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Improving Neonatal Outcome Through Practical Shoulder Dystocia Training

Draycott, Timothy J. MD1; Crofts, Joanna F. BMBS1; Ash, Jonathan P. MBBS1; Wilson, Louise V. MBChB2; Yard, Elaine RM1; Sibanda, Thabani MSc1; Whitelaw, Andrew MD3

doi: 10.1097/AOG.0b013e31817bbc61
Original Research

OBJECTIVE: To compare the management of and neonatal injury associated with shoulder dystocia before and after introduction of mandatory shoulder dystocia simulation training.

METHODS: This was a retrospective, observational study comparing the management and neonatal outcome of births complicated by shoulder dystocia before (January 1996 to December 1999) and after (January 2001 to December 2004) the introduction of shoulder dystocia training at Southmead Hospital, Bristol, United Kingdom. The management of shoulder dystocia and associated neonatal injuries were compared pretraining and posttraining through a review of intrapartum and postpartum records of term, cephalic, singleton births in which difficulty with the shoulders was recorded during the two study periods.

RESULTS: There were 15,908 and 13,117 eligible births pretraining and posttraining, respectively. The shoulder dystocia rates were similar: pretraining 324 (2.04%) and posttraining 262 (2.00%) (P=.813). After training was introduced, clinical management improved: McRoberts’ position, pretraining 95/324 (29.3%) to 229/262 (87.4%) posttraining (P<.001); suprapubic pressure 90/324 (27.8%) to 119/262 (45.4%) (P<.001); internal rotational maneuver 22/324 (6.8%) to 29/262 (11.1%) (P=.020); delivery of posterior arm 24/324 (7.4%) to 52/262 (19.8%) (P<.001); no recognized maneuvers performed 174/324 (50.9%) to 21/262 (8.0%) (P<.001); documented excessive traction 54/324 (16.7%) to 24/262 (9.2%) (P=.010). There was a significant reduction in neonatal injury at birth after shoulder dystocia: 30/324 (9.3%) to 6/262 (2.3%) (relative risk 0.25 [confidence interval 0.11–0.57]).

CONCLUSION: The introduction of shoulder dystocia training for all maternity staff was associated with improved management and neonatal outcomes of births complicated by shoulder dystocia.


Change in clinical management and improved neonatal outcomes of shoulder dystocia followed the introduction of directed shoulder dystocia training for all staff.

From the 1Department of Obstetrics and Gynaecology, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom; the 2Department of Obstetrics and Gynaecology, United Bristol NHS Trust, St. Michael’s Hospital, Bristol, United Kingdom; and the 3University of Bristol, Bristol, United Kingdom.

Presented at the Institute of Healthcare Improvement Conference, December 9–12, 2007, Orlando, Florida.

The authors thank Denise Ellis (Registered Midwife) and Cathy Winter (Registered Midwife), who aided the research by searching the STORK maternity database.

Corresponding author: Dr. Timothy Draycott, Consultant Obstetrician, Department of Obstetrics and Gynaecology, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK; e-mail:

Financial Disclosure Dr. Draycott has been a consultant to Limbs and Things Ltd (Bristol, UK), manufacturers of the PROMPT Birthing Simulator. The other authors have no potential conflicts of interest to disclose.

© 2008 The American College of Obstetricians and Gynecologists