Shoulder dystocia is a condition that can occur during natural labor and delivery, when the baby’s head is delivered but the shoulder gets stuck behind the pubic symphysis. It is an emergency because it requires fast recognition and action by the OB/GYN doctor to avoid a significant permanent injury to the baby, and possibly the mother.
Who is at risk?
While most obstetrics/gynecology physicians find shoulder dystocia difficult to predict, the general risk factors are well-known. They include:
· Mother over 35 years old.
· Mother with a short height.
· Mother with a small or abnormal pelvis.
· The pregnancy is over two weeks past the due date.
· The mother has diabetes (maternal diabetes can double or even quadruple the risk).
· The mother delivered a previous child who experienced shoulder dystocia.
In addition, labor and delivery factors that increase the risk of shoulder dystocia include:
· The use of oxytocic medications, like oxytocin (Pitocin), methylergonovine (Methergine), Carboprost (Hemobate), or some prostaglandins.
· Long first or second stages of labor.
· When the baby’s head is delivered, it fails to return to its natural position in relation to the shoulders. The medical term for this is failure to restitute.
· When the shoulders do not rotate during delivery.
· The need to use instruments to assist with delivery.
The dangers shoulder dystocia
Shoulder dystocia is a dangerous condition that needs proper emergency management, or it can lead to serious, lifelong injury, and even death of the baby.
As soon as shoulder dystocia is diagnosed, the standard of care requires OB/GYN and other healthcare providers to give immediate attention to delivering the baby. Any unnecessary delay could lead to compression of the umbilical cord and the birth canal, which could kill the baby.
As a Houston, Texas medical malpractice lawyer, I more often see babies with brachial plexus injuries caused by improper physician management of shoulder dystocia. I remember first learning about the brachial plexus as a first-year medical student, and was surprised at how so many important upper extremity nerves run through the armpit area.
The brachial plexus is a bundle of nerves that supplies both sensory and motor functions to the shoulders, arms, and hands. Experts believe that many brachial plexus injuries occur during delivery by excessive stretching of the shoulder and nerves. This physical trauma can actually rip the nerve roots away from the baby spinal column, leaving the baby with total paralysis of the affected arm.
Common complications from shoulder management include brachial plexus injuries, Klumpke paralysis, Erb’s palsy, diminished or total loss of oxygen to the baby causing cerebral palsy, and even death of the baby. In addition, some mothers who deliver babies with shoulder dystocia experience post-partum hemorrhaging after delivery. Other maternal complications include vaginal tears and uterine rupture.
Medical malpractice in handling shoulder dystocia
An example of a medical malpractice case illustrates how poor decision-making by an OB/GYN doctor can cause permanent injuries to a baby.
A woman was admitted to the hospital 39 weeks into her pregnancy for induction of labor, but went into spontaneous labor before she could be given an oxytocin injection to induce labor. In the first hours of labor, the mother progressed well, dilating from 4 to 7 cm, and the doctor then gave her an oxytocin injection to augment labor. The mother continued to dilate to 9.5 cm and remained there for two hours.
The doctor chose to proceed with natural labor and vaginal delivery.
The birth note reflects that the mother was fully dilated at the time of birth and that the OB/GYN had to use a second degree midline episiotomy to deliver the baby. An episiotomy is a deliberate surgical cut made between the vagina and anus to prevent tearing and allow delivery of the baby.
The baby’s birth certificate records a weight of 9 pounds, 3 ounces (4,175 grams). After birth, the baby was left with a significant brachial plexus injury.
The medical records also reflected presence of shoulder dystocia, with the doctor using the McRobert’s Maneuver and pressure above the pubic bone and “slow, steady, downward pressure and rotation of the shoulders” to aid the delivery.
In the medical malpractice lawsuit, the plaintiff’s expert testified that the OB/GYN doctor provided negligent, sub-standard care in three significant ways.
First, the doctor did not appreciate or act on the significant risk of vaginal delivery posed by a mother whose pelvic size was small carrying a large baby (weighing over 4,000 grams).
Second, the doctor did not recognize the enhanced risk presented by the mother’s prolonged first and second stages of labor.
Third, as soon as the OB/GYN doctor recognized shoulder dystocia, he should have converted the delivery to an emergency C-section.
In short, this case showed that the OB/GYN was unaware of the mother’s pre-labor risk factors, as well as additional risk factors that presented themselves during her period of labor. As a result, the doctor did not have a good birth plan and was unprepared to handle the baby’s shoulder dystocia quickly and appropriately when it presented itself.
We are here to help
The medical malpractice attorneys at Painter Law Firm, in Houston, Texas are experienced in investigating and filing negligence lawsuits against OB/GYN physicians, hospitals, and other healthcare providers based on shoulder dystocia and other birth injuries. For a free consultation about your potential case, call us at 281-580-8800.
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Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas, where he represents patients and family members in medical malpractice and wrongful death cases. He is a former hospital administrator who frequently speaks and writes on health care and medical negligence topics. He is a past editor-in-chief of The Houston Lawyer magazine and currently serves on the editorial board of the Texas Bar Journal.
