A nice family came in last week with a beautiful little girl who had shoulder dystocia. Did she have a viable birth injury case? She has a significant injury if it is permanent and there is a strong reason to suspect malpractice. The child is so young there is still reason to be hopeful her body will mend itself.
There are a lot of crazy paradoxes with this job, so much so that I’m used to it. But in cases like this, we are hoping it not a case because that would mean the child got better.
Anyway, this gave me the idea to write a blog post explaining these injuries and how to know, if you are a lawyer or a parent, if you may have a viable birth injury case.
What Is Shoulder Dystocia?
In labor and delivery, shoulder dystocia means complication in the delivery of the shoulders that occurs when the baby’s shoulder is struggling to clear the mother’s pubic bone.
This complication is a relatively common type of obstructed childbirth where the head of the baby comes out okay but the shoulders become stuck behind the mother’s pelvis. Shoulder dystocia can occur due to the size of the mother’s pelvis, the size of the baby’s shoulders and body, and the angle of the baby in the birth canal.
When shoulder dystocia occurs during delivery it requires an emergency response because the baby can potentially die from compression of the umbilical cord. Umbilical cord compression is when the flow of blood (and oxygen) is obstructed either as the result of pressure or misalignment of the cord itself. It is serious but not uncommon. It is the responsibility of the OB/GYN and delivery staff to identify umbilical cord compression and shoulder dystocia and take appropriate steps in response.
There are a number of procedures and obstetrical maneuvers, including emergency c-section, that delivery room doctors can employ in response to shoulder dystocia during labor. Shoulder dystocia gives rise to a large number of malpractice claims because improper management and response by the OB/GYN often result in permanent birth-related injury.
Shoulder dystocia is a fairly common concern during delivery. There are a number of well-establish medical procedures and techniques that obstetricians should be well trained and prepared to employ in response to shoulder dystocia. Shoulder dystocia must be resolved quickly and competently to avoid injury to the baby or mother. So proper decision making and application of the various procedures and techniques is key.
What Should an Obstetrician Do When Shoulder Dystocia Is a Concern?
When an obstetrician encounters shoulder dystocia, the doctor’s first step is to properly assess the specific orientation of the baby’s shoulder.
This is important because the orientation of the shoulder will determine what combination of maneuvers or other actions should be taken in response. There is a well-established obstetrical protocol for assessing shoulder orientation. Failure to follow this protocol and properly assess shoulder orientation can lead to improper response and injury to the child or mother.
After that, and quickly, the standard of care requires that she attempt to resolve the shoulder dystocia utilizing maneuvers developed to reduce shoulder dystocia.
Four Shoulder Dystocia Maneuvers
There are three established techniques that focus on the maneuvering of the baby to resolve shoulder dystocia. These are known as the Rubin, Jacquemier, Woods-screw maneuver, and the posterior arm maneuver. The McRoberts maneuver is another commonly employed technique that involves the repositioning of the mother. Suprapubic pressure is yet another technique available. Most cases of shoulder dystocia are resolved by a combination of these techniques.
All of these techniques involve a series of careful maneuvers in which the OB/GYN attempts to reposition the baby and essentially dislodge the stuck shoulder. The McRoberts Maneuver is another widely used technique in which health care provider repositions the mother’s legs upward in an effort to shift the angle of her pelvic bone.
The success rate of these techniques is high. Studies have shown, for example, that once the OB begins using the Woods maneuver, there was a precipitous drop in brachial plexus injuries or other complications. in deliveries.
Shoulder Dystocia Injuries
Improper management of shoulder dystocia can and often does result in permanent injury to both baby and mother. In addition to broken bones and facial damage, there are at least 4 birth injuries that are typically caused by improper handling of shoulder dystocia:
- Erb’s Palsy: permanent injury to the upper nerves attaching to the spinal cord which can leave the baby’s arm partially paralyzed.
- Klumpke’s Palsy: this is an injury to the lower spinal cord nerves which can result in paralysis of the baby’s hands or lower arms.
- Cerebral Palsy: cerebral palsy (“CP”) is a neurological disability that impairs the brain’s ability to control muscle and body movement. CP can result from mismanagement of shoulder dystocia causing loss of oxygen to the baby’s brain.
- Developmental Delays: similar to CP, a child may suffer various developmental delays as a result of extended oxygen loss during delivery
Common Shoulder Dystocia Malpractice Claims
Proper handling of shoulder dystocia requires care and skill on the part of the doctor. This is particularly true when maneuvering the baby because too much force or over-rotation can easily result in permanent injury. All OB/GYN’s are well trained in the various techniques and how to properly use them.
The problem is that shoulder dystocia must be resolved very quickly or the baby could potentially die. Even good, experienced doctors and nurses are prone to panic and make mistakes under this sort of pressure. A doctor may be liable for medical malpractice if his or her handling of shoulder dystocia did not meet the medical standard of care.
Although shoulder dystocia malpractice can occur in a variety of ways, there are 2 general types of malpractice claims asserted in shoulder dystocia cases.
(1) Failure to Anticipate Shoulder Dystocia
In these cases, the plaintiff alleges that the doctor should have known that shoulder dystocia was likely to occur based on various risk factors (e.g., prior history, elevated blood pressure, size of baby/mother, gestational diabetes).
This allegation suggests that the doctor should have recognized that shoulder dystocia was likely and simply avoided it by performing a cesarean delivery or at least giving the mother the option of a c-section. These types of claims are often aggressively defended by doctors and hospitals because they involve questions of medical judgment.
The biggest tragedy is when a brachial plexis injury could be avoided with a simple fetal ultrasound to assess the size of the baby. In too many of these cases our birth injury lawyers see, if an ultrasound had been performed, the baby would have been identified as large for gestational age and at an increased risk for shoulder dystocia because of the challenges the child’s size presents in getting the baby through the birth canal.
(2) Excessive Force
Plaintiffs in these Baltimore birth injury cases allege that the doctor used excessive force or traction while maneuvering the baby and/or mother in response to the shoulder dystocia cases. Our attorneys see this all of the time. Obstetricians simply cannot use excessive traction. It is well-documented throughout medical literature on shoulder dystocia, and commonly understood in obstetrical practice: permanent brachial plexus injuries are caused by excessive lateral traction applied to a baby.
Excessive force claims are frequently based on specific types of birth injuries. For example, there is a wealth of medical evidence suggesting that certain injuries, most specifically Erbs Palsy, can only be caused by excessive force or traction to a baby’s head during delivery. Excessive force claims based on injuries such as Erb’s Palsy can be very difficult for doctors to defend.
Shoulder Dystocial Settlement and Verdict Stories
2020 – Virginia $2,000,000 – Settlement
A baby boy was born after 38 hours. He suffered hypoxic-ischemic encephalopathy, cyanosis, and microcephaly. The boy also lacked a respiratory rate and muscle tone. He developed seizures, spastic quadriplegia, hemiparesis, and cortical blindness. The boy’s mother alleged that the hospital staff’s negligence caused his permanent injuries. She claimed they negligently administered Cytotec and Pitocin, delayed the delivery, improperly addressed shoulder dystocia, and applied excessive force. This case settled for $2,000,000.
2019 – New Jersey $1,747,505 – Verdict
A newborn boy suffered a brachial plexus injury. His parents claimed the nurse-midwife failed to properly address shoulder dystocia, deliver via C-section, and warn her of a vaginal delivery’s risks. The jury ruled in the family’s favor and awarded $1,747,505.
2019 – Virginia $975,000 – Settlement
A baby girl suffered a permanent right brachial plexus injury at birth. Her mother alleged that the obstetrician’s negligence caused her permanent injuries. She claimed he failed to address shoulder dystocia, used excessive traction, prolonged the pregnancy, and failed to offer a C-section. This case settled for $975,000.
2019 – Washington $370,000 – Verdict
A newborn boy suffered a brachial plexus injury. He was left with permanent cervical and thoracic nerve injuries, a C7-T1 psuedomeningocele, a C8 nerve root avulsion, and a phrenic nerve injury. The boy’s mother alleged that the OB/GYN’s negligence caused his permanent injuries. She claimed he negligently addressed shoulder dystocia by using excessive force. The defense denied liability. They disputed whether their care and treatment caused the boy’s injuries. A jury ruled a plaintiff verdict. They awarded $370,000.
2019 – New York $926,358 – Settlement
A newborn weighed 11 pounds, 4 ounces. She also suffered a brachial plexus injury and neuropathy. Her mother alleged that the nurse-midwife’s negligence caused her permanent injuries. Her birth injury lawsuit claimed she failed to test for macrosomia and properly address shoulder dystocia. The case settled for $926,358.
2019 – New York $850,000 – Settlement
A macrosomic baby was born with a brachial plexus injury, Erb’s palsy, and a neurologic injury. He was left with delays in motor skills, speech, and development. The boy’s mother hired a malpractice lawyer who filed a lawsuit alleging that the hospital staff’s negligence caused these permanent injuries. She claimed they failed to diagnose macrosomia and properly address shoulder dystocia. The woman argued that the hospital staff should have performed a C-section. This case settled for $850,000.
Call Me About Shoulder Dystocia Malpractice
If you believe that you or your child has been injured as the result of negligent handling of shoulder dystocia in Baltimore, Maryland, or Washington, D.C., call Miller & Zois at 800-553-8082 or get a FREE from our lawyers in an online consultation.