The newborn’s head arrived first. A shoulder should have followed, but it was lodged securely behind the mother’s pubic bone. The baby’s head made the “turtle sign” as it delivered, rocking back as if to retreat into his mother’s vagina.
“Shoulder dystocia!” the obstetrician called out.
The obstetric team at Boston’s Beth Israel Deaconess Medical Center jumped into action. Within seconds, additional nurses were in the room; in less than a minute, other physicians were standing by, too. Two nurses flexed the mother’s legs gently backward. Simultaneously, another nurse positioned a stool next to the labor bed, preparing to push the baby’s shoulder to the side to dislodge it.
“Two minutes,” one of the nurses called out, a reminder of how long the team had been at work. Brain injury, due to a lack of oxygen, can occur after approximately five.
Twenty seconds later, it was over. The baby slipped out, the umbilical cord was cut, and the infant was handed to two pediatricians. The infant was soon in his mother’s arms.
Complications like shoulder dystocia are rare in obstetrics. Even when they occur, mothers and babies are overwhelmingly likely to do well. This sounds like a blessing, but it actually has long been the field’s most dangerous curse. Obstetric medicine is like aviation: As even the worst airlines go years without a crash, so can even the most cavalier, careless hospitals go years without a mother or a baby dying or being serious injured. But these rare catastrophes add up: In 1990, the maternal mortality rate in the United States was just over one in 10,000—on par with many Eastern European countries, but about double the rate in the “safest” countries, such as Canada.