• Article

Strategies to improve management of shoulder dystocia under the AHRQ safety program for perinatal care

Objective: To assess implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units.

Design: Mixed-methods implementation evaluation.

Setting/Local Problem: Labor and delivery units (N = 18) in 10 states participating in the Safety Program for Perinatal Care (SPPC). Shoulder dystocia is unpredictable, requiring rapid and coordinated action.

Participants: Key informants were labor and delivery unit staff who implemented SPPC safety strategies.

Intervention/ Measurements: The SPPC was implemented by using the TeamSTEPPS teamwork and communication framework and tools, applying safety science principles (standardization, independent checks, and learn from defects) to shoulder dystocia management, and establishing an in situ simulation program focused on shoulder dystocia to practice teamwork and communication skills. Unit staff received training, a toolkit, technical assistance, and unit-specific feedback reports. Quantitative data on unit-reported process improvement measures and qualitative data from staff interviews were used to understand changes in use of safety principles, teamwork/communication, and in situ simulation.

Results: Use of shoulder dystocia safety strategies improved on the units. Differences between baseline and follow-up (10 months) were as follows: in situ simulation (50% vs. 89%), teamwork and communication (67% vs. 94%), standardization (67% to 94%), learning from defects (67% vs. 89%), and independent checks (56% vs. 78%). Interview data showed reasons to address management of shoulder dystocia, various approaches to implement safety practices, and facilitators and barriers to implementation.

Conclusion: Successful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The SPPC strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.


McArdle, J., Sorensen, A., Fowler, C. I., Sommerness, S., Burson, K., & Kahwati, L. (2018). Strategies to improve management of shoulder dystocia under the AHRQ safety program for perinatal care. JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing, 47(2), 191-201. https://doi.org/10.1016/j.jogn.2017.11.014