Suprapubic Pressure Used During Labor
Suprapubic pressure is a technique used in combination with the McRoberts maneuver to release the baby’s impacted shoulder when shoulder dystocia is occurring during labor. Shoulder dystocia is an emergency situation in which the child’s head is delivered while the shoulders and body remain lodged and unmoving in the womb. Medical professionals should recognize shoulder dystocia immediately by the “turtle sign” – when the infant’s head emerges from the womb and then retracts against the mother’s perineum.
In suprapubic pressure, the doctor attempts to release the baby’s shoulder by applying pressure to the mother’s lower abdomen over the pubic bone. This is done by making a fist, placing it just above the mother’s pubic bone, and pushing the infant’s shoulder in one direction or another.
The McRoberts maneuver, which is typically performed along with suprapubic pressure, involves sharply flexing the mother’s legs up toward the abdomen, which tilts the pelvis to facilitate delivery of the baby’s shoulder. These two maneuvers performed together are reported as resolving 50% to 60% of shoulder dystocia cases.
Importance of Emergency Medical Response to Shoulder Dystocia
Obstetrical healthcare providers must be fully prepared to respond effectively and immediately when shoulder dystocia occurs during delivery, particularly when risk factors are present. According to an article published in American Family Physician, obstetrical medical teams should have a structured framework in place with a specific set of actions, determined in advance, for dealing with shoulder dystocia if it occurs. Immediate and effective emergency response, beginning with suprapubic pressure and the McRoberts maneuver, can be essential in preventing serious birth injuries.
Shoulder dystocia is a dangerous situation for both the mother and the child. The umbilical cord can be compressed between the infant’s body and the mother’s pelvis, causing the baby to become oxygen-deprived. The pH of the fetus will drop every minute during the delivery of the baby’s trunk, creating a significant risk for fetal acidosis – a serious condition involving high acidity of the infant’s blood that can lead to brain damage or death.
Possible complications of shoulder dystocia for the mother include uterine rupture, postpartum hemorrhage (bleeding), rectovaginal fistula (small opening between the rectum and vagina, allowing contents to leak through), and third- or fourth-degree episiotomy (surgical incision to widen the vaginal opening) or tear. The child could suffer serious birth injuries from shoulder dystocia, including brachial plexus palsy (damage to the nerves that supply the shoulder, arm, and hand), fractured clavicle or humerus, oxygen deprivation, brain damage, or a combination of injuries.
Shoulder Dystocia Risk Factors
The single most common risk factor associated with shoulder dystocia is when delivery is assisted with forceps or vacuum extractor. Other risk factors include:
- Pregnancy that has gone beyond 42 weeks
- Large baby weighing more than 8 lbs. 13 oz.
- Abnormal pelvic anatomy in the mother
- Mother who is short in stature
- Gestational diabetes
- Previous occurrence of shoulder dystocia
- Excessively long labor
What Is the McRoberts Maneuver?
The McRoberts maneuver is a procedure performed to release a baby’s impacted shoulder during shoulder dystocia. The mother’s legs are held back in a flexed position and pulled to her chest to further open the pelvis and allow the baby’s shoulder to be released. At the same time suprapubic pressure is applied to the mother’s lower abdomen over the pubic bone.
Fundal pressure, pressure applied to the upper abdomen, SHOULD NOT be used. Fundal pressure can cause serious injury to the mother and the baby.
Legal Help After Shoulder Dystocia Birth Injuries
The Texas birth injury lawyers at Brown Trial Firm focus their practice on helping families of children who have been injured during pregnancy or at their time of birth due to acts of medical negligence. To be advised of the legal options you’re able to take, Please call (866) 393-2611 for a free, no-obligation consultation.
Birth Injury Case Results
Oxygen Deprivation During Labor & Delivery Resulting in Brain Damage & Cerebral Palsy
A contingent (%) fee charged on the successful recovery resulted in a fee of $1,441,584 and $33,666.12 in litigation expenses which were reimbursed by the client out of the gross settlement amount.
Oxygen Deprivation During Labor & Delivery Resulting in Brain Injury & Cerebral Palsy
A contingent (%) fee charged on the successful recovery resulted in a fee of $1,300,000 and $81,511.14 in litigation expenses which were reimbursed by the client out of the gross settlement amount.
Note: If any of the cases listed here had been unsuccessful, the law firm would have paid all of the expenses for the case without being reimbursed by the client and would have received $0 dollars in attorney’s fees.
- ShoulderDystociaInfo.com: Can Shoulder Dystocia Be Resolved Without Fetal Injury When It Does Occur?
- American Family Physician: Shoulder Dystocia