Outlet Shoulder Dystocia with an Arm Swept Behind the Back

If we have a mid-pelvis or outlet shoulder dystocia wouldn’t we start timing the actual length of the dystocia separate than head to body? In an inlet shoulder dystocia the impact has started to happen with the neck stretching and the baby’s head turtling as it emerges.  Thus we start at the point we recognize the baby cannot continue to come any further.  The impact with a mid-pelvis or outlet happens later.  The head arrives and then it restitutes possibly even with the next contraction.  Wouldn’t we begin to time the shoulder dystocia from the moment the baby completed restitution?  

Here you can see that the baby is in the outlet from the outside.  First of all, the baby has already restituted as noted by the baby’s head turned to ROT.  Second of all, we can see that my hands seem to be where the shoulders of the baby should be which is not nearly as far in as an inlet dystocia.  Third, you can also look at the rear end of the birth giver and see that her bum is flattened and coccyx is raised.  This baby had its right arm swept behind its back after a quick rotation from OP to ROA. The baby was also a 9 pound 8 ounce baby that is 2 pounds larger than its previous sibling.  This too affects the space available within.  

I find the anterior shoulder without problem but seem to initially be confused about the posterior shoulder.  Then I run my hand down the back of the baby and notice that the arm has been swept there.  I then try to complete the rotation the baby was making as it emerged.  It did not budge.  I then tried to reduce the shoulder and sweep the arm.  We did move a leg up on each side but this too did not change the space. We moved to the back in McRoberts.  The shift itself assisted when I did a Posterior Axillary Crease (PAC) pull to assist the baby in being born. From the time the head was called to delivery was 5 minutes, yet there wasn’t a feeling of an emergency.  I even thought for a moment that the baby might even have enough space to breathe, but it didn’t as shown by the purple color shift in its head (Not seen in black and white).  

Want to learn more? Join me for the Spinning Babies® Resolving Shoulder Dystocia Workshop: https://www.eventbrite.com/e/san-diego-ca-spinning-babies-rsd-workshop-w-nicole-mar-13-2022-tickets-226027573557

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