Shoulder dystocia is not an injury, but it can cause many different injuries. After the baby’s head is delivered, one of the baby’s shoulders can become trapped behind the mother’s pubic bone. The doctor and the obstetrical team must act quickly—failure to act can lead to permanent brain damage or death.
Shoulder Dystocia Risk Factors
Shoulder dystocia is more likely in the following situations:
- Fetal macrosomia (baby larger than 4,000 grams (8.8 pounds))
- Previous births complicated by shoulder dystocia
- Maternal obesity
- Post-term pregnancy (a pregnancy that lasts longer than 42 weeks)
- Prolonged second stage of labor
Shoulder Dystocia Statistics
- Shoulder dystocia likely occurs in 0.5% to 1.5% of all deliveries
- 20% of babies who experience shoulder dystocia during delivery will have a temporary or permanent injury
- 10% of babies who experience shoulder dystocia during delivery will have a brachial plexus injury
- Between 4% and 15% of babies who experience shoulder dystocia during delivery will have a permanent injury
- When a mother’s prior delivery has been complicated by shoulder dystocia, there is a 10% to 15% risk of shoulder dystocia in the later deliveries
- Almost half of all shoulder dystocia events occur in babies weighing less than 4,000 grams
Medical Malpractice Causing Shoulder Dystocia Injuries
Birth injuries caused by shoulder dystocia are among the most preventable—obstetric experience over the years has resulted in a proven step-by-step method for doctors to respond. Negligent doctors often claim that shoulder dystocia injuries were not preventable and that they are caused by emergencies. While it is technically an obstetric emergency, it is absolutely foreseeable (especially where the mother carries one or more risk factors), and injuries are preventable. Obstetricians must rehearse management of shoulder dystocia events, and be prepared to respond when they occur.
The obstetrical team must carefully keep track of the time from the beginning of the emergency, because shoulder dystocia can trap the baby’s head and pinch the umbilical cord, which restrict oxygen and blood flow to the baby. In most shoulder dystocia emergencies, the baby must delivered in five minutes or less.
Once shoulder dystocia is identified, the doctor must perform this sequence of events:
- McRoberts Maneuver: the obstetric team must sharply bend the mother’s legs toward her chest. This increases the space and sometimes allows the baby’s shoulder to become free from the mother’s pubic bone.
- Suprapubic Pressure: pressure should be applied to the mother’s lower abdomen (stomach) at a forty-five degree angle. This often rotates and pushes the trapped shoulder below the mother’s pubic bone.
- Woods/Rubens Maneuver: The doctor puts his hand inside the birth canal next to the baby’s shoulder and rotates the baby to try to dislodge the trapped shoulder.
- Episiotomy: Though some doctors disagree with this method, many believe that it can prevent shoulder dystocia injuries. The doctor cuts the area between the vagina and the anus to increase the amount of room for delivery.
- Zavenelli Maneuver: Infrequently used, the obstetrician pushes the baby back into the vagina, and then performs a cesarean section.
- Symphsectomy: Also rare, the doctor surgically cuts the mother’s pubic bone. This increases the amount of room for the baby to pass through.
If the initial steps (McRoberts maneuver, suprapubic pressure and Woods/Rubens maneuver) do not resolve the situation, they can be repeated if there is enough time. If not, the obstetrician must move on the other steps. Some doctors also believe that fracturing the baby’s clavicle (collar bone) can free the shoulder.
Injuries Caused by Shoulder Dystocia
The only actual injury that can be caused by shoulder dystocia alone is hypoxic brain injury or death. All other injuries to the baby are caused by the obstetrician’s reactions to the shoulder dystocia—excessive pulling or twisting of the baby can cause severe and permanent injuries. Types of shoulder dystocia injuries include:
- Fracture of the humerus (arm bone from the shoulder to elbow)
- Fracture of the clavicle (collar bone)
If your pregnancy was complicated by shoulder dystocia, and if your child was injured during the delivery process, contact our medical malpractice lawyers at (855) 712-7818 or online for a free consultation. We can tell you if your child’s Erb’s palsy, Klumpke’s palsy, or cerebral palsy was caused by medical malpractice. Your child may be entitled to money that can pay for expensive therapies and medical care.