Shoulder Presentation – All You Should Be Aware Of
Most doctors and midwives will recommend that you have a natural vaginal birth if you have a choice. However, there are certain complications that can sometimes present themselves and stop this from happening. Shoulder presentation is one such complication.
When Does the Fetus Move in Birthing Position?
A baby will most likely begin to move into the birthing position latest by week 30. She will have her head down and facing your spine, her body and face more inclined to one side and arms will be folded across the chest. Any other position is not normal.
What Is Shoulder Presentation?
This is an abnormal fetus position where the baby is in a transverse lie, causing the baby’s shoulder to be positioned to come out first if vaginal delivery is attempted. However, since this is very easy to diagnose, doctors will always recommend a C-Section and never even suggest attempting to deliver the child through normal vaginal delivery.
What Is Transverse Lie?
A transverse lie is a position where your baby is lying sideways with her head to one of your sides and her bottom at your other side. This position is considered normal before 26 gestational weeks.
What Is the Frequency of Shoulder Presentation?
Shoulder presentation takes place in 1 out of every 300 births and is commonly seen in premature and macerated babies. It is five times more likely to happen in a woman who has had children before than it is to occur in a first-time mother. Mothers carrying twins are also 40% more likely to have at least one baby in shoulder position.
What Causes Shoulder Presentation?
Here are some reasons why a shoulder presentation can take place:
1. Contracted Pelvis
A very narrow pelvis in the mother can cause a shoulder presentation to occur.
2. Placenta Previa
A condition where the placenta covers the uterus opening, either completely or partially. This makes it difficult for your baby’s head to enter the pelvic brim.
3. Intra-Uterine Fetal Death
There are times when the fetus dies inside the womb, and when this happens, the muscle tone starts to degenerate, which results in the fetus falling lower into the uterus.
4. Lax Abnormal Musculature
Women who have had multiple pregnancies may have more relaxed uterine and abdominal muscles. This will make their ability to keep the baby in a normal position very difficult.
5. Uterine Over Distension
There are many reasons why a uterus can become enlarged. Some of these include a large baby, polyhydramnios, multiple pregnancies and others. A uterus that is too large very often leads to shoulder presentation.
A very large amount of amniotic fluid that is present in the uterus is known as polyhydramnios. This causes the fetus to be able to move very freely in the uterus and will lead to shoulder presentation.
7. Uterine Abnormalities
There are different abnormalities in the uterus that can cause your baby to move into shoulder presentation. Some of these are the bicornuate uterus, a sub-septate uterus and even a large fibroid uterus.
How Is Shoulder Presentation Diagnosed?
Here is how Shoulder presentation diagnosed:
- The top of the mother’s uterus to the top of the pelvic bone is called a fundus. The height of the fundus is an indicator of whether or not the baby is in the shoulder presentation.
- The uterus becomes broader.
- The mother can feel the baby’s head on one abdominal side.
- If shoulder presentation takes place, arms prolapse will cause the baby’s arm to be seen outside the vagina.
- During a vaginal examination, the doctor will be able to feel the babies ribs.
Complications of Shoulder Presentation
If your doctor identifies that you have shoulder presentation before you go into labour, he will opt for a C-Section instead. If there is a case of neglected shoulder presentation and it is only identified after you go into labour, it becomes very dangerous, and you face many complications. Here are some of the complications that can occur:
1. Cord Prolapse
When the umbilical cord comes out before the fetus does, it is called a cord prolapse and is very dangerous as it can cause the baby’s heart rate to drop, cause changes in blood pressure and even result in brain damage or death of the baby.
2. Ruptured Uterus
The myometrial wall is the middle layer of the wall of the uterine. The breach of this layer during childbirth is a rupture in the uterus, and it is very dangerous for both mother and child.
3. Fetal Hypoxia
When your baby doesn’t get enough oxygen, it will lead to suffocation, and if the necessary measures are not taken, it will result in death.
4. Obstructed Labour
Though contractions are taking place, the baby is not able to come through the birth canal as there is something blocking the way. Failure to diagnose and remedy this condition is a major reason why both mother and child die during childbirth.
5. Trauma to Prolapsed Arm
If there is a prolapsed arm, there is a higher chance that it will be injured or damaged. This injury may be severe and could last for a lifetime.
How Is Shoulder Presentation Managed?
Here is how Shoulder presentation is managed:
The first choice for doctors who have a case of shoulder presentation is a C-Section. This is the safest method that ensures the safety of both mother and child.
2. External Cephalic Version
In this procedure, your baby’s heartbeat will be monitored, and you will be given medication through an IV to ensure a relaxed uterus. Your doctor will then place her hands on the outside of your stomach and attempt to turn your baby into the correct position. This is done only before labour starts.
3. Internal Podalic Version
This is only used in the case of twins, where the second twin will need to be moved into a breech position and then extracted.
Though it sounds scary, if you keep a careful track of your baby’s position in the weeks before delivery, you will be able to identify and rectify the problem before it becomes serious. Exercising throughout your pregnancy will be very helpful in ensuring that your baby gets into the correct position for labour.