Software Makes Childbirth Safer -- Research Summary

BACKGROUND: Shoulder dystocia takes place when a baby gets stuck by the shoulders behind the mother's pelvic bone during delivery. This happens when a baby is already in the birth canal, so to ease the baby out, a doctor has to do immediate maneuvers. Shoulder dystocia is described in an American Family Physician research article as "one of the most frightening emergencies in the delivery room." Authors wrote, "Although many factors have been associated with shoulder dystocia, most cases occur with no warning." Risk factors for shoulder dystocia include having diabetes, being overweight, carrying a large baby and having a history of births with shoulder dystocia.

While some cases of shoulder dystocia are overcome without injury to the baby, 20 percent cause injury, according to shoulderdystociainfo.com. These injuries include collar bone fractures, humerus fractures, contusions, lacerations, birth asphyxia and damage to the brachial plexus nerves. The brachial plexus nerves are found at the base of the neck. When the nerves are damaged, a baby can suffer paralysis of the arm and hand.

TREATMENT: The majority of brachial plexus injuries resolve on their own over the course of several months to a year, but physical therapy is usually recommended following birth. For permanent injuries, physical therapy can strengthen nerves that are partially damaged. Although some surgeries, like nerve grafting and muscle transposition, are carried out after these types of injuries, their effectiveness remains controversial.

IS IT PREVENTABLE? Traditional thought is that shoulder dystocia is unpredictable and unpreventable. However, the United Brachial Plexus Network says using the proper positioning during labor will help reduce the chances of shoulder dystocia. To prevent the complication, experts recommend a mother not lie on her tailbone during delivery. This is because the position reduces the amount of space a baby has to pass through and increases the likelihood of a forceps or vacuum delivery. In some cases, a woman who presents multiple risk factors for shoulder dystocia is told a C-section is the safest option for delivery.

A NEW WAY TO PREDICT: Dr. Emily Hamilton of Montreal has developed an algorithm that, using multiple pieces of data about a pregnant mother and her baby, can calculate a probability of shoulder dystocia with injury occurring. She took this algorithm and developed a software system called CALM Shoulder Screen, which is now being utilized by obstetricians throughout the United States. The Web-based system can be used to predict a woman's risk of shoulder dystocia during birth from 37 weeks of gestation onward. Henry Lerner, M.D., Assistant Clinical Professor of Obstetrics and Gynecology at Harvard Medical School in Boston, Mass., was involved in the testing of the software after it was first developed but no longer works for the company. He still uses it in his practice.

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