Let’s Talk About Shoulder Dystocia.
Let’s talk about something that doesn’t come up often—until it does. Shoulder dystocia. It’s one of those terms that can make your heart race if you’ve heard it before, especially if it showed up in your own birth story. As a physical therapist trained in the Body Ready Method® and someone who’s spent years caring for NICU babies and their parents, I’ve seen firsthand how birth can take some pretty wild and unexpected turns. I’ve also seen how bodies—and families—can heal in really beautiful ways afterward.
What Is Shoulder Dystocia?
Shoulder dystocia happens when, after the baby’s head is born, one or both shoulders get stuck behind the pelvic bone and need help to be released. It’s a true “birth emergency”—not because it always causes injury, but because the baby needs to be born quickly and carefully. Providers often respond by trying specific positions or maneuvers to create more space and help the baby out safely.
Here’s something really important: most of the time, babies are totally fine after a shoulder dystocia. And parents are left a little shell-shocked but relieved, holding a healthy baby in their arms.
The Best-Case Scenario
In a best-case scenario, your care team responds quickly. Maybe they try the McRoberts position, apply suprapubic pressure, or roll you to hands-and-knees—and it works. Baby is born moments later, pink and crying, with nothing more than some swelling at the shoulder.
If you’re sitting there thinking… wwhhhhatttt is the McRoberts position?
Here’s how it works:
The birthing person is lying on their back, usually flat or with the head of the bed lowered.
Their knees are pulled up as high as possible toward their chest (like a deep squat on your back).
Support people or staff usually help hold the legs in place.
This position rotates the pelvis, specifically lifting and flattening the sacrum and opening the space where the baby’s shoulders are stuck.
It’s simple, doesn’t require any special equipment, and often works quickly. In fact, McRoberts alone can resolve the majority of shoulder dystocia cases when used right away, especially when combined with suprapubic pressure (a downward push just above the pubic bone—not on the belly).
From the PT side of things, I often see these babies show signs of tension or asymmetry—maybe they like turning their head one way or favor one side when feeding. But with early support (a little bodywork, intentional positioning, and tummy time that’s actually fun), most of those things resolve easily. And the nervous system? It loves early, responsive care—especially when we help baby (and you) come down from the intensity of birth.
The In-Between: Clavicle Fracture
Sometimes, the body protects itself in wild ways. In some shoulder dystocia births, a baby’s clavicle (collarbone) will actually fracture during birth—intentionally, in a way. That little bone breaks to create just enough space to prevent more serious nerve damage. Sometimes the OB will break it on purpose, sometimes it breaks on its own. I know that sounds intense, but babies heal so fast it’s kind of astonishing. Often by two weeks old, they’re already using the arm again with no sign anything ever happened.
You might notice that your baby avoids their arm for a bit, or that certain feeding positions seem uncomfortable. This is where early PT support makes a difference: we help you find feeding positions that feel good and ease baby back into full mobility when the time is right. And this kind of injury? Usually doesn’t have any long-term effects.
The Worst-Case Scenario: Brachial Plexus Injury and Brain Injury
In the most severe cases, shoulder dystocia can lead to nerve damage in the baby’s arm—called a brachial plexus injury—or even brain injury from a prolonged delay in delivery... especially if this happens under water.
These cases are rare, but real. I’ve worked with families whose babies came out limp, needed resuscitation, and sometimes were whisked to the NICU. Some had little to no movement in one arm. Some experienced seizures or struggled with feeding and regulation. I’ve been at those NICU beds. I’ve seen parents holding hope in one hand and heartbreak in the other. I’ve walked along side them as they learned the best ways to support their babies recovery, and I’ve seen incredible recoveries.
Outcomes vary. Some babies make full or near-full recoveries, especially with early, skilled therapy. Others may face long-term challenges like cerebral palsy or persistent motor differences from a long time without oxygen to their brain. But no matter the outcome, one thing stays the same: this is still your baby.
There is still joy. Still connection. Still so much that’s possible.
How We Heal: PT, Nervous System Work, and Family-Centered Support
As a Body Ready Method® pro, I think about shoulder dystocia both in terms of preparation and repair. During pregnancy, we focus on pelvic mobility, strength, and balance. Sometimes that means adjusting daily movement patterns. Sometimes it’s about softening tension or helping baby settle into an optimal position before labor starts.
After birth, especially in the NICU or early postpartum days, we turn our attention to:
Releasing tension and restoring movement in baby’s shoulders, neck, and trunk
Supporting feeding—however that looks for your baby
Helping you feel grounded again so your nervous system can help calm theirs
Making movement and play a joyful, connected part of recovery
If Shoulder Dystocia Was Part of Your Story
Whether you’re reading this pregnant and preparing, or holding a baby who’s already been through it—your story matters. It’s okay to grieve, even when the outcome is "okay." It’s okay to feel relief, even when things were scary. And if you’re still somewhere in the middle? You’re not alone.
Birth is big. Sometimes messy. Sometimes miraculous. Sometimes both at once.
And healing? That’s not just possible—it’s inevitable.
Love,
Emily
