New Medical Devices and Technologies That Could Prevent Shoulder Dystocia Complications During Birth

Shoulder dystocia represents one of the most frightening obstetric emergencies, occurring suddenly during vaginal delivery when a baby’s shoulder becomes lodged behind the mother’s pubic bone. While healthcare providers train extensively to manage this complication using established manual techniques, medical innovation continues pushing forward with new devices and technologies designed to improve outcomes when this emergency strikes.

Recent developments including specialized extraction devices, sensor-guided tools, and advanced monitoring systems show promise for reducing the devastating injuries that can result from shoulder dystocia. Understanding these innovations helps expectant families appreciate how obstetric care continues evolving to address one of childbirth’s most unpredictable complications.

This guide explains what shoulder dystocia is, how often complications occur, the current standard management techniques, and the emerging technologies that could make deliveries safer when this emergency happens.

What Is Shoulder Dystocia and Why Is It Considered a Delivery Emergency?

Shoulder dystocia is an unpredictable complication that occurs during vaginal delivery when the baby’s head delivers successfully but one or both shoulders become stuck behind the mother’s pubic bone. This impaction prevents the rest of the baby’s body from delivering, creating an urgent situation where every passing minute increases risk to both mother and child.

How Shoulder Dystocia Happens

During normal vaginal delivery, the baby’s head is the largest part that must navigate through the birth canal. Once the head delivers, the shoulders typically rotate and deliver shortly after. However, in shoulder dystocia, the anterior shoulder (the shoulder closer to the mother’s front) becomes wedged behind the pubic bone and cannot pass through.

This obstruction occurs suddenly and cannot be predicted with certainty, even when risk factors are present. One moment the delivery seems to be progressing normally with the head delivered, and the next moment providers realize the shoulders are stuck and immediate intervention is required.

Why Time Matters Critically in Shoulder Dystocia

The urgency of shoulder dystocia stems from what happens to the baby when the head has delivered but the chest remains inside. With the head outside but the chest still compressed in the birth canal, the umbilical cord is compressed against the pelvis, cutting off the baby’s oxygen supply. The baby cannot breathe because the chest cannot expand, yet the umbilical cord is no longer providing oxygenation.

Each minute that passes without delivering the shoulders increases the risk of hypoxic brain injury due to oxygen deprivation. Beyond 4 to 5 minutes without adequate oxygen, the risk of permanent brain damage or death rises substantially. This narrow time window creates intense pressure on healthcare providers to resolve the dystocia quickly.

Serious Complications That Can Result from Shoulder Dystocia

When shoulder dystocia occurs and resolution takes time or requires excessive force, several serious injuries can result:

• Brachial plexus injuries including Erb’s palsy occur when the nerves controlling arm and hand movement are stretched or torn during efforts to release the shoulder, potentially causing temporary or permanent arm weakness or paralysis
• Clavicle or humerus fractures can result from the pressure and manipulation required to free the shoulder, though these typically heal well
• Hypoxic-ischemic encephalopathy develops when oxygen deprivation during the impacted delivery causes brain injury, potentially leading to cerebral palsy, developmental delays, or other neurological conditions
• Maternal injuries including severe perineal tears, uterine rupture, or postpartum hemorrhage from the emergency maneuvers

According to CDC and NCHS data, approximately 5.2% of deliveries complicated by shoulder dystocia result in traumatic injury to either mother or baby. While this percentage might seem small, it represents hundreds of families each year dealing with permanent consequences from this complication.

How Common Is Shoulder Dystocia and Who Is at Higher Risk?

Understanding the frequency of shoulder dystocia and the factors that increase risk helps put this complication in perspective, though it’s important to recognize that shoulder dystocia can occur even without identifiable risk factors.

Overall Incidence of Shoulder Dystocia

Global incidence of shoulder dystocia varies from 0.2% to 3% of all vaginal deliveries, with rates in the United States typically falling in the middle of this range at around 1% to 2% of vaginal births. This means that shoulder dystocia occurs in approximately 1 out of every 50 to 100 vaginal deliveries.

While this might sound infrequent, given the roughly 2.5 million vaginal deliveries in the United States annually, shoulder dystocia affects tens of thousands of deliveries each year. Every labor and delivery provider will encounter this emergency multiple times throughout their career.

Known Risk Factors for Shoulder Dystocia

Certain factors increase the likelihood of shoulder dystocia occurring, though their presence doesn’t guarantee dystocia will happen and their absence doesn’t guarantee it won’t:

• Fetal macrosomia, meaning estimated fetal weight over 4,000 grams (8 pounds 13 ounces), particularly when combined with maternal diabetes
• Maternal diabetes including gestational diabetes and pre-existing diabetes, which increases baby size and alters body proportions
• Previous shoulder dystocia in a prior delivery significantly increases risk in subsequent pregnancies
• Prolonged second stage of labor when pushing extends beyond expected timeframes
• Operative vaginal delivery using forceps or vacuum assistance
• Maternal obesity and excessive weight gain during pregnancy

However, the challenge with shoulder dystocia is that it often occurs in deliveries without identified risk factors. Studies show that roughly half of shoulder dystocia cases occur in pregnancies with no recognized risk factors, making prediction and prevention extremely difficult.

Why Shoulder Dystocia Remains Largely Unpredictable

Despite knowing certain risk factors, healthcare providers cannot reliably predict which specific deliveries will experience shoulder dystocia. Ultrasound estimates of fetal weight are imprecise, often varying by a pound or more from actual birth weight. Maternal pelvic dimensions and baby positioning during labor also influence whether shoulders will deliver smoothly or become impacted.

This unpredictability means that all labor and delivery providers must be prepared to manage shoulder dystocia at any delivery, regardless of whether risk factors are present.

Current Standard Techniques Doctors Use to Manage Shoulder Dystocia

For decades, healthcare providers have relied on a series of manual maneuvers to resolve shoulder dystocia quickly and safely. These established techniques remain the current standard of care and form the foundation that new devices aim to enhance rather than replace.

The McRoberts Maneuver as First-Line Treatment

The McRoberts maneuver represents the initial intervention for shoulder dystocia and resolves up to 40% of cases without requiring additional maneuvers. This technique involves having assistants sharply flex the mother’s thighs back toward her abdomen, which rotates the pelvis and often releases the impacted shoulder.

The beauty of the McRoberts maneuver lies in its simplicity and effectiveness. It requires no instruments, causes no additional trauma, and can be performed within seconds of recognizing shoulder dystocia. When it works, delivery typically completes almost immediately.

Suprapubic Pressure to Assist Shoulder Rotation

Suprapubic pressure is often applied simultaneously with or immediately after the McRoberts maneuver. An assistant applies firm, downward pressure just above the mother’s pubic bone, attempting to push the baby’s anterior shoulder down and rotate it into a position where it can pass under the pubic bone.

When combined with the McRoberts maneuver, suprapubic pressure achieves resolution in over 50% of shoulder dystocia cases. These two interventions together represent first-line management that providers implement within the first minute of recognizing the complication.

Additional Maneuvers When Initial Attempts Fail

If the McRoberts maneuver and suprapubic pressure don’t resolve the dystocia, providers move through a sequence of progressively more invasive maneuvers:

The Rubin II maneuver involves the provider inserting their hand into the vagina and applying pressure to the back of the baby’s posterior shoulder, attempting to rotate the shoulders into an oblique position that fits through the pelvis.

The Woods screw maneuver also involves internal rotation, with the provider applying pressure to the front of the baby’s posterior shoulder to rotate the baby’s body and free the anterior shoulder.

Delivery of the posterior arm requires the provider to reach into the vagina, locate the baby’s posterior arm, and deliver it, which reduces the shoulder width and often allows the anterior shoulder to then deliver.

When Standard Maneuvers Must Progress to Emergency Measures

In rare cases where all standard maneuvers fail, providers may need to perform emergency procedures including intentional fracture of the baby’s clavicle to reduce shoulder width, the Zavanelli maneuver which involves pushing the baby’s head back into the vagina and performing emergency cesarean delivery, or symphysiotomy which surgically cuts the mother’s pubic joint to widen the pelvis.

These emergency measures are truly last resorts used only when the baby’s life is in immediate danger and all other options have failed.

Prevention Through Elective Cesarean Delivery

For pregnancies at very high risk for shoulder dystocia, particularly those with fetal weight estimated over 4,500 grams combined with maternal diabetes, some providers recommend elective cesarean delivery to avoid the risk of shoulder dystocia entirely. However, this approach requires accurately predicting fetal weight, which remains challenging, and subjects many women to major surgery to prevent a complication that might not occur.

The Yaari Extractor Device for Mechanically Assisted Shoulder Release

Among the most promising new technologies for managing shoulder dystocia is the Yaari Extractor, a mechanically-assisted device specifically designed to safely release impacted shoulders when conventional manual maneuvers fail or prove difficult.

How the Yaari Extractor Works

The Yaari Extractor is designed to apply gentle, controlled traction to help free the impacted shoulder after standard maneuvers have been attempted. Unlike manual techniques that rely on provider strength and positioning, which can vary considerably, the device provides consistent, measurable force applied in the optimal direction for shoulder release.

The mechanical assistance aims to reduce the excessive force that sometimes accompanies manual extraction attempts, particularly in high-stress emergency situations. By controlling the amount and direction of traction, the device potentially reduces trauma to both the baby’s brachial plexus nerves and the mother’s tissues.

Clinical Trial Results from 2024 and 2025

Recent clinical trials evaluating the Yaari Extractor have shown promising initial results. Studies published in 2024 and 2025 demonstrate potential for reducing severe brachial plexus injuries when the device is used to manage shoulder dystocia cases that don’t resolve with initial manual maneuvers.

Perhaps most significantly, the trials show that the device can shorten head-to-body delivery time, which directly relates to reducing hypoxic injury. Every minute saved in resolving shoulder dystocia translates to reduced risk of oxygen deprivation injury to the baby’s brain.

Current Status and Ongoing Validation

While these early results appear encouraging, the Yaari Extractor is still undergoing validation through controlled clinical trials. The device has not yet received widespread regulatory approval or entered routine clinical use in most hospitals. Researchers continue evaluating its safety profile, effectiveness compared to standard techniques, optimal timing for device deployment, and training requirements for providers who will use it.

The Goal of Mechanical Assistance

The fundamental goal of devices like the Yaari Extractor is not to replace skilled manual techniques but rather to enhance them. In straightforward shoulder dystocia cases that resolve with McRoberts and suprapubic pressure, no device is needed. However, for the percentage of cases where standard maneuvers prove insufficient, having a tool that provides controlled, consistent assistance could potentially reduce injury rates.

The device represents a middle option between manual techniques alone and the emergency procedures like intentional clavicle fracture that providers currently must resort to when all else fails.

Other Innovative Technologies Being Developed to Prevent Birth Injuries

Beyond the Yaari Extractor, several other technological approaches are being researched and piloted to improve outcomes when shoulder dystocia occurs or to better predict and prepare for high-risk deliveries.

Robotic and Smart Assistive Technologies for Delivery

Researchers are developing robotic and smart assistive technologies that could eventually help guide clinicians during complicated deliveries. These systems might include advanced pressure sensors that measure the exact force being applied during delivery attempts, force-modulating devices that prevent providers from applying excessive traction that could injure nerves, and guidance systems that help position the baby optimally for shoulder release.

While these technologies remain largely in research phases, they represent the broader trend toward bringing precision and measurement to situations that have traditionally relied entirely on provider skill and judgment.

Electronic Monitoring Systems That Identify High-Risk Deliveries

Some hospitals are piloting electronic labor monitoring systems that attempt to identify fetuses at higher immediate risk for shoulder dystocia before the head even delivers. These systems analyze real-time data including fetal size estimates, maternal pelvic measurements, labor progression patterns, and the baby’s position and descent.

The goal is to flag high-risk deliveries early enough that the care team can prepare appropriately, ensuring that experienced providers are present, extra assistance is available, and everyone is mentally prepared to execute shoulder dystocia protocols if needed.

Integrated Clinical Protocols Using Real-Time Data

Beyond specific devices, some medical centers are implementing new clinical protocols that integrate real-time data on fetal size, maternal anatomy, and labor progress to create dynamic risk assessments. These protocols use algorithms that continuously update risk predictions as labor progresses, alerting teams when risk factors align in ways that significantly increase shoulder dystocia likelihood.

These data-driven approaches don’t prevent shoulder dystocia but aim to improve preparedness and enable faster, more coordinated response when it occurs.

Simulation Training Enhanced by Technology

While not a device used during actual deliveries, technology-enhanced simulation training helps providers practice managing shoulder dystocia in realistic scenarios without risk to real patients. Advanced simulators can recreate the physical sensations and time pressure of actual shoulder dystocia, allowing providers to practice maneuvers repeatedly until they become automatic.

Regular simulation training has been shown to improve provider performance during actual emergencies, reducing time to delivery and potentially reducing injury rates.

What Recent Research Shows About Preventing Shoulder Dystocia Complications

Scientific research continues exploring whether shoulder dystocia can be prevented or its complications reduced through various interventions. Understanding what recent studies show helps families and providers make evidence-based decisions.

The 2025 Trial on Labor Induction for Suspected Macrosomia

A significant multicenter randomized trial published in 2025 investigated whether labor induction before 39 weeks in pregnancies with suspected macrosomia (large babies) could reduce shoulder dystocia rates. The study compared inducing labor around 38 weeks versus waiting for spontaneous labor or induction at 39 to 40 weeks in pregnancies where ultrasound suggested baby size over 4,000 grams.

The results showed mixed findings. In per-protocol analysis, which looked only at women who actually underwent induction as assigned, shoulder dystocia rates were lower in the induction group at 2.3% compared to 3.7% in the standard care group. However, in intent-to-treat analysis, which included all women regardless of whether they actually underwent induction, the reduction did not reach statistical significance.

What These Results Mean for Clinical Practice

The trial results demonstrate that while earlier induction might reduce shoulder dystocia risk in some cases, the benefit isn’t dramatic enough to justify universal early induction for all pregnancies with suspected large babies. Risk mitigation must be individualized, carefully weighing the risks of induction including increased cesarean rates against the potential benefit of reduced shoulder dystocia risk.

Importantly, the study reinforces the challenge of preventing shoulder dystocia through delivery timing alone, since ultrasound estimates of fetal weight are imprecise and shoulder dystocia can occur even with average-sized babies.

Evidence Against Prophylactic Maneuvers

Research has definitively shown that prophylactic maneuvers—performing McRoberts or other techniques before shoulder dystocia actually occurs—provide no benefit and are not recommended. This finding highlights that shoulder dystocia management techniques should only be deployed when the complication is actually present, not preemptively based on risk factors alone.

This evidence base is why device innovation focuses on better managing dystocia once it occurs rather than attempting prevention in all high-risk deliveries.

The Importance of Immediate Recognition and Response

Studies consistently show that the time from recognition of shoulder dystocia to completion of delivery strongly correlates with outcome. Deliveries completed within 2 to 3 minutes of head delivery generally have excellent outcomes, while those requiring more than 5 minutes have significantly higher rates of permanent injury.

This research underscores why innovations that reduce time to delivery, whether through better devices, improved protocols, or enhanced training, could have meaningful impact on reducing injuries.

Current Guidelines from ACOG and Other Medical Organizations

Professional medical organizations provide evidence-based guidelines for managing shoulder dystocia that inform current practice and set the standards against which new innovations are evaluated.

ACOG Recommendations for Shoulder Dystocia Management

The American College of Obstetricians and Gynecologists (ACOG) recommends that all birth attendants receive training in recognizing shoulder dystocia early and performing the standard sequence of release maneuvers. ACOG emphasizes that shoulder dystocia is largely unpredictable and that preparedness is more important than prediction.

Key ACOG recommendations include calling for immediate assistance when shoulder dystocia is recognized, not applying fundal pressure (pushing on the top of the uterus), which can worsen shoulder impaction, performing the McRoberts maneuver and applying suprapubic pressure as first-line interventions, documenting the specific maneuvers used and timing of delivery, and conducting regular simulation drills to maintain provider proficiency.

Royal College of Obstetricians and Gynecologists Guidelines

The Royal College of Obstetricians and Gynecologists (RCOG) in the United Kingdom provides similar recommendations, emphasizing systematic approach to maneuvers, clear communication among team members during the emergency, and post-delivery debriefing to identify opportunities for improvement.

RCOG particularly stresses the importance of avoiding excessive traction on the baby’s head and neck, which increases brachial plexus injury risk. This emphasis on controlled, measured force aligns with the rationale behind mechanical assistance devices that aim to provide consistent, appropriate traction.

Where New Devices Fit Within Guidelines

Current guidelines don’t specifically address newer devices like the Yaari Extractor because these technologies are still being validated. However, the guidelines acknowledge that innovation in obstetric emergencies is important and that new approaches should be rigorously evaluated through clinical trials before widespread adoption.

As devices complete validation and demonstrate clear benefit, medical organizations will likely update guidelines to include recommendations about when and how to use them as adjuncts to standard manual techniques.

How New Technologies Could Improve Outcomes When Shoulder Dystocia Occurs

Understanding the potential benefits of emerging technologies helps contextualize why ongoing research and development in this area matters for families and future births.

Reducing Brachial Plexus Injury Rates

Brachial plexus injuries, particularly Erb’s palsy, represent one of the most common and distressing complications of shoulder dystocia. These injuries occur when the nerves controlling the arm are stretched or torn during efforts to deliver the impacted shoulder. While many brachial plexus injuries resolve within months, some result in permanent weakness or paralysis affecting the child throughout life.

New devices that provide controlled, measured traction rather than variable manual force could potentially reduce the rate of these nerve injuries. By applying force more precisely in the optimal direction and limiting excessive pulling, mechanical assistance might achieve shoulder release with less trauma to delicate nerve structures.

Shortening Time from Head Delivery to Body Delivery

Perhaps the most critical potential benefit of new technologies is reducing the time required to complete delivery once shoulder dystocia is recognized. Even saving 30 to 60 seconds could make substantial difference in preventing hypoxic brain injury.

Devices that work quickly or monitoring systems that enable faster recognition both contribute to this goal. When seconds matter, any innovation that streamlines the process or makes it more efficient potentially saves lives and prevents disabilities.

Reducing the Need for Emergency Procedures

Currently, when standard maneuvers fail to resolve shoulder dystocia, providers must resort to increasingly invasive emergency procedures including intentional fracture of the baby’s clavicle or the Zavanelli maneuver. Having an intermediate option—a device that provides mechanical assistance—might resolve some cases that would otherwise require these desperate measures.

Reducing the frequency of these traumatic procedures benefits both babies and mothers while still achieving successful delivery.

Improving Provider Confidence and Reducing Stress

Shoulder dystocia represents one of the most stressful emergencies for labor and delivery providers. The combination of sudden onset, narrow time window, and potential for catastrophic outcomes creates immense pressure. Tools that provide additional options and support during these emergencies could help providers manage the stress more effectively and perform optimally under pressure.

Better outcomes stem not just from the devices themselves but from providers feeling more confident and capable when faced with this frightening complication.

Questions to Ask Your Healthcare Provider About Shoulder Dystocia Risk

While shoulder dystocia cannot be predicted with certainty, discussing this complication with your healthcare provider during pregnancy helps ensure you understand your individual risk factors and your provider’s preparedness to manage emergencies.

Understanding Your Personal Risk Factors

Ask your provider whether you have specific risk factors for shoulder dystocia including estimated fetal weight at your latest ultrasound, whether you have gestational diabetes or pre-existing diabetes, whether you experienced shoulder dystocia in previous deliveries, and what your provider recommends given your risk profile.

Remember that having risk factors doesn’t mean shoulder dystocia will occur, and not having them doesn’t guarantee it won’t. However, understanding your situation helps you feel informed.

Learning About Your Provider’s Experience and Training

Consider asking about your provider’s experience managing shoulder dystocia, how often they and their practice conduct simulation drills for obstetric emergencies, what the protocol is at your delivery hospital when shoulder dystocia occurs, and how quickly additional experienced help can arrive if needed.

These questions aren’t meant to challenge your provider but rather to understand the systems in place to handle emergencies effectively.

Discussing Whether New Technologies Are Available

If you’re particularly concerned about shoulder dystocia, you might ask whether your hospital has access to any newer devices or technologies for managing this complication, what the hospital’s experience has been with shoulder dystocia outcomes, and whether there are any research studies or innovative protocols you might participate in.

While most hospitals still rely on standard manual techniques, some academic medical centers may be participating in trials of newer approaches.

Understanding the Plan if Shoulder Dystocia Occurs

Ask your provider to explain what would happen if shoulder dystocia occurs during your delivery, what maneuvers they would use and in what order, how they would communicate with you during the emergency, and what follow-up care would be provided for you and your baby afterward.

Having this conversation before labor helps you feel more prepared even though you hope these measures will never be necessary.

Looking Forward to Continued Innovation in Obstetric Emergency Care

Shoulder dystocia remains one of obstetrics’ most challenging complications—unpredictable, urgent, and potentially devastating. While current management techniques using manual maneuvers remain effective for most cases, ongoing innovation aims to further improve outcomes through mechanical assistance, better monitoring, and enhanced training.

The Yaari Extractor and other emerging technologies represent meaningful progress toward giving healthcare providers additional tools for managing this emergency safely and quickly. As these devices complete validation through rigorous clinical trials, they may enter wider use, complementing rather than replacing the skilled manual techniques that form the foundation of current care.

For families, understanding that research continues actively in this area provides some reassurance that the medical community recognizes shoulder dystocia as a serious problem deserving of continued attention and resources. While no innovation can eliminate this complication entirely or prevent all injuries, incremental improvements in management add up to better outcomes for babies and mothers.

The goal of all these innovations remains consistent: resolving shoulder dystocia as quickly and gently as possible to bring babies safely into the world without injury. Whether through mechanical devices, smart monitoring systems, enhanced protocols, or improved training, each advance moves closer to that goal. Future births will benefit from today’s research, continuing the evolution of obstetric care that has dramatically improved maternal and infant outcomes over decades.

If your family has been affected by complications from shoulder dystocia, know that ongoing research and innovation are driven in part by lessons learned from past cases. Your experience, while difficult, contributes to the collective knowledge pushing medical care forward to protect future families from similar outcomes.