Shoulder Dystocia Causes

Quick Answer

Shoulder dystocia is a condition that occurs when one or both of a baby’s shoulders get stuck in the birth canal during delivery. Shoulder dystocia causes include larger-than-average babies and mothers with small pelvises. The condition can lead to severe newborn injury, including Erb’s palsy and brain damage. Learn about other shoulder dystocia causes and what legal options you may have if your baby was harmed.

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What Causes Shoulder Dystocia During Birth?

Shoulder dystociaA pregnant mother in a hospital gown holds her hands over the baby she is carrying. causes can vary, including a larger-than-average baby (fetal macrosomia) and the baby’s position in the womb. The condition usually occurs during the second stage of labor in a vaginal birth, but it can also happen in some cesarean (C-section) births.

Here are some common shoulder dystocia causes.

Birthing Position of Mother

Certain birthing positions are more likely to lead to shoulder dystocia. For example, if the mother is lying flat on her back, the sacrum may not move properly during birth. This could reduce the amount of room in the mother’s pelvis for the baby’s shoulders.

When mothers squat or kneel on their hands and knees during delivery, their newborns are much less likely to experience shoulder dystocia.

Larger-Than-Average Baby

A baby with fetal macrosomia (larger than 8 pounds, 13 ounces) is at greater risk for shoulder dystocia. This is because their large size makes their shoulders more likely to get stuck behind the mother’s pubic bone or sacrum (the area above the tailbone at the back of the pelvis).

“The rate [of shoulder dystocia] increases to 5% to 9% of babies born weighing more than 8 pounds, 13 ounces.”

—Cleveland Clinic

Small Pelvic Opening of Mother

When the mother’s pelvis is smaller than average, the baby is at greater risk of getting stuck in the birth canal.

Wrong Position of Baby During Birth

Breech babies whose heads are facing away from the cervix are more likely to develop shoulder dystocia due to their position.

What Are the Signs of Shoulder Dystocia?

There are no definite signs of what causes shoulder dystocia, so it cannot be predicted. Even though the condition is considered rare, delivery teams must be trained to handle the complication to prevent harm.

Did You Know

Shoulder dystocia is a medical emergency. When a baby is stuck, the umbilical cord may become pressed, cutting off blood or oxygen flow and putting them at risk for brain damage or even death.

If you have questions about shoulder dystocia causes, our registered labor and delivery nurses are here to help.

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Risk Factors for What Causes Shoulder Dystocia

Here are the main risk factors for the causes of shoulder dystocia during childbirth.

Being Overweight

Maternal obesity is a risk factor for shoulder dystocia. According to a 2019 American Journal of Obstetrics and Gynecology study, overweight women are more likely to experience shoulder dystocia during childbirth.

Giving Birth to Multiple Babies

When mothers give birth to twins, triplets, or other multiples, the babies have a high risk of shoulder dystocia. This is because babies in multiple births can easily get stuck behind the mother’s sacrum or pubic bone due to limited space.

Health Issues in the Mother During Pregnancy

The same 2019 study revealed that women with health issues, such as pre-existing and gestational diabetes, have significantly increased risk.

Previous Birth History Involving Shoulder Dystocia

Mothers who previously had babies with shoulder dystocia are more likely to have other children with the same condition.

Complications of Shoulder Dystocia

Medical professionals must act quickly when they suspect shoulder dystocia. Otherwise, the mother and baby may suffer a range of complications at birth.

Complications of shoulder dystocia in newborns include:
  • Compressed umbilical cord: A baby’s umbilical cord can get trapped between the mother’s pelvic bone and their own arm. A flattened umbilical cord can cut off blood and oxygen flow, causing brain injury or death.
  • Damage to the brachial plexus nerves: The brachial plexus nerves start at the neck and go down the arm. Babies with damaged brachial plexus nerves may develop Erb’s palsy (paralysis or weakness in the arm or shoulder).
  • Fractures: A baby’s upper arm bone (humerus) and the collarbone (clavicle) can break from the trauma.
  • Horner’s syndrome: This is a rare nerve damage disorder that affects a baby’s face and eyes.
  • Shoulder dislocation: Your baby may suffer dislocation in the posterior (back) arm and anterior (front) shoulder.

If your baby was harmed after experiencing shoulder dystocia during birth, you may be entitled to compensation through a birth injury lawsuit. Get a free and confidential consultation today.

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A free case review is the first step in pursuing compensation for you and your family.

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Can You Prevent Shoulder Dystocia Causes?

Unfortunately, there is very little you can do to prevent shoulder dystocia since it is unpredictable.

However, watching your weight during pregnancy and managing diabetes can help. You can also decrease shoulder dystocia causes and risk factors by talking to your labor and delivery team about what position you will be in. Delivering your baby on all fours, squatting, or lying on your side may be safer for you.

Delivery teams can help reduce shoulder dystocia causes while you are giving birth. If your obstetrician or midwife suspects shoulder dystocia, they should tell you to stop pushing. They may then use the HELPERR procedure.

HELPERR is a mnemonic device that stands for:
  • Help: The obstetrician will call for help from other professionals, including a neonatologist, an anesthesiologist, and extra labor and delivery staff.
  • Evaluate: The team may suggest an episiotomy (a cut made to the perineum, the area between the vagina and the anus). After making the cut, the medical team will ask you to get onto all fours. The doctor or midwife will then put their hand inside the birth canal to free the baby’s body.
  • Legs: The team may use the McRoberts maneuver and ask you to lie on your back with your knees pulled back as far as possible. This helps rotate and flatten your pelvis.
  • Pressure: The doctor may gently press on your stomach to help free the baby’s shoulder.
  • Enter maneuvers: Your health care team may perform enter maneuvers or internal rotation by reaching into the birth canal to turn the baby.
  • Remove posterior shoulder and arm: Your team may use Jacquemier’s maneuver to remove one of your baby’s arms from the birth canal. This will make it easier for the child to pass through.
  • Roll the patient: The doctor may use the Gaskin maneuver and have you turn over on your knees and hands to get into a new birthing position.

If HELPERR doesn’t work, the obstetrician may perform the following procedures:

  • Clavicle fracture: The baby’s collarbone is broken to release their shoulders.
  • Symphysiotomy: An incision is made in the cartilage between the mother’s pubic bones to enlarge the pelvic opening.
  • Zavanelli maneuver: The baby’s head is pushed back into the uterus, and a C-section is performed.

Treatment for Shoulder Dystocia

Most babies will make a full recovery from shoulder dystocia. However, they may need to spend time in the neonatal intensive care unit due to a lack of oxygen or injuries.

Some newborns may also require Erb’s palsy treatment if they suffered from brachial plexus nerve damage.

Shoulder Dystocia and Medical Negligence

Obstetricians, midwives, and hospitals should have the experience, expertise, and equipment to handle shoulder dystocia causes and complications.

Medical negligence could be to blame if your delivery team failed to properly respond to shoulder dystocia and your baby was harmed.

Medical negligence occurs when health care professionals deviate from standards of care and cause injury or death to a patient. A birth injury lawyer can help you determine whether you can take legal action through a medical malpractice claim.

Get a free legal consultation to find out if you can get connected with one of the nation’s best birth injury law firms.

Get a Free Case Review

A free case review is the first step in pursuing compensation for you and your family.

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Filing a Shoulder Dystocia Birth Injury Lawsuit

When medical malpractice is suspected, an experienced birth injury lawyer can help you file a lawsuit.

Compensation from a birth injury lawsuit may include:
  • Economic damages, such as medical expenses associated with your baby’s injury and your lost wages
  • Non-economic damages, such as pain and suffering and loss of enjoyment of life

If you believe the delivery team’s failure to properly respond to shoulder dystocia caused your baby lasting harm, contact the Birth Injury Justice Center without delay.

Call (800) 914-1562 or fill out our online form for a free case review.

Shoulder Dystocia Causes FAQs

What are 5 risk factors for shoulder dystocia?

According to the National Institutes for Health (NIH), the most common risk factors for what causes shoulder dystocia are:

  1. Fetal macrosomia (babies who are 8 pounds, 13 ounces or larger)
  2. Having a previous birth involving shoulder dystocia or brachial plexus injury
  3. Maternal obesity
  4. Diabetes mellitus in the mother
  5. Excessive weight gain during pregnancy

What is the highest risk factor for shoulder dystocia during birth?

The biggest risk factor for shoulder dystocia is a larger-than-average baby (fetal macrosomia).

What maternal age causes shoulder dystocia?

Some studies have suggested that advanced maternal age (over the age of 35) can be what causes shoulder dystocia.

Can shoulder dystocia be prevented?

What causes shoulder dystocia to occur is not always clear, so avoiding the condition can be difficult.

However, you can decrease the chances of shoulder dystocia by:

  • Giving birth on all fours, lying on your side, or squatting
  • Managing diabetes
  • Watching your weight during pregnancy

Can shoulder dystocia be predicted?

There is no accurate way to predict whether shoulder dystocia will happen. However, if failure to properly respond to shoulder dystocia caused a birth injury, you may be able to pursue financial compensation and justice. Get a free consultation to learn more about your options.

Birth Injury Support Team
Reviewed by:Beth Carter, RN

Registered Nurse, Legal Nurse Consultant Certified

  • Fact-Checked
  • Editor

Beth Carter has over 18 years of experience as a Registered Nurse. She spent nearly half of that time working in labor and delivery units. This, combined with her own experience giving birth to a premature baby, ignite Beth’s passion for helping new mothers access the information and resources they deserve.

The Birth Injury Justice Center was founded in 2003 by a team of legal professionals to educate and empower victims and families affected by birth injuries. Our team is devoted to providing you with the best resources and legal information for all types of birth injuries.

View Sources
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  3. Cleveland Clinic (2022 January 23). “Shoulder Dystocia.” Retrieved April 17, 2023 from
  4. National Library of Medicine: PubMed Central (2016 March). Cochrane Database of Systematic Reviews. “Induction of labour at or near term for suspected fetal macrosomia.” Retrieved April 17, 2023 from
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  7. National Library of Medicine: PubMed Central (2022 September 4). StatPearls. “Shoulder Dystocia.” Retrieved April 17, 2023 from
  8. National Library of Medicine: PubMed Central (2016 March). Women’s Health. “Shoulder Dystocia: Prediction and Management.” Retrieved April 17, 2023 from
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