Shoulder dystocia is a common cause of birth injuries. This article discusses medical malpractice claims involving shoulder dystocia, and answers common questions patients and their family members may have about shoulder dystocia, and the birth injuries it can cause.
What is shoulder dystocia?
During a vaginal delivery, the baby's head emerges, and the physician or nurse midwife will use his or her hands to gently pull the baby's head to deliver the body. If the medical provider's pull or pulls do not result in delivery of the baby's shoulders because one of the shoulders is stuck on the mother's pubic bone, a quick diagnosis of shoulder dystocia should be made. If a medical provider fails to diagnose shoulder dystocia, or makes the diagnosis too late, and if that results in injury to the baby, the medical provider may have committed medical malpractice.
Once the diagnosis of shoulder dystocia is made, the medical provider must act quickly to address this emergency to prevent severe birth injuries to the mother and baby. Obstetricians and other medical providers who deliver babies are trained to respond to a shoulder dystocia by immediately obtaining assistance from other staff, so that they can rapidly employ maneuvers to dislodge the stuck shoulder and deliver the baby safely. If the medical provider delays a request for assistance, or fails to employ maneuvers to deliver the baby, the medical provider may be guilty of medical malpractice and held responsible for any injuries caused by their negligence. Medical providers can also be held responsible for medical negligence if they fail to utilize appropriate maneuvers to deliver the baby safely.
Which birth injuries are caused by shoulder dystocia?
Shoulder dystocia is associated with an increased risk of birth injury to both the mother and baby. Some of the risks to the mother exist because medical providers may need to make a laceration (called an episiotomy) to dislodge the baby's stuck shoulders. The laceration is made at the opening of the mother's vagina, and it increases the risk of significant bleeding and nerve injury. If a larger laceration is required to deliver the baby, then it may cause injury to the mother's sphincter. Other maneuvers used to address a shoulder dystocia can also increase the risk that the mother will suffer a bladder injury, uterine rupture, or urethral injury.
Shoulder dystocia also increases the risk of serious birth injuries to the baby. The most common birth injury for a baby to suffer due to shoulder dystocia is a brachial plexus injury. Briefly, the brachial plexus is a bundle of nerves that start in your neck and extend through your shoulders and down to your fingers. When a medical provider attempts to dislodge the baby's shoulder from under the mother's pubic bone, the provider may pull too hard on the arm or shoulder, stretching the brachial plexus nerves in the neck, which can result in injury to the nerves and loss of movement and sensation in the shoulder, arm or fingers. Brachial plexus injuries can be severe and permanent. If the medical provider causes a brachial plexus injury by pulling too hard on the baby, he or she may have committed medical malpractice and can be held responsible for the injuries they caused.
Shoulder dystocia also increases the risk the baby will suffer a severe brain injury at birth. Cerebral palsy is a type of brain injury that can result from medical malpractice during birth. The risk of brain injury increases with shoulder dystocia because, while the baby is stuck in the birth canal, the umbilical cord may be positioned or compressed in such a way that it stops providing the baby oxygen. If the baby is deprived of oxygen, he or she may suffer injury to their organs, including the brain. Brain injuries occurring near the time of birth can be severe, resulting in a number of permanent neurologic problems, including loss of muscle movement, and problems with speech, swallowing, behavior, and cognition. In some cases, a birth-related brain injury can result in the baby's death.
What causes shoulder dystocia?
There are certain factors, specific to the mom and baby, that may increase the risk of shoulder dystocia. Common factors that increase the risk of shoulder dystocia and that are specific to the mother include a prior delivery complicated by shoulder dystocia, and maternal diabetes. If either of these factors are present, the mother's prenatal providers and delivery team should be made aware of these factors, evaluate the risk of shoulder dystocia, and develop a plan to either prevent a shoulder dystocia or immediately address it if it occurs.
A larger fetus (called fetal macrosomia) is one of the main factors that increases the risk of shoulder dystocia. In this situation, the baby may simply be too large to get through the birth canal to be delivered, and that increases the risk that the baby's shoulder will get stuck on the mother's pubic bone. Because a larger fetus increases the risk of an emergency during delivery, it is very important that the medical providers who are responsible for your prenatal care during pregnancy assess your baby's weight and the diameter of the head and abdomen to assess whether the baby is too big to safely deliver vaginally. These assessments should also be made when you present for delivery at the hospital, so that an appropriate delivery plan can be made. If your medical team fails to appropriately assess your baby's size, and your baby develops a shoulder dystocia, they may be guilty of medical malpractice and responsible for any injuries that result.
Did medical malpractice cause shoulder dystocia or a related birth injury?
Unfortunately, medical malpractice can cause a patient to unnecessarily encounter shoulder dystocia or a birth injury related to shoulder dystocia. There are different types of medical malpractice claims involving shoulder dystocia. One is a medical provider's failure to appreciate the risk of shoulder dystocia. That failure can occur during prenatal care or delivery. During either prenatal care or delivery, the medical provider may commit medical malpractice by failing to appropriately assess the size of the baby, or by failing to appreciate the risk that the baby's size may cause a shoulder dystocia. As discussed above, shoulder dystocia increases the risk of serious birth injuries to the mother and baby. Therefore, it is very important that medical providers consider the risk of shoulder dystocia so that they can appropriately advise the patient of the risks of proceeding with a vaginal delivery and, in some cases, advise the patient that a Cesarean delivery is a safer option for the mother and/or baby.
Another type of medical malpractice claim related to shoulder dystocia is a medical provider's failure to timely diagnose shoulder dystocia during delivery. If the diagnosis is not made, or it is made too late, the baby may lose oxygen, resulting in a brain injury. A failure to timely diagnose shoulder dystocia may also cause the delivering medical provider to apply too much force while the shoulder remains stuck, stretching the brachial plexus nerves beyond their limit, resulting in a brachial plexus injury.
Finally, another common claim relates to a medical provider's failure to use appropriate maneuvers to deliver the baby after the shoulder dystocia has been diagnosed. A medical provider's use of too much force, moving the baby's head too far away from the shoulder, or using too many maneuvers before deciding a different form of delivery is needed, can result in injuries to the mother and baby. When this happens, the medical provider may be guilty of medical malpractice, and can be held responsible for birth injuries to the mother or baby.
If you or your child suffered a shoulder dystocia-related birth injury, what does that mean?
If you or your child suffered an injury at birth, and a shoulder dystocia diagnosis was also made, you should certainly discuss the next steps with the appropriate medical providers to ensure that you and your child are evaluated and treated by the appropriate specialist. Some shoulder dystocia-related birth injuries may only be temporary, but others may be permanent and require life-long medical care.
Birth injuries related to shoulder dystocia can cause life-long difficulties with everyday activities, requiring modifications to your or your child's schooling, job-responsibilities, and leisurely activities. It may also require ongoing therapy to prevent the injury's impact from worsening over time. Future activity modifications and therapy over the course of a lifetime can be very expensive. These injuries can also cause physical disfigurement and significant emotional harm to a child or parent, as these injuries may make the child feel different and impact his or her social wellbeing.
If you or your baby suffered a birth injury due to medical malpractice, the physician can be held responsible for the birth injury and all its consequences, including the costs of future medical care. It is very important to retain a lawyer who is experienced in handling birth injury cases and understands who to successfully hold the physician accountable. The medical malpractice attorneys at Morris James are experienced in birth injury cases, and can assist you and your child in presenting the strongest claim possible.
When should I speak with a lawyer?
If you or your child has suffered an injury related to shoulder dystocia, and if you believe that you or your baby were not treated appropriately during your pregnancy or labor and delivery, then you should consider speaking with an attorney. Given the complexity of pregnancy and the labor and delivery process, it can be difficult to determine whether a healthcare provider's medical malpractice caused injuries to you or your child. Hiring a medical malpractice lawyer who has handled several cases involving shoulder dystocia is key to making these determinations, as the lawyer has the tools and knowhow to investigate your case to determine whether the medical team committed medical malpractice, and how to prove such a claim in the court of law. An experienced birth injury lawyer also knows how to get answers from your healthcare team, and can make them pay fair compensation for your and your child's injuries.
Originally published 29 August 2022
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