Experience of shoulder dystocia in a district general hospital: what have we learnt?

Shoulder dystocia is an obstetric emergency that currently affects 0.6% of all deliveries in the UK. This potentially serious obstetric emergency requires early recognition and prompt involvement of appropriately trained personnel to deliver the baby safely and without delay. Failure to do so may result in significant neonatal and maternal morbidity, with ensuing litigation. As part of clinical governance, hospital trusts are under pressure to continually improve the quality of service provided to their patients. Meticulous and accurate documentation is the crucial first step. The second step is preparedness and practice. Although we are still not very good at being able to prevent or predict shoulder dystocia, when it occurs, we must be ready and able to deal with it effectively. This can best be accomplished through re-education and re-training of obstetric staff and the updating of Trust management protocols. By promptly acting in accordance with established evidence-based guidelines, we will improve our ability to carefully and competently manage deliveries complicated by shoulder dystocia. However, failing to do so will inevitably have dire repercussions for all.