Maneuvering Through the Challenges of Shoulder Dystocia


Shoulder dystocia is a phrase that strikes fear in many of us – fear of it happening, fear of not managing the problem fast enough, fear of causing injury while trying to relieve it, and fear of legal ramifications. This fear can be debilitating, but the best way to deal with fear is to arm yourself with knowledge. Knowledge is power.

You may ask yourself, “where do I get this knowledge?” This year at the ACNM Annual Meeting, we will be discussing this important topic and will cover the following aspects:

  • Maneuvers – Including traditional management techniques learned about in school and a few newer maneuvers,
  • Institutional Readiness – How to work with your facility to properly train and prepare for shoulder dystocia,
  • Legal Ramifications – Important considerations in protecting ourselves as midwives, and
  • Psychological Effects – Especially secondary traumatic stress.

The maneuvers used to manage shoulder dystocia have deep roots in midwifery and obstetrical practice. Advances in our ability to accurately model the safety and efficacy of these maneuvers have led to some changes in the recommendations for management. Current guidelines support both the individualization of management and some standard approaches that must be met to conform with contemporary standards of care.

Effective shoulder dystocia management requires a well-trained, cohesive team. Staff development at the institutional level requires training, drills, and standardized documentation. Every person working in the intrapartum unit has a role to play in a shoulder dystocia emergency. Every team member must know their role and be familiar with the roles others will play to support and enhance each other’s efforts. When necessary, they should be able to step in to take over a role typically filled by someone else.

Unfortunately, shoulder dystocia has a high risk for litigation. Protection against this risk begins during antepartum care, continues through the intrapartum period, and must also be considered after the event occurs. Due to the unpredictable nature of shoulder dystocia, these measures must be taken in the care of every pregnant individual, every time.

Secondary traumatic stress (STS) has symptoms similar to the better-known condition known as post-traumatic stress disorder (PTSD). STS may occur when individuals observe trauma experienced by others. Midwives are especially vulnerable to STS because of the close relationships we develop with individuals in our care. It can be detrimental to the individual midwife’s health, happiness, and professional practice as well as to the midwifery workforce as a whole. In our session, we will discuss ways to reduce the impact of STS both personally and professionally.  

You can learn more about shoulder dystocia by joining us at the ACNM 66th Annual Meeting, May 23-25, 2021.


Frances Sahrphillips, CNM, MS and Cheri Van Hoover, CNM, MS, FACNM