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Childbirth Complications: Breech Birth and Shoulder Dystocia

Pregnancy complications can affect childbirth, increasing the chances of a difficult birth and health risks for both mother and baby. Conditions such as breech birth and shoulder dystocia may require assisted delivery with forceps, vacuum extraction or an emergency C-section.

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Breech Birth: C-Section or Vaginal Delivery?

A breech birth occurs when the baby enters the birth canal feet or buttocks first. The normal position for a baby during childbirth is head first. A breech birth makes childbirth more complicated, and increases the risk of fetal or maternal difficulties.

Breech birth is one of the more common pregnancy complications. Three to four percent of pregnancies are breech births. Complications that increase the chances of a breech birth baby include premature childbirth, high levels of amniotic fluid and multiple birth pregnancies.

A baby may assume a breech position throughout pregnancy, but by childbirth the baby has usually righted itself and is head first. If the baby is in a breech position in late pregnancy, several alternatives are available to avoid childbirth complications:

External Version: During an "external version" a doctor attempts to move the baby out of breech position while the baby is still in the uterus by physically manipulating the baby. An external version is usually used between weeks thirty and forty of a pregnancy, and has a fifty percent chance of success.

An external version cannot be performed in the presence of certain other pregnancy complications, including vaginal bleeding, multiple births, premature rupture of the membranes, a very small baby, low levels of amniotic fluid or abnormalities in the baby's heart rate.

Vaginal Childbirth: Vaginal childbirth is possible with a breech birth, but the risks to both baby and mother are greater than for babies in the normal head-down position. Breech birth complications include damage to the umbilical cord during childbirth, a serious event that can be fatal to the baby or the mother. If a vaginal breech birth develops complications, an emergency cesarean section is required.

Planned C-Section: If a breech birth is diagnosed in conjunction with other pregnancy complications, or if vaginal childbirth is not an option, a planned C-section may be arranged. A planned C-section gives the mother the option of regional anesthetic, so she can be awake for her baby's birth.

Shoulder Dystocia

Shoulder dystocia is a term that describes difficulty delivering a baby's shoulders. "Dystocia" means "a difficult childbirth". Shoulder dystocia is often caused if the baby is especially large, although the complication can happen with a baby of any size.

Obstetricians use a number of special strategies and techniques to help deliver a baby with shoulder dystocia. If these fail, forceps or vacuum assisted delivery may be required. Shoulder dystocia can result in a number of childbirth complications. The risks of brain damage and nerve damage, bone fractures or fatigue are higher in a baby born with shoulder dystocia than with a normal childbirth.

Shoulder dystocia nerve damage may take the form of a brachial plexus injury, also known as Erb's palsy. One or two babies out of every thousand are born with Erb's palsy, usually due to shoulder dystocia complications. Erb's palsy describes damage to the nerves that control movement and sensation in the arm, hand, and fingers. Fortunately, the effects of Erb's palsy are in most cases temporary, and diminish within a year of childbirth.

Assisted Delivery: Forceps and Vacuum

Many pregnancy complications can interfere with childbirth and threaten the health of the baby and mother. In such cases, an emergency C-section may be required. In other cases, forceps or vacuum delivery is used as an alternative to C-section.

A forceps delivery occurs when the baby's head is secured within a pair of forceps (not unlike a large pair of salad tongs), and the baby is pulled from the birth canal in time with the mother's contractions.

A vacuum delivery attaches a cone to the head of the baby, which seals to the baby's head using a partial vacuum. The baby can then be pulled out.

Assisted delivery methods are used only when childbirth must be ended quickly, or when pregnancy complications suddenly interfere with childbirth. For either method of assisted delivery, the baby's head must be fully engaged in the birth canal, the cervix must be fully dilated and the mother must give her informed consent. For this last reason, assisted childbirth options must be discussed with your doctor in advance, especially if you're experiencing pregnancy complications.

Assisted Delivery Risks

Both forceps and vacuum-assisted deliveries can cause complications.

A forceps delivery may cause lacerations to the vagina, cervix, bladder or perineum that result in urinary or fecal incontinence. A forceps delivery often causes temporary trauma and scalp lacerations to the head of the baby. In some cases, the baby may suffer a skull fracture or a higher risk of cerebral palsy, behavioral problems or mental retardation.

Vacuum deliveries also carry the possibility of scalp injury. Maternal injuries with vacuum-assisted childbirth are low, but the possibility of vaginal and perineal lacerations still exists, with the possibility of incontinence.

While a rare complication, either forceps or vacuum deliveries may rupture a baby's emissary veins—veins in the scalp and head—causing a subgaleal hemorrhage . A subgaleal hemorrhage causes severe bleeding, and can be fatal.

Resources

American Academy of Family Physicians. (updated 2004). Breech babies: What can I do if my baby is breech?

American Academy of Orthopedic Surgeons. (2001). Erb's palsy (brachial plexus injury).

Beers, M.H. & Berkow, R. (ed). Normal pregnancy, labor, and delivery. The Merck Manual of Diagnosis and Therapy, 17th Edition. Merck Research Laboratories, NJ, 1999.

Bonni, A., Ross, M. (updated 2004). Forceps delivery.

Callahan, T.L., Caughey, A.B., & Heffner, L.J. (2001). Blueprints in Obstetrics and Gynecology, 2nd Edition. Blackwell Publishing, MA.

Department of Reproductive Health and Research, World Health Organization. (nd). Forceps delivery.

Massengale, A. (nd). Turning a breech before labor.

Physician's Insurance. (nd). Minimizing obstetrical risk: Shoulder dystocia.

Pope, S., O'Grady, J. (updated 2004). Vacuum extraction.

Reuters Health. (2004). Vacuum-assisted birth as safe as forceps delivery.