Shoulder dystocia (SD) happens during childbirth when a baby’s shoulder gets stuck in the pelvic opening. Shoulder dystocia can cause injury to or death of the baby and maternal injury. These are impacts to the patient safety goals.
A very basic Cause Map shows that the potential for maternal and infant injury occurs from difficulty delivering the baby. The difficulty is caused by a combination of shoulder dystocia (which occurs during vaginal delivery when the fetal shoulder width is greater than the pelvic opening) and improper management of the delivery. Based on this very simplified Cause Map, two solutions are to plan for a cesarean section (C-section) when there is the potential for shoulder dystocia, and to define the process for delivery when shoulder dystocia occurs.
We can define a very basic process map for delivery management. First, the patient should be evaluated for the potential for shoulder dystocia. Then, the labor team prepares for the potential for shoulder dystocia. If shoulder dystocia is diagnosed, the team should perform the appropriate response, deliver the baby and then administer post-partum follow-up. The key to this, of course, is to define the appropriate response.
We can add more detail to part of this process map. Specifically, the additional detail outlines the “HELPERRZ” process used by some medical facilities for the management of shoulder dystocia. (To view the Outline, Cause Map and Process Map, click on “Download PDF” above).