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“Midwife’s role in shoulder dystocia”

Nowadays, midwives handle a greater number of high-risk pregnancies and deal with various childbirth emergencies. Shoulder dystocia is an obstetric emergency which midwives do occasionally encounter. To make matters worst, it is usually unpredictable.

I have been working as a Labour Room midwife for 19 years and is now the Nursing Supervisor in my hospital. From my experience, shoulder dystocia were often chaotic. Most nurses tend to lose their composure and forget the appropriate actions to take.

In my opinion, anticipation, recognition and reaction are essential when dealing with shoulder dystocia. During intrapartum period, a midwife should identify the patient’s risk factors for shoulder dystocia such as diabetes, obesity or previous history of shoulder dystocia. We should also perform abdominal palpation to estimate the fetal weight, and pay close attention to the patient’s labour progress. If the labour progress is suboptimal, the midwife should report promptly to the doctor on-duty.

After delivery of the fetal head, the midwife should watch out for turtle-neck sign which would indicate shoulder dystocia. In the event of such an emergency, we need to always remain calm and called for help. We should also instruct the patient to stop pushing while we carry out various manoeuvres systematically to deliver the fetal shoulders.

Once the emergency is over, the midwife should document the events in a timely manner in patient’s case notes.

With regular training or drills, midwives can have more confidence in managing shoulder dystocia.