What is shoulder dystocia?
Shoulder dystocia is a medical emergency that occurs when, after delivery of the baby’s head, the shoulder gets stuck on the mother's pelvic bone. If the head passes through the maternal pelvis without difficulty, the rest of the baby follows easily. However, when the baby’s shoulders and chest are somewhat larger than the head, the chances of a shoulder dystocia are significantly increased. It carries with it the potential for high risk complications. Trauma to the newborn may occur following shoulder dystocia deliveries because the tender nerves in the baby’s neck can be injured when the obstetrician applies extreme force to release the shoulder from being stuck
What are the effects of shoulder dystocia?
One of the most serious injuries that can occur with shoulder dystocia is a brachial plexus injury. The "brachial plexus" is a complicated set of nerves that emerge from the spinal column in the neck, travel across the shoulder, along the arms, into the hands and ultimately down to the fingertips. Damage to these nerves can cause one or both arms to be paralyzed. Some brachial plexus injuries are mild and will improve in a short time. However, a very large population of babies with brachial plexus injuries will have a permanent disability. Those babies will grow up with limited or no use of the affected arm, sometimes without feeling and with a limp, atrophied arm that marks them as different from other children. They may need multiple surgeries and physical therapy.
Are there risk factors associated with shoulder dystocia?
According to the American College of Obstetricians and Gynecologists ("AAFP"), most cases of shoulder dystocia are not predicted and can occur in babies with a normal birth weight. However, there are several risk factors or warning signs for shoulder dystocia that an experienced obstetrician should be aware of. They include:
- Suspected large baby – over 8lbs. 14.oz (High birth weight is a leading risk for shoulder dystocia.)
- Maternal diabetes / gestational diabetes (Babies born to mothers with gestational diabetes may have larger shoulders.)
- Maternal obesity
- An overdue baby - over 40 weeks
- Short maternal stature
- Contracted or flat (platypelloid) pelvis
- Unusually long labor or delivery
- Maternal weight gain -more than 35 lbs.
Other factors for an increased risk for shoulder dystocia may include a history of shoulder dystocia during a previous delivery or a history of giving birth to large babies. Another common risk factor for shoulder dystocia is the use of a tool such as a vacuum extractor or forceps to help with the birth.
How common shoulder dystocia?
Brachial plexus injuries are one of the most important fetal complications of shoulder dystocia and statistics show that anywhere from 1 to 8 out of 1000 babies born each year will receive a brachial plexus injury.
Can shoulder dystocia be prevented?
There are steps doctor can take to possibly reduce the risk of injury. Given screening procedures and the availability of pre-natal care and technology, many cases of shoulder dystocia can be avoided. There are accepted medical strategies for doctors to use in shoulder dystocia cases. Doctors can try repositioning either the mother or the baby to allow the shoulder to pass and using several gentle pulling or pushing methods. More serious procedures include cutting a very deep episiotomy, breaking the mother's pelvis or the baby's collarbone, or even an emergency cesarean section. Failure of the medical professionals to employ certain techniques for dealing with the problem can result in injury to both the baby and the mother.
Medical mistakes can cause shoulder dystocia.
Some injuries from shoulder dystocia can be attributed to the negligence of doctors, nurses or other medical personnel. All doctors and nurses (See "Nursing Negligence") owe duties to the patients they serve. When a doctor or other health care professional is determined to be negligent because of a medical mistake during the course of pregnancy or labor, it means that they have failed to use the same degree of skill and learning, under the same or similar circumstances, that are used by other members of the medical profession. Failure to provide pregnancy, labor or delivery care that is outside the accepted standards of practice can result in significant birth injury, disability and even death.
If the doctor or other health care professional fails to monitor or to respond properly to certain situations that arise during the delivery, that individual could be considered negligent with regard to the duty owed to patients. A delivery medical team should monitor the mother and child throughout labor and delivery in order to be aware of any complications that may develop. Negligence of doctors, nurses, and other medical personnel can arise in any of the following situations:
Failure to provide appropriate prenatal care and appropriate interventions during labor and delivery
Failure to diagnose and treat an infection in the mother
Failing to rapidly diagnose and treat preterm labor
Failure to diagnose macrosomic (large) baby
Failure to properly manage prolonged or post term pregnancy
Failing to respond appropriately to bleeding
Failure to treat maternal preeclampsia or infections
A negligent management of labor and delivery or delay in delivery
Failure to appropriately respond and intervene to non-reassuring fetal heart monitor changes and evidence of fetal distress.
Failure to perform a timely cesarean section (c-section) to remove a baby in distress
Failure to successfully resuscitate and intubate newborn
Only a careful review of the medical records can determine the cause of injuries and whether the actions of the delivery team played a part in causing the birth injury. Our lawyers and medical analysts who handle birth injury cases have experience investigating medical mistakes and birth injury malpractice and have the resources to access the type of qualified medical experts necessary to review complicated birth injury cases.
If you or your child suffered a birth injury from shoulder dystocia due to improper care during your pregnancy or at the time of delivery, perhaps we can help. You will be able to speak to a registered nurse who understands the complex issues of labor and delivery that can result in serious injury. Please call our lawyers who handle birth Injuries at 1.800.552.7115 or contact us. If you think you have a medical malpractice case within MN, ND, SD, IA or WI, please call 1.800.207.6771.
American College of Obstetricians and Gynecologists. Shoulder Dystocia. Washington, D.C.: ACOG, 1997.
American College of Obstetricians and Gynecologists. Practice Bulletin Number 40: Shoulder Dystocia. Washington, D.C.: November 2002.
Blickstein I. Shoulder dystocia: the obstetrician’s nightmare - revisited. Harefuah 1997; 132:204-11. 3.
Blickstein I, Ben-Arie A, Hagay ZJ. Antepartum risks of shoulder dystocia and brachial plexus injury for infants weighing 4200g or more. Gynecol Obstet Invest, 1998; 45:77-80.
Collins JH, Collins CL. What is shoulder dystocia? J Reprod Med. 2001;46:148-149.
Dyachenko A, Ciampi A, Fahey J, Mighty H, Oppenheimer L, Hamilton EF. Prediction of risk for shoulder dystocia with neonatal injury. Journal of Obstetrics and Gynecology 2006 Dec;195(6):1544-9. Epub 2006 Jul 17.
Lerner M.D. Henry, “Shoulder Dystocia.” 2004-2007 < http://www.shoulderdystociainfo.com/index.htm>
O’Leary JA.,Shoulder Dystocia and Birth Injury. O’Leary JA. McGraw-Hill: 1992.
The articles on our Website include some of the publications and papers authored by our attorneys, both before and after they joined our firm. The content of these articles should not be taken as legal advice.