Lots of things can go wrong in a delivery, but none are more frightening than stuck shoulders. When the shoulders are larger than the head they can wedge behind the pubic bone after the head emerges. The baby is truly stuck- unable to come out and nearly impossible to push back in. The umbilical cord is pinched and with it all of the baby's oxygen. If the baby is not freed within just seven minutes, brain damage occurs. It is truly a race against time.
In 17 years of delivering babies I encountered the problem less than twenty times. I remember many of them. The worst was about 15 years ago, and it was a surprise.
The mom was petite, only 4 feet 9 inches tall. Dad was over 6 feet tall but I was not concerned about the baby being too large as this was their second child and her previous delivery of a 6 pound baby had been uneventful. I was anticipating a perfect little 7 pounder. Nothing about her labor raised any concern, as dilation progressed at a normal rate and the baby's descent was smooth as well.
When the time came I prepared for the moment of delivery by going through my pre-delivery checklist. I arranged the instruments on the delivery table, making sure everything was in its proper place and readily accessible. While I did so I went through my mental checklist, rehearsing in my mind protocols for any emergencies that might arise. It did not matter that things were going well, I had been taught to prepare as if every delivery was an emergency waiting to happen.
As part of my routine I paused and gave my "just in case the shoulders get stuck" instructions to those in the room. I pointedly told the father and the nurse that if I said, "Legs up!" they were to put a hand behind the Mother's knees and pull them up to her arm pits. I then reminded the nurse that if the shoulders were stuck to be prepared to push down hard just behind the mom's pubic bone to try to free the shoulder. These instructions were typically unnecessary (I had no reason to think they were going to be needed this time) but it never hurt to be ready.
A few minutes later the head emerged, and then, it stopped, as if it had been partially sucked back in. I instantly recognized the sign- the shoulders were stuck, badly. I took a deep breath as I realized the seven minute clock had started.
In my calmest voice I spoke to the dad and nurse, "Legs up!" They quickly complied, sensing my urgency. I applied downward traction on the baby's head. It did not move. At least 30 seconds were gone.
"Suprapubic pressure!" I called to nurse. As the top shoulder was stuck behind the pubic bone, pushing down hard might help it slide under the bone and come free. The nurse literally climbed on the bed, balled her fist and pushed down with all her might while I continued to pull the head down toward the floor. I pulled as hard as I dared, for pulling too hard could tear the nerves in the neck and result in paralysis of the arm. Still no movement at all. About 90 seconds were gone. This was now the worst case of shoulder dystocia I had ever encountered. My remaining efforts to free the baby would be ones I had only read about or discussed, techniques I had never performed before. (gulp!)
Next up was the corkscrew maneuver, where the doctor inserts a hand into the vagina behind the baby's head, sliding it behind the upper shoulder. The doctor then pushes as hard as he can to try and turn the baby sideways in an effort to free the shoulder. If this failed I would need to take scissors and make the opening as large as I could, reach inside and try to deliver one of the baby's arms. If that didn't work, I would have to attempt to intentionally break the collarbone before trying the final step, which would be to try and shove the baby back inside until an emergency c-section could be performed, a desperate act that almost never worked.
I began the corkscrew maneuver, inserting my left hand in behind the baby's head, working it behind the shoulder. I pushed hard. Nothing. I repositioned my hand and pushed again, the baby did not turn at all. I took a breath and pushed as hard as I could...I felt movement! The top shoulder gave way suddenly, the baby turned and was free! It was out in seconds! I took the baby in my arms, cut and clamped the cord and handed him to the nurse. I looked at the clock- there were about 3 minutes to spare.
As the nurse examined the baby we saw why the shoulders had gotten stuck and how they had gotten free. The 4 foot 9 inch mom had just delivered a 9 pound 6 ounce baby! A baby who had also had a fracture of his left collarbone. We had gotten "lucky." The clavicle had snapped during the corkscrew maneuver, narrowing the shoulders just enough to free the baby.
When it was over, I sat and thought about the case, grateful for the training that had led me to diligently prepare for just that scenario, the training that caused me to review those techniques before every delivery. Although I ended up performing techniques I had never done, being prepared had saved the baby's life.
When I think about being prepared for a delivery, I think about all that Mary and Joseph had to face. They knew a baby was coming and they knew it would be difficult. People would talk about the circumstances of the conception, accuse them of immorality and question Jesus' heritage. I think that without preparation the task before them would have been nearly impossible. As it was it was surely very difficult to be young and under such scrutiny.
But God prepared them, giving them signs and dreams before the birth, and then allowing them to hear the stories of the shepherds, the blessings of Anna and Simeon when Jesus was presented at the temple, and later by the words of the wise men from the East. All of these events confirmed the promise of God, providing a foundation of faith and preparing them for what was to come. Preparation that made a difference.
- Bart
This is the fifth in a series of 6 Amazing Childbirth Stories, leading up to the most amazing childbirth story, the birth of Jesus. (for the other stories click here, here, here, or here). To get future posts and stories, sign up to receive blog posts via email via the button below my photo on the right. Finally-If you enjoyed this post or the blog, please share it with a friend!