title: Shoulder dystocia in primary midwifery care in the Netherlands.
abstract: BACKGROUND
  In the Netherlands, low-risk pregnancies are managed by midwives in primary care. Despite strict definitions of low risk, obstetric complications can occur. Midwives seldom encounter uncommon labour complications, but are sufficiently trained to manage these. We assessed neonatal and maternal outcome after management of shoulder dystocia in primary midwifery care.
  
  
  METHODS
  In this 2-year prospective cohort study from April 2008 to April 2010, primary-care midwives, who participated in an obstetric emergency course, reported all obstetric complications. Main outcome was neonatal and maternal outcome.
  
  
  RESULTS
  In sixty-four cases of shoulder dystocia McRoberts was the first maneuver in 42/64 (65.6%) cases with a success rate of 23.8%. All-fours maneuver was most frequently used as the second maneuver (24/45; 53.3%). No neonatal mortality occurred, none of the infants suffered from hypoxic ischemic injury, two (3.1%) had transient brachial plexus injuries, two (3.1%) had fractured clavicles and one (1.6%) had a fractured humerus. Eight (12.5%) neonates were successfully resuscitated because of birth asphyxia. All infants fully recovered. In neonates with immediate adverse outcome significantly more maneuvers were used compared with those without adverse neonatal outcome (p = 0.02). Postpartum hemorrhage occurred in 2/64 (3.1%) women, deep vaginal lacerations in 2/64 (3.1%), perineal tears in 23/64 (35.9%). No anal sphincter injuries occurred.
  
  
  CONCLUSIONS
  McRoberts and all-fours maneuvers are widely used by primary-care midwives in the management of shoulder dystocia. Low rates of adverse neonatal and maternal outcomes were observed in cases of shoulder dystocia up to 6 weeks postpartum.
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Athanasios F
authors.identifier: http://orcid.org/0000-0001-6078-1185
authors.initials: AF
authors.lastname: Kallianidis
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Marrit
authors.identifier: http://orcid.org/0000-0001-7258-9641
authors.initials: M
authors.lastname: Smit
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.|Athena Institute, VU University, Amsterdam, the Netherlands.
authors.forename: Jos
authors.identifier: http://orcid.org/0000-0002-6746-3259
authors.initials: J
authors.lastname: Van Roosmalen
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology* / Q000517:prevention & control*; D004420:Dystocia / Q000453:epidemiology* / Q000517:prevention & control*; D004511:Education, Nursing, Graduate; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery / Q000193:education / Q000592:standards*; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors; D000070599:Shoulder Injuries
keywords: Shoulder dystocia; delivery; home birth; labor complications; midwifery; primary health care; the Netherlands