ElMadany et al (1990) reviewed deliveries complicated by shoulder dystocia during a three year period at Fawania Hospital, Kuwait. Of 24,357 deliveries during this period 98(0.45%) were complicated by shoulder dystocia. The definition used in this study was, difficulty in delivery of the shoulders requiring any additional procedure other than the usual downward traction. To eliminate clinician bias cases were included in this study only if physician and nurses notes both confirmed shoulder dystocia.