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Risk Factors for Shoulder Dystocia: the Impact of Mother’s Race and Ethnicity

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Abstract

Shoulder dystocia is a rare but severe birth trauma where the neonate’s shoulders fail to deliver after delivery of the head. Failure to deliver the shoulders quickly can lead to severe, long-term injury to the infant, including nerve injury, skeletal fractures, and potentially death. This observational study examined shoulder dystocia risk factors by race and ethnicity using a sample of 19,236 pregnant women who presented for labor and delivery from July 1, 2010 until June 30, 2013 at five locations. Multivariate analyses were used to identify risk factors associated with shoulder dystocia occurrence in racial/ethnic groups with high incidence rates. For White non-Hispanic mothers, the strongest risk factors were delivering past 40 weeks’ gestation (odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.5, 3.9; p < .01) and use of epidural anesthesia during delivery (OR = 4.4; 95% CI = 3.0, 6.4; p < .01). Among Black non-Hispanic mothers, the risk factors with the greatest impact were use of epidural (OR = 5.3; 95% CI = 3.2, 8.7; p < .01) and having gestational diabetes and controlling the condition with insulin (OR = 4.6; 95% CI = 1.5, 13.8; p < .01). Additionally, among Hispanic mothers, having Spanish as primary language increased shoulder dystocia likelihood compared to those who did not cite it as their primary language (OR = 2.3; 95% CI = 1.1, 4.6; p < .05). This study provides evidence that risk factors for a labor and delivery condition can vary significantly across racial and ethnic subgroups. These differences emphasize the importance of evaluating risk by population subgroups and might provide a basis for labor and delivery clinicians to enhance personalized medicine to reduce adverse events.

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Notes

  1. Among Hispanic mothers, the estimate for gestational diabetes treated with insulin was far less than 1.0. However, due to the small sample size, the confidence interval for this effect was so large that no meaningful conclusion could be drawn.

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Acknowledgements

This study was partly funded by the Agency for Healthcare Research and Quality (AHRQ) (Grant No. 1R18 HS19608-01).

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Authors and Affiliations

  1. University of Massachusetts Boston, 100 William T. Morrissey Boulevard, Boston, MA, 02125-3393, USA

    Jennifer Gaudet Hefele

  2. Brandeis University, 415 South Street, MS035, Waltham, MA, 02454-9110, USA

    Palmira Santos & Grant Ritter

  3. University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA

    Neha Varma

  4. Ascension Health, 4600 Edmundson Road, St. Louis, MO, 63134, USA

    Ann Hendrich

Authors
  1. Jennifer Gaudet Hefele
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  2. Palmira Santos
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  3. Grant Ritter
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  5. Ann Hendrich
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Correspondence to Palmira Santos.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All five demonstration sites received approval for human subjects’ research by their institutional review boards as well as by Brandeis University IRB. The analysis team received approval for this study by their institutional review board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

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For this type of study, formal consent is not required.

Additional information

MSC Codes: 92-02: Research exposition (monographs, survey articles), Biology, and other natural sciences

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Hefele, J.G., Santos, P., Ritter, G. et al. Risk Factors for Shoulder Dystocia: the Impact of Mother’s Race and Ethnicity. J. Racial and Ethnic Health Disparities 5, 333–341 (2018). https://doi.org/10.1007/s40615-017-0374-9

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  • DOI: https://doi.org/10.1007/s40615-017-0374-9

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