4. Shoulder Dystocia

Question 1

When is shoulder dystocia identified?

Answer 1

When baby’s shoulders are delayed because the anterior shoulder is stuck behind the symphysis pubis.

Question 2

Once shoulder dystocia is identified…

Answer 2

Position mother in the McRoberts position.

Question 3

What quantifies delayed shoulders? (4)

Answer 3

Shoulders not born within two contractions following the head / difficulty delivering face and chin / head remains tightly applied to the vulva or retracts (turtlenecking) / the fetal head fails to fully rotate to face the mothers inner thigh once born.

Question 4

Descibe McRoberts position.

Answer 4

Mother laid flat with her bottom at the end of the bed and bring her knees to her abdomen. Push with the next contraction.

Question 5

If the shoulders don’t deliver with McRoberts alone,

Answer 5

use gentle axial traction applied to baby’s head. (Outward traction, keep head in line with spine)

Question 5

How long should we apply axial traction for?

Answer 5

30 seconds

Question 6

If undelivered using axial traction, move on to…

Answer 6

Suprapubic pressure still in McRobert’s position.

Question 7

Suprapubic pressure is…

Answer 7

hands in a CPR grip, heel of hand two finger breeadths above pubis, apply moderate pressure onto baby’s back for 30 seconds.Combine with mother pushing or axial traction

Question 8

If intermittent pressure is unsuccessful, move to…

Answer 8

ALL FOURS with hips well flexed (like an upside down mcroberts)

Question 8

Following suprapubic pressure is…

Answer 8

intermittent pressure for 30 seconds.

Question 9

If axial traction on all fours doesn’t work…

Answer 9

TRANSPORT

Question 10

__ to the ambulance and position with ___ during transport

Answer 10

Walk, pillow between legs to protect babys head