Plus-Size Pregnancy Risk: Shoulder Dystocia

Plus-size pregnancies, like all pregnancies, carry certain risks, but some risks are more common to plus-size pregnancies. If you're a plus-size gal who's pregnant, it's important to educate yourself about these risks so you can take precautions to avoid them. One of the major risks of the plus-size pregnancy is shoulder dystocia.

Shoulder dystocia occurs after the baby's head is born, but the shoulders remain stuck behind the mother's pelvic bone. This prevents the birth of the baby's body. This type of complication is most often seen during a vaginal birth, with or without the use of forceps, but is sometimes seen in cesarean deliveries, too.

Small Delay

It's normal for there to be a small delay between the delivery of the baby's head and his body, but in shoulder dystocia, the delay is extended. The baby cannot begin breathing while his chest is compressed within the small space of his mother's pelvis. The baby also cannot get oxygen through his umbilical cord at this time because his body compresses the cord. Since oxygen is critical, a way must be found to release the baby's body as soon as possible.

Shoulder dystocia occurs in 0.5% of all births, or 1 every in 200 births. While every birth carries a small risk for shoulder dystocia, some factors predispose the mother to such a birth. These factors include:

*Plus-size pregnancy

*Large babies weighing over 10 pounds

*Gestational diabetes

*Previous shoulder dystocia

*Induced labor

*Slow labor

Inaccurate Picture

While there is a definite link between large moms, large babies and shoulder dystocia, most big babies are born without any difficulty. Note that ultrasounds administered during the end of the pregnancy may not give an accurate picture of the baby's weight, so the prediction of a large baby may not be a reason to avoid a vaginal delivery. Also, half of all babies with shoulder dystocia weigh less than 9 pounds.

Every health care provider involved in the process of labor and delivery knows about this potential risk and is prepared to deal with such a scenario. If you've had a previous birth with shoulder dystocia, your health care provider may consider delivering you by c-section.

Steps To Take

If your health care provider suspects shoulder dystocia:

*You will be asked to stop pushing

*You will be asked to lie on your back and your legs will be pushed toward your abdomen. This allows the baby maximum room inside the birth canal so it can be born.

* Health care providers may press on your abdomen just above the pelvic bone in an effort to release the baby's shoulder

*An episiotomy may be performed to enlarge the vaginal opening

*The health care provider may try to reposition the baby within the birth canal in an effort to free the baby's shoulders

*Mother and baby will be monitored after the birth for any possible injuries

Baby Risks

Possible injuries to the baby include:

*Nerve damage, especially to the brachial plexus. This may cause some paralysis of the baby's arm, which resolves within hours or days, most of the time. One in 100 babies experiences permanent nerve damage.

*Arm or shoulder fractures

*Brain damage due to lack of oxygen

*Death, also due to lack of oxygen

Mommy Risks

Possible injuries to the mother include:

*Vaginal tears necessitating repair

*Heavy postpartum bleeding in up to 10%, sometimes a blood transfusion will be needed.

*Emotional upset—a feeling that this complication may have been avoided though no literature exists to support this idea.

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