislodge the stuck shoulder
• Woods screw maneuver, where the provider reaches inside and rotates the baby’s shoulders
• Delivery of the posterior arm, where the provider gently pulls the baby’s back arm out first to reduce shoulder width
• Repositioning the mother onto hands and knees, which can change pelvic dimensions

No single maneuver works in every case. Providers often move through several techniques quickly until one succeeds. The goal is always to deliver the baby as safely and quickly as possible.

These maneuvers can be physically intense. They may cause injury to the baby or mother even when performed correctly, because the situation itself is inherently dangerous. Providers are trained to balance the urgency of delivery with the need to minimize trauma.

Injuries That Can Result From Shoulder Dystocia

Despite the best efforts of skilled medical teams, shoulder dystocia can result in injuries to both the baby and the mother.

Injuries to the Baby

Brachial plexus injury is the most common serious complication. The brachial plexus is a network of nerves that runs from the neck through the shoulder and down the arm, controlling movement and sensation. When the shoulder is compressed or stretched during delivery, these nerves can be damaged.

Erb’s palsy is a type of brachial plexus injury affecting the upper arm. Babies with Erb’s palsy may have weakness or paralysis in the shoulder, elbow, or hand. This injury occurs in about 1 to 3 per 1,000 births overall, and in a much higher percentage of shoulder dystocia cases.

Other potential injuries include:

• Fractured clavicle or humerus, which typically heal well with minimal treatment
• Lack of oxygen during the delay, which in severe cases can lead to brain injury or other complications
• In very rare cases, death

Injuries to the Mother

Mothers can also be injured during the emergency maneuvers needed to deliver the baby. These injuries may include:

• Severe vaginal or perineal tearing
• Postpartum hemorrhage
• Injury to the anal sphincter
• Uterine rupture, especially if the mother has had a prior cesarean section

These injuries can be painful and may require surgical repair, extended recovery, and follow-up care.

Immediate Medical Care After Birth

After a delivery complicated by shoulder dystocia, both mother and baby receive close monitoring and assessment.

For the Baby

Medical staff will immediately check the baby’s breathing, heart rate, and muscle tone. If a brachial plexus injury is suspected, a pediatrician or neonatologist will perform a detailed neurological exam, checking for movement, strength, and reflexes in the arms and hands.

Imaging tests such as X-rays may be done to check for fractures. In some cases, an MRI or nerve conduction study may be recommended to assess nerve damage.

Babies with breathing difficulties or signs of oxygen deprivation may be transferred to the neonatal intensive care unit (NICU) for observation and treatment.

For the Mother

Mothers are assessed for blood loss, tears, and other injuries. Repair of lacerations may be done immediately after delivery. Postpartum monitoring will include checking for signs of excessive bleeding or infection.

Emotional support is also important. Experiencing a birth emergency can be traumatic, and many mothers benefit from counseling or support groups as they process the experience.

Long-Term Treatment and Recovery

Many babies affected by shoulder dystocia recover completely with no lasting effects. Fractures heal within weeks, and mild nerve injuries often resolve on their own within a few months.

For babies with brachial plexus injuries, the path forward depends on the severity of the nerve damage.

Physical and Occupational therapy

Early therapy is the foundation of treatment for nerve injuries. Physical therapists work with families to teach exercises that maintain range of motion, prevent stiffness, and encourage the baby to use the affected arm as the nerves heal.

Occupational therapy becomes more important as the child grows, helping them develop fine motor skills and adapt to any remaining weakness.

Most mild to moderate brachial plexus injuries improve significantly within the first six months of life. Families typically see gradual progress, with the baby regaining movement and strength over time.

Surgical Options

If there is no improvement after several months, or if the injury is severe, surgery may be considered. Nerve grafting or nerve transfer procedures can help restore function in some cases. These surgeries are complex and are typically performed by specialized pediatric neurosurgeons or orthopedic surgeons.

Timing matters. Surgery is most effective when done within the first year of life, so ongoing evaluation and close follow-up are essential.

Ongoing Monitoring

Even children who recover well may need periodic check-ins as they grow to ensure they are meeting developmental milestones and maintaining strength and coordination.

Can Shoulder Dystocia Be Prevented?

There is no reliable way to predict or prevent most cases of shoulder dystocia. Even with careful prenatal monitoring and risk assessment, the majority of cases occur without warning in pregnancies considered low risk.

Prenatal considerations

For mothers with diabetes or babies measuring large on ultrasound, discussions about delivery options may take place. Some providers recommend scheduling a cesarean delivery for very large babies, particularly if the mother has diabetes. However, ultrasound estimates of fetal weight are not always accurate, and cesarean delivery carries its own risks.

Routine cesarean delivery for all large babies is not recommended, because it would result in many unnecessary surgeries for a complication that remains relatively rare.

Hospital preparedness

The most effective prevention strategy is ensuring that every delivery team is trained and ready to respond. Hospitals use simulation drills to practice shoulder dystocia management, so providers can act quickly and confidently when a real emergency occurs.

Clear protocols, teamwork, and communication are essential. Many hospitals have implemented standardized response procedures that have been shown to improve outcomes.

Support and Resources for Families

Coping with a birth injury can feel overwhelming. Families often have questions about their baby’s prognosis, treatment options, and what daily life will look like as their child grows.

Medical resources in New York

Several major medical centers in New York offer specialized care for children with brachial plexus injuries and other birth-related complications:

• The Brachial Plexus Clinic at NewYork-Presbyterian/Columbia University Irving Medical Center provides multidisciplinary evaluation and treatment
• NYU Langone Health has pediatric orthopedic and neurosurgery teams experienced in nerve injuries
• Mount Sinai Hospital offers pediatric rehabilitation and therapy services
• Albany Medical Center provides regional access to specialized pediatric care

Therapy and rehabilitation services

Early intervention programs are available throughout New York State to provide therapy services for infants and toddlers with developmental delays or physical challenges. These services are often provided at no cost to families and can begin as early as the first weeks of life.

Emotional and community support

Connecting with other families who have experienced similar challenges can provide comfort and practical advice. Support groups, both in person and online, offer spaces to share experiences and learn from others.

Counseling and mental health support are also important. Parents may experience grief, guilt, or anxiety after a difficult birth, and these feelings are valid and deserving of care.

At nybirthinjury.com, we provide trusted, compassionate information to help families understand birth injuries and connect with qualified medical and support resources across New York and throughout the United States.

What to Do Next

If your baby was affected by shoulder dystocia, taking the following steps can help ensure they receive the care and support they need.

Schedule a follow-up evaluation. If you have concerns about your baby’s movement or strength, ask your pediatrician for a referral to a specialist. Early assessment and treatment improve outcomes.

Start therapy early. Even if nerve damage seems mild, physical therapy can prevent complications and support recovery. Ask your healthcare provider about early intervention services.

Keep detailed records. Document your baby’s progress, therapy appointments, and any medical evaluations. This information will be helpful as your child grows and if additional treatment is needed.

Seek support. Reach out to family, friends, or support groups. You don’t have to navigate this experience alone.

Ask questions. Don’t hesitate to ask your child’s medical team about anything you don’t understand. You are your child’s best advocate, and clear communication is essential.

Take care of yourself. Recovering from a traumatic birth takes time, both physically and emotionally. Make space for your own healing as you care for your baby.

Shoulder dystocia and its complications are serious, but with prompt medical care, therapy, and support, many children go on to live healthy, active lives. Understanding what happened and what options are available empowers you to make informed decisions and provide the best possible care for your child.