Shoulder Dystocia During Delivery: What Parents Need to Know

As expectant parents, you probably knew the day of your child’s birth would come with stress and some pain, but anticipated it would end with tremendous joy and the celebration of a healthy new life. When a baby or mother is harmed during a birth involving shoulder dystocia, the celebration is tarnished with worry and uncertainty.

If your medical team did not handle your case of shoulder dystocia properly and caused you or your child harm, a Philadelphia medical malpractice lawyer can help. The legal team at Lopez McHugh, LLP will work to hold your medical team accountable for the losses you and your baby have suffered from their negligence.

Understanding Shoulder Dystocia

Shoulder Dystocia is a problem that occurs during a baby’s delivery. The National Institute of Health (NIH) describes shoulder dystocia as a “mechanical problem” during a natural birth when the baby’s shoulders do not exit the birth canal solely through “gentle downward traction” after the head emerges. Instead, the shoulders are blocked either by the mother’s pubic bone or the sacrum.

During a natural birth, there is typically a pause, an interval not more than one minute, after a baby’s head is delivered and before its body emerges. In cases of shoulder dystocia, that delay is longer.

The occurrence of shoulder dystocia is an obstetric emergency as the baby needs emergency help to be born.

Risk Factors for Shoulder Dystocia

According to the American Academy of Family Physicians (AAFP), there are risk factors for shoulder dystocia, but there are no “accurate models to predict or prevent” cases. Risk factors include:

• Fetal macrosomia (giving birth to a large baby)
• Prior occurrence of shoulder dystocia
• Pre-existing or gestational diabetes
• Maternal obesity
• Excessive weight increase during pregnancy
• Use of Oxytocin to induce labor
• Prolonged first or second stages of labor
• Deliveries using forceps or a vacuum

Though doctors should be aware of these conditions, risk factors are not definitive or even strong predictors of shoulder dystocia. The NIH acknowledges the emergency’s unpredictability, stating, “All obstetric providers are required to be knowledgeable regarding the risk factors and management of shoulder dystocia.”

Frequency of Shoulder Dystocia Cases

Shoulder Dystocia is not a common condition. According to the Cleveland Clinic, data varies widely as occurrences can be over- or under-diagnosed. However, statistics indicate shoulder dystocia occurs in:

• 6% – 1.4% of babies weighing between 5.8 and 8.13 pounds and
• 5% – 9% of babies weighing more than 8.13 pounds

The NIH gives a rate of 0.15-2% for all deliveries.

How Doctors Should Respond

Though shoulder dystocia is somewhat unpredictable, doctors must be on the lookout and prepared for its occurrence.

Your doctor should alert a nurse or assistant about the delivery of the baby’s head so they can start a timer and announce every 30 seconds that pass. If the baby does not deliver through normal means within one minute, the doctor must then announce the shoulder dystocia, tell the mother to stop pushing and call for additional help.

The NIH describes both “first-line” and “second-line” maneuvers and then “heroic measures” teams must take to produce the best outcome.

First-Line Maneuvers

These maneuvers include moving the mother’s position and having them assume the “McRoberts position” of lying flat on their backs and drawing the knees back as far as possible. Doctors or nurses may also apply pressure to your pubic bone in an attempt to shift the baby’s shoulder.

Second-Line Maneuvers

If first-line maneuvers are not productive, doctors must attempt second-line options, which include:

• Rubin’s Maneuver: rotating the baby’s shoulder toward its chest
• Woods Corkscrew Maneuver: rotating the baby’s shoulder toward its back
• Delivery of the posterior arm
• Gaskin Maneuver: having the mother get on all fours and applying upward or downward pressure depending on the baby’s position

For these and other methods, assistants must properly support the baby’s head.

Heroic Measures

These actions are more extreme and only used if first- or second-line maneuvers fail.

Doctors may intentionally fracture the baby’s clavicle to allow for the body’s delivery. Though it can be successful, this method is difficult to execute and can cause additional damage.

Sometimes, doctors may rotate the baby’s head back into the uterus and perform a C-section or use another surgical method called an “abdominal rescue.”

Positive Outcomes and Complications from Shoulder Dystocia

There are many positive outcomes from shoulder-dystocia births. Research reported by the NIH shows that at three months old, 50 percent of babies experiencing shoulder dystocia births have regained full function. That percentage increases to 82 percent at 18 months. However, all babies who needed surgical interventions had reduced use of the affected body part, specifically regarding fine motor skills.

Complications

Shoulder Dystocia can cause problems with long-term or permanent consequences for both mother and baby.

Mothers can experience:

 Tears to the vagina, bladder, or rectum

• Nerve damage, causing pain, burning, tingling, or numbness
• Postpartum hemorrhaging
• Uterine ruptures
• Emotional trauma

Babies can experience:

 Collarbone or upper arm fractures

• Nerve damage affecting the face, shoulders, arms, hands, or fingers
• Loss of the affected limb if it is denied oxygen for too long
• Brain damage if the brain is deprived of oxygen
• Death

The NIH stresses the importance of having an interprofessional team coordinate to ensure optimal outcomes both during and after delivery. Teams can include obstetricians, nurses, orthopedic surgeons, pediatricians, and therapists.

Managing the Aftermath of Shoulder Dystocia

Though many mothers and babies recover from shoulder dystocia births, some are left with severe and lifelong consequences affecting their entire quality of life.

If your child’s birth was compromised by healthcare professionals who were unprepared for handling shoulder dystocia or mismanaged their treatment of it, you can hold the negligent parties accountable for the physical, financial, and emotional suffering they have caused. A Philadelphia birth injury lawyer from Lopez McHugh LLP can work to get you the compensation you and your child need, including but not limited to:

• Medical care is expensive. Long-term injuries bring a lifetime of serious financial costs.
• Medical care takes time. Hours ultimately equaling weeks, months, or perhaps years of your life will be spent in medical settings.
• Physical injuries affect how you live and work. If you or your child has chronic pain, paralysis, or limited mobility, certain opportunities are unavailable to you. Whether recreational or professional, these injuries can limit your options.
• Physical trauma can bring emotional trauma. Your child will not remember the events of their birth, but you will–and it can lead you to develop post-traumatic stress disorder (PTSD). But both you and your child will live with the effects of that traumatic birth and are more susceptible to experiencing stress, frustration, anxiety, or depression as a result.

You Are Not Alone

You imagined the birth of your child as the happiest day of your life. When that birth is mishandled and those medical mistakes cause lasting damage to you and / or your precious new baby, it is easy to become overwhelmed with fear. A Philadelphia birth injury lawyer from Lopez McHugh, LLP can help relieve some of that fear by pursuing compensation from your negligent medical team. With a settlement or trial verdict, you will see justice for your child and have the financial means to give them the best care possible. Contact us today to discuss your legal options.