New software makes childbirth safer

null A strong heartbeat is music to any expectant mother's ears. But there are other worries lingering in Jen Harley's mind.

"You have a 10-percent chance of having a repeat shoulder dystocia," said Harley.

Thirty-thousand babies in the U.S. are born each year with shoulder dystocia. That's one out of every 100 births. It happens when the baby gets stuck in the birth canal. In extreme cases it causes permanent nerve damage.

"The baby is unable to use its arm or hand for the rest of that child's life," said Dr. Henry Lerner, Harvard Medical School.

Jen is at high risk because her second child had shoulder dystocia and she tends to carry larger babies.

"The thought of something happening to them as I am trying to bring them into the world is certainly scary," said Harley.

A new software program is bringing peace of mind by calculating the risk of shoulder dystocia with permanent injury.

"It aids tremendously. In the past, one of the problems that bedeviled doctors and midwives is that there is no way to predict who would be at risk for shoulder dystocia," said Dr. Lerner.

The software uses the mom's height and weight along with other factors to calculate risk. A read-out indicates the probability of the baby getting into trouble during birth. It spots the condition up to 60-percent of the time.

"It is better for the doctor. It is better for the patient, and most of all, it's better for the baby," said Dr. Lerner.

Armed with this information the doctor recommended Jennifer have a C-section, taking away some of the worry that goes along with being a mom.

Dr. Lerner says originally there was fear the software would cause more C-sections. But he says that hasn't happened. Besides having larger babies, having diabetes is also a risk factor for shoulder dystocia.

Web extra Information: Software Makes Childbirth Safer

BACKGROUND:

Shoulder dystocia takes place when a baby gets stuck by the shoulders behind the mother's pelvic bone during delivery. This happens when a baby is already in the birth canal, so to ease the baby out, a doctor has to do immediate maneuvers. Shoulder dystocia is described in an American Family Physician research article as "one of the most frightening emergencies in the delivery room." Authors wrote, "Although many factors have been associated with shoulder dystocia, most cases occur with no warning." Risk factors for shoulder dystocia include having diabetes, being overweight, carrying a large baby and having a history of births with shoulder dystocia.

While some cases of shoulder dystocia are overcome without injury to the baby, 20 percent cause injury, according to shoulderdystociainfo.com. These injuries include collar bone fractures, humerus fractures, contusions, lacerations, birth asphyxia and damage to the brachial plexus nerves. The brachial plexus nerves are found at the base of the neck. When the nerves are damaged, a baby can suffer paralysis of the arm and hand.

TREATMENT:

The majority of brachial plexus injuries resolve on their own over the course of several months to a year, but physical therapy is usually recommended following birth. For permanent injuries, physical therapy can strengthen nerves that are partially damaged. Although some surgeries, like nerve grafting and muscle transposition, are carried out after these types of injuries, their effectiveness remains controversial.

IS IT PREVENTABLE?

Traditional thought is that shoulder dystocia is unpredictable and unpreventable. However, the United Brachial Plexus Network says using the proper positioning during labor will help reduce the chances of shoulder dystocia. To prevent the complication, experts recommend a mother not lie on her tailbone during delivery. This is because the position reduces the amount of space a baby has to pass through and increases the likelihood of a forceps or vacuum delivery. In some cases, a woman who presents multiple risk factors for shoulder dystocia is told a C-section is the safest option for delivery.

A NEW WAY TO PREDICT:

Dr. Emily Hamilton of Montreal has developed an algorithm that, using multiple pieces of data about a pregnant mother and her baby, can calculate a probability of shoulder dystocia with injury occurring. She took this algorithm and developed a software system called CALM Shoulder Screen, which is now being utilized by obstetricians throughout the United States. The Web-based system can be used to predict a woman's risk of shoulder dystocia during birth from 37 weeks of gestation onward. Henry Lerner, M.D., Assistant Clinical Professor of Obstetrics and Gynecology at Harvard Medical School in Boston, Mass., was involved in the testing of the software after it was first developed but no longer works for the company. He still uses it in his practice.


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