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SHOULDER Dystocia: Nursing Interventions and Risk-Management Strategies

Simpson, Kathleen Rice PhD, RNC, FAAN

MCN: The American Journal of Maternal/Child Nursing: November-December 1999 - Volume 24 - Issue 6 - p 305-311
Feature Articles: CE

Shoulder dystocia is an unpredictable obstetric emergency. Prompt intervention is necessary in order to decrease risk of maternal-fetal trauma and long-term sequella. A thorough knowledge of what to do should this crisis occur is essential for perinatal nurses to ensure the best outcome possible for the woman and fetus. Although generally shoulder dystocia is impossible to predict, there are reasonable steps that providers can take once shoulder dystocia is identified. Key nursing interventions include calling for additional help, calm supportive actions, and working in sync with the physician or certified nurse midwife (CNM) who is directing the maneuvers to deliver the impacted shoulder. Numerous risk factors for shoulder dystocia have been discussed in the literature; however, despite many attempts by researchers to develop predictive models, no single risk factor or combination of risk factors has been shown to predict shoulder dystocia. Interventions described in the literature to relieve the impacted shoulder include suprapubic pressure, the McRoberts, Woods, Schwartz-Dixon, Gaskin, and Zavanelli maneuvers, and symphisiotomy. There is no clear evidence-based order for using these maneuvers. The essential issue is to continue to intervene using an organized expeditious series of steps until the infant has been delivered. If an injury occurs as a result of shoulder dystocia despite the best efforts of the obstetric providers, it is likely that litigation will follow. This article will review what is known about risks for shoulder dystocia, appropriate nursing interventions, and suggestions for risk management.

Kathleen Rice Simpson is a Perinatal Clinical Nurse Specialist at St. John's Mercy Medical Center, Women and Children's Care Center, St. Louis, Missouri and an Editorial Board Member of this journal. She can be reached via e-mail at:

© 1999 Lippincott Williams & Wilkins, Inc.