In what situations is cesarean delivery recommended to prevent shoulder dystocia?

Cesarean delivery is recommended in situations involving identified fetal macrosomia with additional risk factors because these factors significantly increase the likelihood of shoulder dystocia occurring during vaginal delivery. Fetal macrosomia refers to a larger-than-average baby, often defined as a birth weight of more than 4,000 grams (about 8 pounds, 13 ounces). When paired with additional risk factors—such as maternal diabetes, previous shoulder dystocia incidents, or pelvic anomalies—this makes the risk of complications during delivery higher.

In such cases, the use of cesarean delivery can provide a safer option to prevent the complications associated with shoulder dystocia, including nerve damage to the infant or injury to the mother. The proactive approach of opting for a cesarean when weighing these specific risks can help mitigate these potential issues effectively.

Other scenarios, such as a blanket recommendation for all first-time mothers or only during breech presentations, do not take individual patient risks and conditions into account. Similarly, maternal distress alone does not specifically address the mechanical issues presented by shoulder dystocia, making cesarean delivery a necessary recommendation only under certain conditions.