Shoulder dystocia: room for improvement?

A questionnaire was completed by 166 midwives and obstetric junior doctors to assess their knowledge of the management of shoulder dystocia and to establish whether mandatory teaching and updating is required. Ninety-six participants (58%) claimed they were confident in the management of shoulder dystocia. However, only six (4%) respondents gained full marks on the scoring system devised to assess their knowledge. Furthermore 36 (22%) of those surveyed suggested rotation of the shoulders to the anterior-posterior position to alleviate the dystocia and 32 (19%) proposed pulling the head hard. Although there are limitations in assessing competence by the use of a questionnaire, the results of this survey suggest that there is considerable room for improvement. We suggest that a shoulder dystocia drill is introduced to all labour wards in the United Kingdom so that birth attendants can develop and memorize a sequence of procedures to use when confronted with this life-threatening emergency.