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Shoulder Dystocia

Shoulder dystocia is a condition that occurs when the baby’s head is delivered through the vagina, but the shoulders get stuck in the mother’s pubic bone. This type of complication occurs during a difficult labor and delivery, and may create risks both for mother and baby. The word “dystocia” means “slow or difficult labor or birth.” There are a number of risk factors for shoulder dystocia, which can be identified and predicted.

There are also many instances where obstetricians or medical professionals fail to identify these risk factors and/or take the steps that may prevent this condition from occurring. For example, if your baby is larger than average, your provider may recommend that you have a cesarean section or C-section. This is surgery in which your baby is born through a cut the doctor makes in your belly and uterus.

If your child has suffered birth injuries such a brachial plexus injury (Erb’s palsy) or cerebral palsy (as a result of oxygen deprivation) due to shoulder dystocia, you may be able to secure compensation for the injuries, damages and losses. An experienced New York shoulder dystocia lawyer can help you evaluate your legal rights and options.

How Often Does It Occur?

According to HealthResearchFunding.org, which collects statistics about shoulder dystocia, these numbers are often underreported by hospitals due to the fear that if an incident is recorded, it may later be used as evidence against the hospital, especially if the affected family later files a medical malpractice lawsuit. Here are some of the key facts and statistics about shoulder dystocia compiled by this organization:

  • The incidence of shoulder dystocia is reported to be between 0.5 percent and 1.5 percent. However, independent observers during a delivery have reported that shoulder dystocia is not noted in up to 50 percent of the times that it occurs.
  • The percentage of very large babies, according to one study, has increased by 300 percent between 1970 and 1988. This is one of the main risk factors for shoulder dystocia. When newborns weigh around 9 pounds at birth, the incidence rate of shoulder dystocia increases up to 9 percent.
  • Shoulder dystocia occurs with equal frequency in first-time moms and in women who have given birth to multiple children.
  • Women who are diabetic experience a six times greater risk of shoulder dystocia compared to women who are not diabetic.
  • The single most common risk factor for shoulder dystocia is the use of a vacuum extractor or forceps during delivery.
  • Palsies occur in up to 15 percent of the newborns that experience shoulder dystocia.
  • About 12 percent of mothers will have a second instance of shoulder dystocia after experiencing it with a previous child.
  • Without any type of intervention taking place within the first five minutes of shoulder dystocia occurring, up to one in two children may experience a fatal injury during birth.

Common Injuries Caused by Shoulder Dystocia

It is important to understand that shoulder dystocia in itself is not an injury. However, it is a condition that occurs during a difficult labor and delivery, which may result in a number of injuries. Here are some of the common injuries caused by shoulder dystocia.

Brachial Plexus Injuries

Brachial plexus injury is the classic injury following shoulder dystocia, first described by Duchenne in 1872. The brachial plexus comprises nerve roots of spinal cord segments. These nerve roots form three trunks, which divide into anterior and posterior divisions. The upper trunk is made up of nerves from C5 and C6, the middle trunk from undivided fibers of C7 and the lower most trunk is made up of nerves from C8 and T1. There are two main types of brachial plexus injury: Erb’s palsy and Klumpke’s palsy.

Erb’s palsy, the more common of the two, involves injury to the upper trunk of the brachial plexus (nerve roots C5 through C7). This condition affects the muscles of the upper arm and causes abnormal positioning of the scapula (shoulder blade). The supinator and extensor muscles of the wrist, which are controlled by C6, may also be affected. These injuries result in a child having a humerus (upper arm bone) that is pulled in toward the body. The child’s arm may also become permanently paralyzed due to this condition.

Klumpke’s palsy involves the nerves of the lower brachial plexus. In this type of injury, the elbow becomes flexed and the forearm supinated, with a claw-like deformity of the hand. Sensation in the palm of the hand is also diminished.

Fractured Clavicle or Collarbone

This is the second most common injury sustained by infants following shoulder dystocia deliveries. The incidence of this injury after shoulder dystocia is about 10 percent. If the fetal shoulders and chest are relatively large in relation to the mother’s pelvis, significant pressure may be placed on them as they pass through the birth canal following delivery of the baby’s head. In some infants, this pressure causes the collarbone or clavicle to break. Shoulder dystocia increases the risk of collarbone fractures 30-fold. It is also important to note that clavicular fractures in C-sections are extremely rare.

Fractured Humerus and Contusions

In about 4 percent of infants with shoulder dystocia deliveries, the long bone of the upper arm, also known as the humerus, may fracture. These fractures are often the result of maneuvers that may be used to resolve shoulder dystocia. The force with which the infant’s shoulder is compressed against the maternal pubic bone and the pressure of the doctor’s hands on a fetus while performing various maneuvers to effect delivery will often result in bruises on the baby’s body. Such bruising or contusions may be used as evidence that a baby was handled roughly at the time of delivery.

Fetal Asphyxia

This is probably the most feared complication of shoulder dystocia. The reason asphyxia occurs during a delivery that involves shoulder dystocia is that once the fetal head emerges from the mother, the baby’s umbilical cord becomes tightly compressed between its body and that of the mother’s birth canal. This significantly decreases or totally cuts off blood flow between the mother and the infant. If the pressure on the cord is not rapidly relieved, the child may become asphyxiated. Cerebral palsy and fetal death are consequences in shoulder dystocia deliveries where the doctor doesn’t take prompt action.

Risk Factors for Shoulder Dystocia

A woman may be more at risk for shoulder dystocia if:

  • Her baby is larger than average.
  • She has diabetes or is obese.
  • She is pregnant with more than one baby.
  • She gives birth past the baby’s due date.
  • She had a very large baby or a shoulder dystocia in the past.
  • Her labor is induced.
  • She gets an epidural to help with pain during labor. An epidural is pain medicine you get through a tube in the lower back that helps numb your lower body during labor.
  • She has an operative vaginal birth. This means that her provider uses tools such as forceps or vacuum extractor to help the baby through the birth canal.

Preventing Injuries Caused by Shoulder Dystocia

Birth injuries that are caused by shoulder dystocia are preventable. There are also appropriate techniques that doctors should use when dealing with shoulder dystocia. If the medical professional stated that your baby’s shoulder dystocia as well as any subsequent injuries could not have been predicted, then he or she may be held negligent. The likelihood of shoulder dystocia occurring may be established prior to the delivery of the baby, especially in cases where the mother has one or more risk factors. Obstetricians must be properly trained on how to respond to shoulder dystocia. In most shoulder dystocia emergencies, the baby must be delivered in five minutes or less in order to prevent catastrophic injury or death.

There are a number of life-saving maneuvers that doctors can perform in these emergency situations. For example, the McRoberts Maneuver, which is performed with a high degree of success, requires sharply bending the mother’s legs toward her chest. This allows the baby’s shoulder to dislodge from the pubic bone. In some cases, pressure may be applied to the mother’s lower abdomen at an angle that helps rotate and push the baby’s shoulder below the pubic bone.

The Woods/Rubens Maneuver is where the doctor puts a hand inside the birth canal and rotates the baby in an attempt to dislodge the trapped shoulder. Doctors may also choose to perform an episiotomy where the doctor cuts the area between the vagina and the anus to increase the amount of room for delivery.

Our Clients’ Results

$43,940,000: Verdict secured for family whose child was diagnosed with cerebral palsy. The hospital failed to diagnose fetal distress, which led to brain damage and cerebral palsy from lack of oxygen supply to the brain. The delay in diagnosing the fetal distress and ordering a C-section delivery caused the child’s condition. Defense attorneys argued that the child’s injuries were caused by premature birth and that the obstetrical care was appropriate. The $43,940,000 verdict was eventually reduced on appeal, because the verdict was so large.

$23,500,000: In this case, doctors departed from proper medical procedures in allowing a resident to handle the birth of the child. They also failed to inform the mother of a urinary tract infection for which they had tested her weeks earlier. The mother went into premature labor, but wasn’t treated for the infection. The resident who handled the emergency C-section was said to have applied too much pressure on the infant’s head causing trauma to the head and bleeding in the brain. As a result, the child was born with severe mental retardation and cerebral palsy. The $23,500,000 verdict was reduced on appeal, due to the huge size of the verdict.

$4,500,000: This was a case where a doctor negligently used forceps to deliver a baby cutting oxygen supply to the baby’s brain. The child suffered from cerebral palsy as a result. We were able to prove that a C-section should have been performed, which may have prevented the cerebral palsy from occurring.

$1,400,000: We recovered this amount for a newborn, who lost motion in the arm during birth due to doctors applying incorrect force on the baby’s head. As a result, the child now suffers from a brachial plexus injury.

$1,175,000: Settlement in a brachial plexus palsy case.

$1,000,000: We recovered this amount for a baby who suffered from Erb’s palsy after doctors were negligent during the delivery.

$850,000: Settlement reached in Erb’s palsy case.

$2,850,000: Verdict for one of our Erb’s palsy clients that was reduced by the appeals court to $1,850,000 because the verdict was so large. This was the highest amount upheld by the appellate courts for many, many years.

Contacting an Experienced Lawyer

Parents of children who have suffered birth injuries due to shoulder dystocia and/or negligence may be able to file a lawsuit seeking compensation for damages including, but not limited to, medical expenses, lost income and benefits, loss of livelihood, hospital and rehabilitation costs, permanent injuries, disabilities, past and future pain and suffering, etc.

Children who suffer such types of injuries are looking at a long road ahead with extensive rehabilitation and treatment to help them live a certain quality of life. The related expenses add up very quickly for families that strive to give their children the physical and emotional support they need.

If your child has suffered a birth injury as the result of medical negligence, the experienced New York personal injury attorneys at the Law Offices of Kenneth A. Wilhelm can help you better understand your legal rights and options, and also fight hard to recover just compensation for you.

Please contact us TOLL FREE 24 hours a day, 7 days a week at 1-800-WORK-4-YOU (1-800-967-5496). WE CAN EVEN COME TO YOU. There is no attorneys’ fee unless we recover money for you. We can also help with personal injury cases in New York, New Jersey, Connecticut, Pennsylvania, or Florida. If you have been seriously injured in any of the 50 U.S. states, please call us and we will try to help you with your case.

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1-800-RADIO-LAW, 1-888-WYPADEK, OR 1-800-LAS-LEYES

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