Shoulder Dystocia

What is Shoulder Dystocia?

Shoulder dystocia is a birth injury, also known as birth trauma, that happens during the birthing process that is caused by the failure to deliver the baby’s shoulders using solely the mother’s natural downward pushing. When this occurs, and only the baby’s head has passed through the vagina, doctors must apply force via hands, forceps, or a vacuum to aid in the birth. However, when excessive force is used, the shoulders and brachial plexus can be injured and can cause a host of temporary and permanent medical conditions.

Shoulder Dystocia Risk Factors

Several risk factors for shoulder dystocia should be identified before the mother goes into labor. Fetal macrosomia, used to describe babies who will weigh more than 8 pounds, 13 ounces (4000 grams) at birth, is the most significant risk factor for shoulder dystocia and should be identified before birth. Your doctor may suggest a cesarean birth, or c-section, to allow the baby to be born safely.

Another common risk factor for shoulder dystocia is material pregestational (pre-pregnancy) or gestational (developed during pregnancy) diabetes. Diabetes is a condition in which the body is not able to properly process sugar and there will be too much sugar in the blood. This can damage organs in the body. Diabetes increases the risk of fetal macrosomia, which increases the risk for shoulder dystocia.

Other known risk factors include:

• Women who give birth at 42 weeks or more
• Women with multiple births (twins, triplets, etc.)
• Women who have had shoulder dystocia in previous births
• Being overweight or gaining too much weight during pregnancy
• Women who have labor induced by oxytocin (a medicine to start labor)
• Women who received an epidural to numb the pain of birth
• Having a long second stage of labor

If your doctor believes you are at risk for shoulder dystocia, they can prepare you for what to expect ahead of delivering your baby. They can also make sure appropriate staff and equipment are prepared at the hospital.

If shoulder dystocia does occur, your doctor will try several methods to move you and the baby into a better delivery position, including the McRoberts Maneuver, commonly performed first, and suprapubic pressure. If these do not work, the doctor will try rotational maneuvers that can help turn the baby into a better position to be delivered, including Rubin’s maneuver and the woods corkscrew maneuver. The doctor may also attempt to deliver one of the baby’s arms, along with their head, which decreases the shoulder width allowing the shoulders to pass through the birth canal.

Your doctor may choose to use specific medical tools to help deliver the baby, including forceps or a special vacuum extractor; however, improper use of these tools can cause significant birth injuries and leave your baby with disabilities.

If these positional movements and tools do not work, your doctors may opt for more extreme options. They can use what are called ‘heroic measures’ to deliver the baby. These measures are typically not needed, however, when they are performed it can be very traumatizing. They can include an unplanned cesarean section, purposeful fracture of the baby’s bones, and unplanned hysterectomy. Even though the baby may be born alive and well after a heroic measure, these methods can cause severe birth injuries to the baby and mother.

Shoulder Dystocia Complications

Unfortunately, shoulder dystocia can cause a wide variety of complications for newborn babies, including:

• Fractures to the collarbone and arms
• Difficulty moving hand(s), arm(s), and shoulder(s)
• Constant shaking that lasts for prolonged periods of time
• Paralysis in one or more limbs
• Lack of oxygen to the brain, known as asphyxia, causing brain damage, coma, or even death

New mothers can also experience severe complications after giving birth to a baby who suffers shoulder dystocia, including:

• Postpartum hemorrhaging causing heavy bleeding after birth
• Tears of the perineum that may require surgery to repair
• Uterine rupture that will require surgery to repair

These complications can lead to significantly higher medical bills and longer post-partum recovery time.

What is Brachial Plexus Palsy?

The brachial plexus is the network of nerves that sends signals from the spinal cord to your shoulders, arms, and hands. When additional maneuvers used in birthing to enable the delivery of the baby’s shoulders go beyond gentle guidance, babies can suffer serious brachial plexus injury. This injury occurs in 0.2% to 3% of births and can leave the baby’s limbs paralyzed. In fact, this injury is one of the most serious childbirth complications and can occur in 2% to 16% of all shoulder dystocia injuries. While some cases can be resolved, up to 30% result in permanent neurologic impairment – and some even end in death.

Shoulder Dystocia Lawyers

If you suspect your child suffered from shoulder dystocia in childbirth, and you don’t know what to do next, call the experienced Philadelphia birth injury lawyers at Lopez McHugh LLP for help. Not only can we analyze your situation and explain your legal options, we can also help you get justice for your child. Contact us today to schedule a free consultation.