Shoulder Dystocia Nursing Care Plan & Management


  • In shoulder dystonia, the anterior shoulder of the baby is unable to pass under the maternal pubic arch.
  • Shoulder dystocia is associated with advanced maternal age, diabetes maternal obesity, large baby (macrosomia), postdate pregnancy, and multiparity.
  • The plane of the fetal shoulders aligns perpendicular to the pubis instead of at an angle. This causes the shoulder to become wedged under the pubic arch.
Assessment Findings

1. Associated findings. The birth process may seem unnecessarily prolonged.

2. Clinical manifestations

  • The fetal head retracts against the mother’s perineum as soon as the head is delivered. This is known as the “turtle sign.”
  • External rotation does not occur.
Nursing Management
  • Identify shoulder dystocia and assist with management.

1. Place the client in the McRobert’s position (ie, thighs pulled up against the abdomen with hips abducted).

  • The woman flexes her thighs sharply against her abdomen, which straightens the pelvic curve. A supported squat has a similar effect and adds gravity to her pushing efforts.

2.Apply suprapubic pressure by an assistant pushes the fetal anterior shoulder downward to displace it from above the mother’s symphysis pubis. Fundal pressure should not be used, because it will push the anterior shoulder more firmly against the mother’s symphysis.