Shoulder Dystocia Injury Lawyer
Shoulder dystocia can cause serious birth injuries if not properly addressed. If it does happen to you during the birth process, you may need to seek legal advice, particularly if you or your baby are now dealing with a lifetime of medical costs as a result of the incident.
The birth injury attorneys at Levin & Perconti have successfully handled a number of cases involving shoulder dystocia. Through this experience, we understand the risk factors associated with the condition, along with the standard of care that physicians should employ when a dystocia occurs. For example, our attorneys achieved a $2.9 million birth injury settlement for a child who suffered a brachial plexus injury when a physician failed to perform the proper disimpaction (separation of impaction in fractured bone) and placed excessive force on the infant’s head and shoulder. Contact us today if you have any questions so that we can explain your options for the lifelong care of your family after a birth injury occurred.
against a hospital because an inexperienced resident performed a vaginal delivery of a breech presentation resulting in shoulder dystocia and a crippling brachial plexus arm injury.
for a child who suffered mild brachial plexus injuries that resulted from a doctor’s failing to use proper disimpaction techniques to address a shoulder dystocia which caused excessive force placed upon the infant’s head and nerve injury.
against a doctor for improperly performing the McRoberts maneuver in the delivery of a baby who developed shoulder dystocia during birth, resulting in a crippling brachial plexus arm injury.
What is Shoulder Dystocia?
Shoulder dystocia occurs when an infant’s shoulder becomes caught on its mother’s pubic bone during delivery, ultimately damaging the baby’s nerves. If this happens, in order to dislodge the baby’s shoulder, medical staff must be prepared to perform certain maneuvers or interventions to free the newborn in a safe and timely manner. In doing so, it is possible to prevent complications that could result in lifelong injuries. Specifically, if the baby suffers from shoulder dystocia, it can result in a number of different injuries in newborns, including:
- Erb’s Palsy: Weakness in the arm and/or permanent loss of function due to damage to the brachial plexus
- A lack of oxygen to the brain during delivery, resulting in brain injury (see Birth Hypoxia)
- Fractures to the baby’s clavicle bone (collar bone) or humerus (the long bone in the upper arm)
- Fetal Death
Shoulder dystocia can be anticipated, and in many cases is prevented, if a mother’s risk factors are addressed early. Some risk factors for shoulder dystocia include gestational diabetes, excessive weight gain or obesity during pregnancy, a large (macrosomic) baby, or a mother with a history of having large babies.
Who is most at risk?
Experts have identified a variety of factors that may contribute to shoulder dystocia. The Seminars in Perinatology study showed that “newborns delivered by vacuum or forceps have 254% higher likelihood of shoulder dystocia than those born spontaneously.”
In addition to the use of a vacuum or forceps, other conditions may result in shoulder dystocia. According to researchers out of the University of Arizona College of Medicine’s Department of Obstetrics & Gynecology, the presence of one or more of the following risk factors makes shoulder dystocia more likely to occur.
- Macrosomia (baby weighing more than 8 pounds, 13 ounces)
- A history of shoulder dystocia or brachial plexus injury (BPI) occurring in previous births
- Maternal diabetes (preexisting or gestational) or glucose intolerance
- Maternal obesity or excessive weight gain during pregnancy
- Being pregnant with multiple babies
Additionally, the risk of shoulder dystocia is greater for male infants. A 2010 analysis of deliveries in Lamphun Hospital in Thailand concluded that “infant male sex is a risk factor for [shoulder dystocia] independent of other known risks.” The authors of the analysis suggested that obstetricians may want to avoid vaginal delivery when mothers who are carrying male infants have other risk factors for shoulder dystocia.
Certain complications during labor — including abnormal dilation, unusually short or long second stage of labor, problems during descent, and the improper use of instruments — can also cause shoulder dystocia.
Medical staff should be mindful of these risks during labor to avoid shoulder dystocia or be prepared to minimize the likelihood of further complications.
Is shoulder dystocia preventable?
Whether shoulder dystocia is avoidable depends on the cause. Improper use of instruments during delivery, for example, is generally preventable. Additionally, proper prenatal care and patient assessment can help deter or minimize many potential complications. Lastly, expert handling of the condition when it does occur can help to mitigate harm to the baby and the mother.
A 2016 article published by Women’s Health asserts that risk factors identified before pregnancy, throughout the course of prenatal care, and during labor can help health care providers determine which risks are modifiable to prevent possible complications altogether or decide on a management approach that lessens injury when prediction fails to avoid the outcome.
Additionally, the article states that the assumption that shoulder dystocia is largely unpredictable and thereby unpreventable is not entirely accurate. If a pregnant woman presents specific risk factors, performing a cesarean delivery may be advisable. When a C-section isn’t reasonable or recommended, health care providers can use other basic obstetric practices and maneuvers to manipulate the baby from the mother’s pelvis in ways that protect the infant’s head and neck, mainly avoiding those points of contact altogether, and provide less force and invasive measures than more widely used manipulations of the mother and the newborn. The general idea is to ease tension on both the baby and the mother, such as having the patient lay on her side (lateral position), squatting, or kneeling on her hands and knees while giving birth, or performing an episiotomy to assist with carrying out various manipulative tactics.
Also, proper management of certain maternal health conditions and increased monitoring when risk factors are present can lead to a decreased likelihood of birth injuries, including shoulder dystocia and brachial plexus injuries, during labor and delivery. Medical advances and various evaluation and intervention methods can result in mostly superior outcomes when implemented correctly and promptly.
Signs and Symptoms of Infant Shoulder Dystocia
The single symptom of shoulder dystocia is the appearance of the baby’s head followed by the doctor’s inability to deliver the rest of the infant’s body. Medical professionals refer to the phenomenon as “the turtle sign” because the baby’s head will draw back into the birth canal, similar to a turtle retracting its head into its shell.
Possible Complications of Shoulder Dystocia
Shoulder dystocia can have long-lasting effects on both the child and the mother. Rarely, it may result in fetal death. A study published in International Journal of Gynecology & Obstetrics found the mortality rate to be 71.4 per thousand cases of shoulder dystocia.
While most babies survive the ordeal, the problems it can cause for the baby include:
- Fractures to the infant’s collarbone or arm
- Damage to the brachial plexus nerves (the nerves that carry signals from the spinal cord to the arms and hands)
- Brain injury due to lack of oxygen
The mother may also experience complications from shoulder dystocia, including:
- Bleeding after birth
- Rupturing of the uterus
- Abnormal connection between the lower intestines and the vagina, known as rectovaginal fistula
- Tearing of the perineum
- Excessive separation of the cartilage in bones of the pelvic area
Shoulder Dystocia and Birth Injuries
Other birth injuries related to shoulder dystocia may arise. Fractures to the collarbone or arm, may cause sensitivity or discomfort to the newborn with pressure to or movement of the arm.
Complications of shoulder dystocia can also include damaged nerves and lack of oxygen flow to the brain, which can lead to more serious conditions.
Damage to the brachial plexus nerves can lead to Erb’s palsy, a condition characterized by weakness or paralysis in the arm. Alternatively, lack of oxygen to the infant’s brain can cause cerebral palsy, which is a movement and muscle disorder.
Damage to the brachial plexus nerves causes a loss of feeling or motor function in the affected arm, known as Erb’s palsy. Often the condition clears up after a few months, but in extreme cases, the child may never regain full use of their arm.
The symptoms of Erb’s palsy will likely be noticeable soon after birth. If your child is exhibiting the following behaviors, it may be a sign of Erb’s palsy:
- Poor reflexes in one of the baby’s arms
- Lack of movement in one of their arms or hands
- An arm that’s constantly held tight against the body
- Poor grip in one of the baby’s hands
Cerebral palsy affects the cerebral motor cortex — the part of the brain that controls movement, posture, and balance. The severity of this condition varies greatly. Some children with cerebral palsy will go through life with few problems, while others may experience great difficulty and even a reduced lifespan.
The effects of cerebral palsy aren’t immediately visible like those of Erb’s palsy. The condition can also manifest differently in each child. When signs and symptoms do appear, it’s usually within the first few months of the baby’s life. Sometimes, however, they don’t show up until after the age of two. Symptoms may include:
- Delays in reaching milestones such as rolling over, sitting, crawling, or walking
- Abnormal muscle tone — baby is stiffer than they should be or looser or more “floppy” than they should be
What to Do if Shoulder Dystocia Occurs
If shoulder dystocia occurs during childbirth, doctors should implement a series of maneuvers to get the baby through the birth canal safely without excessive force. Medical personnel may perform an episiotomy, have the mother pull her legs to her stomach — an action known as the McRoberts maneuver — or put pressure on her pelvis. Other maneuvers include having the mother roll onto her side or using internal methods to rotate the baby or free one arm at a time.
The above maneuvers have been incorporated into a tool that medical professionals call the HELPERR mnemonic. The full mnemonic, developed by the Advanced Life Support in Obstetrics course from the American Academy of Family Physicians Foundation is as follows:
- H – Call for help
- E – Evaluate for episiotomy
- L – Legs (the McRoberts maneuver)
- P – Suprapubic pressure
- E – Enter maneuvers (internal rotation)
- R – Remove the posterior arm
- R – Roll the patient
These steps, when taken together, have proved effective in relieving the impacted shoulder.
After the baby is born, it’s important to monitor them for signs of birth injuries that can arise as a result of shoulder dystocia. Broken bones and bruising will be apparent almost immediately, but signs of Erb’s palsy or cerebral palsy may take longer to notice.
When should you seek legal action for shoulder dystocia?
Sometimes, the birth injuries that result from shoulder dystocia are unavoidable. Other times, malpractice on the part of a doctor or medical staff member increases the risk of injury to your child. If the doctor or nursing staff behaved in such a way as to cause injury during childbirth, they may be liable for the pain and suffering caused to your newborn and for the medical bills you incur as a result.
If you suspect that your child has suffered a birth injury that may be due to shoulder dystocia during delivery, contact an attorney immediately.
The attorneys at Levin & Perconti will review the circumstances of your child’s birth injury and determine whether you are eligible for compensation. Our lawyers have fought and won many cases for clients who have been the victims of medical malpractice during childbirth. Some of our recent successes include:
- $20 million verdict for a child who suffered a brain injury due to the negligence of nurses and residents during labor
- $11.5 million settlement for a child with hypoxic-ischemic brain injury
- $6.5 million for a girl who developed cerebral palsy after suffering a brain injury during birth
- $3.5 million for a family who lost a child due to birth complications
- $1.35 million for a newborn who suffered severe brachial plexus injuries after shoulder dystocia
If your child suffered an injury caused by a complication of shoulder dystocia during childbirth, contact our team of attorneys. You deserve justice for you and your child.
Not only were they so professional but also so caring and thoughtful. It was very difficult going over the facts in our mother's case but they were so compassionate and understanding and allowed us to be with them every step of the way. We were able to sit in on the depositions and we were really able to see how hard they worked on our behalf.