This is the most frightening complication of childbirth for all concerned. The head of the baby is born but the following shoulders become stuck. There are about 8 minutes to release the shoulder before the baby will suffer from lack of oxygen becoming brain-damaged and may die. It is usually a big baby in a slightly small woman.

It happens unexpectedly in normal birth but is also well recognised after assisted vaginal delivery especially with the vacuum. The reason it is difficult to anticipate is because it can be difficult to judge the size of a baby particularly if the woman is rather overweight. Overweight women produce overweight babies. Typically the second stage of labour and the pushing phase has been prolonged. This may have been the reason to perform an assisted delivery.

1. The woman’s legs must immediately be lifted and placed beside her trunk with the knees flexed. This requires two people.
2. Pressure is then applied above the pubic bone to dislodge the shoulders.
3. The doctor should cut or extend the episiotomy.
4. There is an attempt at rotation and strong pulling is discouraged.

The temptation and natural response in such a situation is to pull very hard. This can damage the baby. Rotation manoeuvres must be used with an attempt to deliver the posterior arm. If too much traction is applied then the nerves in the neck supplying the arm may be torn. This can result in a paralysis of that arm: Erb’s Palsy.

This becomes evident soon after delivery with poor movement of that arm. There is usually some degree of recovery with time although some degree of deficit is not uncommon. Surgical treatment can be helpful. More information can be obtained from the Erb’s Palsy Association.