Shoulder Dystocia

Portland Birth Trauma Lawyer
We are dedicated to providing comprehensive representation to young clients who have suffered permanent nerve injuries following a birth complicated by shoulder dystocia and a physician’s negligence. We have decades of experience working with doctors and other medical professionals to help the injured get full and fair compensation.Conditions are ever-changing during labor. Medical providers must make quick, yet informed decisions while adhering to professional standards. Falling short of those standards can result in injuries that take many forms, including shoulder dystocia.
Shoulder Dystocia & Medical Negligence
Delivery room doctors and staff are responsible for protecting a child from shoulder dystocia by properly monitoring the birth and repositioning the child if necessary. If an emergency extraction is needed, the doctor must use forceps or vacuum extractors with great care, preventing injury to the child. Improper use of extraction devices can result in nerve damage caused by stretches and ruptures.

Proactively identifying risk factors in certain women can also prevent the need for last-minute extractions that cause shoulder dystocia. Certain health-related issues include:

Shorter stature
Gestational diabetes
Excessive weight gain during pregnancy
A history of shoulder dystocia in previous deliveries
Shoulder dystocia leaves a newborn with physical challenges because of nerve damage in the neck or cervical spine. When medical professionals and delivery room staff fall short of the basic standards of care, we hold them accountable. At Pickett Dummigan Weingart LLP, we conduct thorough investigations and build strong cases that maximize compensation for our clients.

Shoulder Dystocia: An Overview

Dystocia refers to an abnormal or difficult childbirth. Shoulder dystocia is a specific type of dystocia generally recognized as a child birth delivery where an obstetrician is required to perform additional maneuvers to deliver a baby when the baby’s shoulders have become obstructed by the maternal pelvis after the infant’s head has emerged from the mother. Shoulder dystocia is considered an obstetric emergency that must be resolved quickly and competently to prevent major fetal and maternal harm, such as permanent nerve injury, neonatal depression, acidosis, asphyxia, central nervous system damage, and death.

The main concern with shoulder dystocia is damaging a newborn’s upper brachial plexus nerves, which are the bundle of nerves that connect from the cervical spine in the neck region to the shoulders and into the newborn’s arms and hands. The brachial plexus is a network of nerves that control the movement and sensation of the shoulders, arms, forearms, and hands. Brachial plexus injuries (BPI) occur when the brachial plexus nerves are stretched or torn during delivery as a result of the baby’s anterior shoulder being obstructed by the mother’s pelvic bone and the baby not being properly repositioned and expediently delivered by the obstetrician. The primary cause of brachial plexus injuries is excessive clinician force. In other words, the doctor or midwife pulls too hard or exerts excessive traction on the baby’s head and neck.

Once the baby’s head emerges from the mother’s pelvis during delivery, the baby’s umbilical cord can become compressed causing blood flow to greatly decrease between the mother and baby. The result is a continuing drop in cord pH levels and hypoxia, a lack of oxygen to the baby. If the pressure on the umbilical cord is not quickly relieved, lack of adequate oxygen can result in neonatal depression, a dangerously low breathing rate by the baby, and respiratory acidosis, a condition occurring when the baby’s lungs do not properly eliminate carbon dioxide and the blood becomes more acidic. Asphyxia, damage to the central nervous system, and death can further occur.

Shoulder Dystocia & Delivery Manuevers

Several procedures are available to obstetricians for managing shoulder dystocia. The first step is for the obstetrician to recognize that the baby’s body is not emerging with moderate traction and maternal pushing after the baby’s head has delivered, or by noticing that the baby’s head emerges and suddenly retracts back against the mother’s perineum and the baby’s cheeks are swollen, often called the “turtle sign” because it resembles a turtle pulling its head back into its shell. Once shoulder dystocia is recognized, several maneuvers are available to deliver the baby safely.

The safest and simplest maneuvers are the McRoberts maneuver and applying suprapubic pressure. The McRoberts involves sharply flexing the mother’s legs tightly against her abdomen to rotate the pelvis and straighten the sacrum bone to allow it to free the child’s impacted anterior shoulder. Suprapubic pressure entails placing a closed fist just above the maternal pubic bone and applying manual pressure to push the baby’s shoulder to one side or the other to facilitate a change in the baby’s position to the natural oblique orientation which allows for delivery. The two methods used together result in resolving more than half of all shoulder dystocia incidents.

Other maneuvers include the Wood’s Screw, which involves applying pressure directly on the posterior shoulder’s anterior surface and progressively rotating the posterior shoulder in corkscrew fashion to release the opposite impacted anterior shoulder. The Rubin is the reverse maneuver and involves pushing on the posterior surface of the posterior shoulder. Another effective maneuver is to identifying the forearm and hand and gently pull to deliver the posterior arm and shoulder first. The baby can then be rotated and the anterior shoulder dislodged, but there is a risk of fracturing the humerus.

More risky procedures are the Zavanelli maneuver, which involves pushing and repositioning the baby’s head back into the maternal pelvis and immediately performing an emergency Cesarean section, intentionally breaking the baby’s clavicle to allow the baby’s body to pass through the birth canal, performing a symphysiotomy, which is breaking the connective tissue between the mother’s pubic bones to facilitate passage of the baby’s shoulders, and abdominal rescue.

Labor and delivery units can and should do mock shoulder dystocia drills to prepare for emergencies. Shoulder dystocia can also be anticipated based on risk factors and obstetricians can prepare prior to delivery. Multiple risk factors can lead to shoulder dystocia, but it can occur in all infants. Major risk factors prior to labor include a mother’s history of prior shoulder dystocia during vaginal delivery, fetal macrosomia (large fetal body compared to the head), gestational diabetes, excessive weight gain, short stature, and maternal obesity. During labor, risks can include a precipitous second stage of labor (less than 20 minutes), operative vaginal delivery (assisted birth), a prolonged second stage (with and without regional anesthesia), and induced labor.

Incidence rates vary depending on the relative weight of newborns. The reported incidence rate for newborns between 6 lbs and 9 lbs ranges from about a half percent to one and half percent. The rate for newborns greater than 9 lbs increases to between 5 and 9 percent. However, it is likely that these figures are under-reported because obstetricians definitions of shoulder dystocia affects when it is reported. Obstetricians may also be hesitant to document shoulder dystocia to avoid malpractice suits if a baby is later found to have been injured. Certain studies have shown that less than half of all shoulder dystocia incidents are documented by delivering obstetricians.

The incidence rate of shoulder dystocia for large babies or babies of mothers with gestational diabetes is higher than for the general population containing all babies. Studies have shown that the rate of shoulder dystocia can be cut by more than half for mothers with mild gestational diabetes if treated during pregnancy with an appropriate diet, blood glucose self-monitoring, and insulin therapy.

Shoulder dystocia can be a traumatic experience for both mother and baby, but most babies recover well. Some babies are left with permanent injuries. These nerve injuries can affect the function of the arm, hand and fingers and present lifelong challenges for the affected child. Our firm works with life care planners who carefully evaluate the medical, educational, and life style needs of those children most profoundly affected to ensure that they are fully and fairly compensated.

Contact A Portland Birth Trauma Lawyer Today

If you feel that you or a loved one has had substandard care during labor, please contact us at 503-223-7770. You will be able to speak to an attorney experienced in shoulder dystocia litigation.

You can find all of our contact information and intake form by visiting our contact page.

We handle all personal injury claims on a contingency basis. We will only bill you attorney fees if we recover compensation for your losses.