Did you and your child experience shoulder dystocia during delivery? If so, it might be time to speak with a birth injury lawyer. This article will help families understand the risks associated with shoulder dystocia, and when to seek compensation through a medical malpractice lawsuit if shoulder dystocia was handled with negligence or substandard care.
Shoulder dystocia is a rare childbirth complication that poses serious risks for both the baby and the mother. When a baby’s shoulder gets stuck during delivery, it can cause significant stress and lead to severe birth injuries or even death if not managed promptly. When this happens, the obstetrician must intervene and ensure the child is delivered free from serious harm.
Although not every occurrence of shoulder dystocia results in a birth injury lawsuit or medical malpractice claim, this complication can have life-altering effects if handled incorrectly. It is important for parents to have a clear understanding of shoulder dystocia and to know when seeking legal advice and filing a medical negligence claim is appropriate.
What is Shoulder Dystocia?
Shoulder dystocia is a childbirth emergency that arises when a baby’s shoulder becomes lodged behind the mother’s pubic bones during delivery. When this happens, the baby’s head has been delivered but then retracts against the mother’s perineum. This retraction, also called the “turtle sign,” alerts doctors and nurses that shoulder dystocia has occurred. Now, certain maneuvers must be performed to dislodge the baby’s shoulder from the birth canal and ensure safe delivery.
During normal vaginal deliveries, after the baby’s head emerges, the mother typically delivers the baby with a few more contractions within 1-2 minutes. Shoulder dystocia halts this progression, demanding immediate attention from medical personnel. This puts the baby at risk, increasing the chances of severe birth injury, and instantly heightens anxiety among everyone involved.
How common is shoulder dystocia?
Shoulder dystocia is not very common, occurring in about 1 in 150 vaginal births. This frequency varies based on the size of the baby, with the lowest chance of complication being for babies weighing between 5 lbs and 8 oz, to 8 lbs and 13 oz (0.6% to 1.4%). The highest chance lies with babies weighing greater than 9lbs, 14 oz, with the odds increasing to the 5% and 9% range. These risks are heightened for diabetic mothers and are not altered based on the number of times the woman has given birth previously. Ultimately, shoulder dystocia is a subjective diagnosis, and may not be reported if handled correctly, so pinpointing the exact frequency of the complication is difficult.
Shoulder Dystocia Risk Factors and Causes
Besides sheer chance, multiple factors can contribute to the likelihood of shoulder dystocia occurring in the delivery room. Some factors may be revealed during prenatal tests, and by understanding the mother’s body and health history. Other causes arise during labor, when it becomes imperative that doctors and other healthcare personnel have anticipated shoulder dystocia and are prepared to handle it correctly.
A combination of risks during pregnancy and during labor often results in serious consequences, and may reveal negligence leading to a birth injury claim. Doctors must be aware of these risks and review all potential factors that may increase the likelihood of shoulder dystocia to be prepared for the complication.
Risk factors During Pregnancy
Some warning signs of shoulder dystocia can be spotted by obstetricians before the mother is in labor. Though these are not direct indicators, being aware of them and anticipating the event during delivery can mean the difference between life-altering complications and a smooth delivery.
Warning signs of shoulder dystocia during pregnancy include:
- Suspected macrosomia, or abnormally high weight (when a baby weighs greater than 8 lbs, 13 oz)
- Mothers with diabetes
- Shoulder dystocia in a previous pregnancy
- Excess weight gain during pregnancy
- Abnormal pelvic structure, or a small pelvic opening to the baby’s size
- Late-term pregnancy
For example, if an obstetrician suspects a baby to be born with an abnormally high weight (macrosomia), the chances of shoulder dystocia are increased. The baby’s precise weight is not known until after childbirth, but it can be preempted with proper measures. This is especially true for women with small pelvic openings who may deliver a baby with macrosomia. Mothers with pre-existing diabetes and gestational diabetes are more likely to give birth to larger babies, and doctors may suggest scheduling C-sections or inducing labor to prevent complications in these cases.
Risk Factors During Childbirth
Although certain health factors of the mother and the infant may increase the likelihood of shoulder dystocia, the majority of cases occur in babies with normal weights and no perceived complications. If the mother shows no warning signs of shoulder dystocia, doctors still must be aware of the risks that arise during labor and delivery.
Risks that can lead to shoulder dystocia during labor, and may further injure the baby after dystocia has occurred include:
- Prolonged labor
- Forceps delivery
- Vacuum extraction delivery
- Using excessive force or incorrect maneuvers to deliver the baby
- Use of epidural
- Inducing labor with Pitocin (oxytocin)
One of the greatest causes of shoulder dystocia birth injuries is the improper use of assisted delivery techniques. For example, if the baby is not properly positioned, and the doctor uses forceps to guide it out of the birth canal, its shoulder can easily become stuck. The same can happen with vacuum-extracted delivery. A macrosomic vacuum injury can occur if a doctor uses vacuum extraction to force a large baby out of the birth canal. This can cause excessive pulling on its shoulders, neck, arm, or head, and potentially cause a brachial plexus injury or bone fracture.
Improper or negligent use of medicine during labor may also cause shoulder dystocia. An epidural can reduce the mother’s ability to push effectively during delivery due to decreased sensation in the pelvic area. This can lead to–or exacerbate–a prolonged second stage of labor and a higher chance of the baby’s shoulder getting stuck behind the mother’s pelvis.
Conversely, Pitocin injections can cause overly strong and frequent uterine contractions, leading to a rapid descent of the baby’s head. This can cause the newborn’s shoulders to become stuck, especially if the baby is abnormally large. Administering Pitocin too rapidly or in excessive amounts further increases the risks of complications from shoulder dystocia. Doctors must monitor the mother’s contractions and the baby’s heart rate diligently to avoid misuse of the hormone.
Can shoulder dystocia be prevented to reduce the risk of birth injury?
While certain steps can be taken to prevent shoulder dystocia in high-risk pregnancies, healthcare professionals face difficulties when weighing their options. Obstetricians, nurses, and other medical personnel must be perceptive to major warning signs to make informed decisions. Medical studies concerned with shoulder dystocia birth injuries have outlined the difficulties doctors face when enacting preventative measures to avoid complications.
According to the American Academy of Family Physicians (AAFP), many doctors believe there is insufficient evidence to support inducing labor to avoid shoulder dystocia. Two studies of 313 women without diabetes showed that inducing labor does not reduce the risk of shoulder dystocia or emergency cesarean delivery, nor does it prevent maternal or neonatal morbidity.
Similar studies show that, for women with gestational diabetes requiring insulin, inducing labor may reduce the risk of shoulder dystocia. However, this does not lower the overall risk of fetal distress or birth trauma associated with macrosomia. Thus, healthcare providers are hesitant to prescribe induction to prevent shoulder dystocia, especially because of the heightened risks that come with assisted delivery and macrosomia.
However, because shoulder dystocia, emergency cesarean sections, and other birth traumas are more common in women with diabetes, some healthcare experts may suggest cesarean deliveries for these women. This decision is up to the discretion of the OB, and suggesting a C-section to diabetic mothers when other shoulder dystocia risks are high could potentially save a life.
If mistakes are made throughout the pregnancy, such as failure to respond to the mother’s heightened risk factors, doctors can fail to anticipate shoulder dystocia. They may also be ill-prepared to handle it during labor and delivery, and negligence may be revealed.
Shoulder Dystocia Birth Injuries & Complications
Once the doctor sees that the baby’s shoulder is stuck, he or she must act skillfully under pressure to resolve the complication without causing further harm. This is a harrowing and urgent situation for everyone involved, but obstetricians are trained to handle it. If doctors fail to act or act outside the standard of care, the baby or the mother could be severely injured.
These are some of the main neonatal birth injuries associated with shoulder dystocia:
Bone Fractures
The most frequent bone injuries from shoulder dystocia deliveries involve the clavicle (collarbone), or the humerus (the upper arm). Once an infant’s shoulder is stuck, using maneuvers that stretch the child’s head away from its stuck shoulder can rupture the clavicle. Studies have shown that attempting to remove the posterior arm (the arm on the bottom, opposite the mother’s pelvis) as the initial maneuver to relieve shoulder dystocia increases the chance of humeral fractures. Making this mistake may be considered malpractice.
Brachial Plexus Injuries
Brachial plexus injuries are the most common injuries associated with shoulder dystocia. The brachial plexus is a collection of nerves that runs from the base of the neck through the shoulder and down the upper arm. Once shoulder dystocia has occurred, bending or twisting the head and neck of the infant can damage these nerves and paralyze the arm, leading to serious complications. This is often the result of a doctor’s improper use of birthing maneuvers or delivery tools like forceps.
Erb’s Palsy
Erb’s Palsy is a kind of brachial plexus injury that results in weakness or total loss of muscle function. If a doctor uses excessive force to pull the baby’s head out of the birth canal, this stretching can damage or tear the brachial plexus nerves. Many babies recover from Erb’s palsy within a few months, but if it is not diagnosed and treated early, surgery may be required to repair damages, or it can result in lifelong paralysis. Shoulder dystocia is the most common cause of this injury.
Klumke’s Palsy
Klumke’s palsy is similar to Erb’s palsy, but it affects the lower brachial plexus nerves instead. A Klumke’s palsy injury results in partial paralysis of the forearm and hand, reducing grip strength, causing a limp or paralyzed arm, or causing a “claw hand.” This injury is most common in newborns affected by shoulder dystocia and needs to be diagnosed and treated early. Delayed response to Klumke’s palsy can require surgery to repair nerve damage.
Fetal Asphyxia and Hypoxic-Ischemic Encephalopathy (HIE)
During the delay caused by shoulder dystocia, the baby’s oxygen supply may be restricted, leading to fetal asphyxia. While the baby is stuck, its chest or the umbilical cord may become compressed in the birth canal, preventing normal breathing and circulation. Prolonged asphyxia can result in Hypoxic-Ischemic-Encephalopathy, or HIE, a serious brain injury caused by reduced oxygen and blood flow to the brain. This injury affects the nervous system, and babies born with HIE may suffer developmental disorders or neurological problems. Moreover, fetal asphyxia can result in fatality if not handled promptly.
Cerebral Palsy
Fetal asphyxia from shoulder dystocia can also cause cerebral palsy, a group of severe neurological conditions. When a newborn child suffers severe oxygen or circulation loss during prolonged labor, it can damage areas of the brain that control movement and coordination, potentially leading to cerebral palsy. This will affect motor skills, coordination, and balance all over the body, and is one of the possible long-term effects of shoulder dystocia.
Legal Rights for Families Affected by Shoulder Dystocia
Complications from shoulder dystocia can have detrimental effects on family members’ physical, psychological, and financial well-being. But there is still hope for families who have suffered through these incidents. Medical teams must be well-trained and prepared to anticipate and respond to signs of shoulder dystocia during labor. If doctors or nurses fail to provide the standard of care, a birth injury case may be opened against the healthcare provider. Families should understand their legal rights and the possible paths to compensation once this door has opened.
How to Prove Medical Malpractice in Shoulder Dystocia Cases
When a shoulder dystocia incident leads to serious injuries, families may pursue legal action against healthcare providers. Proving that preventable injuries occurred as a result of negligence is the key to winning these cases and receiving compensation for damages.
These are some of the ways medical negligence may be proved in shoulder dystocia cases:
- Failure to anticipate: Risk factors like suspected macrosomia, pre-existing or gestational diabetes in the mother, or a history of difficult deliveries can increase the chances of shoulder dystocia. If these factors were present but not adequately addressed during pregnancy, this could indicate negligence. This may also fall under lack of informed consent, in situations where doctors recognized these risks, but did not inform the family and discuss risks and options with them.
- Improper use of delivery tools: Incorrect use of tools like forceps and vacuum extractors can both cause shoulder dystocia and make it far worse once it occurs. There is ample medical literature that weighs risk factors and warns doctors of these outcomes, such as using vacuum extraction methods to deliver large babies, especially when the mother has diabetes. Neglecting to consider these risks can lead to brachial plexus injuries, fractures, and other neurological damages.
- Delayed Response: Medical personnel have a responsibility to intervene and relieve shoulder dystocia, and they are trained in these matters. Delaying to recognize and manage shoulder dystocia can lead to oxygen deprivation and fetal stress, resulting in conditions like HIE, cerebral palsy, and even wrongful death.
- Excessive Force: Excessive force is a common basis for medical malpractice claims that result from complications of shoulder dystocia. This also relates to improper use of delivery tools, as well as improper use of the established delivery maneuvers that doctors use to relieve shoulder dystocia. Using excessive force can rupture the brachial plexus and lead to paralyses like Erb’s Palsy or Klumke’s palsy.
Other ways to prove medical malpractice related to shoulder dystocia may involve a lack of adequate training, or defective hospital equipment. In any case, families who experience shoulder dystocia and may suffer the short-term or long-term effects of the complication should contact an experienced birth injury lawyer. Lawyers trained in medical malpractice can advocate for victims and help families recover damages.
Compensation for Damages in Shoulder Dystocia Lawsuits
Families affected by shoulder dystocia-related injuries may be entitled to multiple forms of compensation, both economic and non-economic. These settlements are calculated based on the severity of injury and who is affected, and they can vary widely. In general, the average birth injury settlement is around $1 million but can be far greater depending on the severity of the injury.
Forms of compensation are designed to address the immediate impacts of the injury and long-term hardships suffered by both the child and the family. If you or your child was harmed by shoulder dystocia, you could be compensated for the following types of damages:
Medical Expenses: Coverage won from birth injury cases may cover the full range of medical costs incurred from the injury. This can include emergency care during delivery, surgical procedures for the mother and baby, hospital stays, medications, and all other medical bills. Families can also recover costs for specialized care like physical therapy and occupational therapy.
Future Care Costs: Birth injuries caused by shoulder dystocia sometimes result in ongoing needs for care, especially in cases involving neurological damage and developmental disabilities. Families can seek compensation for anticipated future expenses, including long-term rehabilitation programs, in-home nursing assistance, home modifications for mobility challenges, and medical equipment like walkers and standers.
Lost Wages: In certain cases, compensation can address the child’s loss of earning capacity if a child’s ability to earn money is permanently inhibited by their injury.
Non-Economic Damages: Birth injuries can cause profound emotional and psychological stress. Besides objective monetary losses, families can be compensated for pain and suffering, emotional distress and psychological harm (PTSD, depression, etc.), and loss of enjoyment of life.
In severe cases, additional damages may be compensated for. These can include lifetime medical care, specialized education programs, and even vocational training to rectify the impact on the child’s earning potential. In terms of compensation, the outcomes of shoulder dystocia lawsuits and other birth injury cases hinge on the specifics of each case. To ensure fair compensation, families should hire a birth injury attorney or medical malpractice lawyer to guide them through the complexities of the case, and ensure that every loss is recovered.
How Birth Injury Lawyers Can Help
After experiencing a shoulder dystocia injury, families are already overwhelmed with the physical and emotional consequences. Hiring an experienced shoulder dystocia lawyer to explore legal options gets families one step closer to compensation, and reduces stress for everyone involved.
Steps to Winning Compensation for Your Claim
If you or your child is suffering the effects of a shoulder dystocia birth injury, you are not alone. Birth injury attorneys at Stalwart Law Group are highly experienced in medical malpractice claims and can help guide you through each step of the legal process, including:
Free Consultation: Families should act quickly, as there are legal deadlines (statutes of limitations) for filing medical malpractice claims. Stalwart Law provides free consultations for families in need, so you can speak with an expert immediately and without risk after experiencing shoulder dystocia.
Gathering Evidence: Medical evidence is invaluable in shoulder dystocia lawsuits. Detailed documentation of the childbirth process, including the actions taken by the medical team, can provide critical evidence in court. Birth injury lawyers at Stalwart work closely with families to gather and present relevant information, including delivery notes, medical records, and witness statements.
Consulting Medical Experts: The availability of expert testimony can significantly influence the outcome of birth injury cases. By contacting doctors and other medical experts for your case, lawyers at Stalwart can establish how standards of care were breached, and explain the connection between the resulting injuries and medical negligence. Dr. Steven Heimberg is a physician and practicing lawyer at Stalwart, whose expertise has proved immensely helpful in getting families the compensation they deserve.
Negotiating with Insurers: Lawyers at Stalwart are experts at negotiating with insurance companies and defense counsel. Once the initial shoulder dystocia or birth injury claim is filed, your lawyer will seek fair compensation for your child. If a fair settlement is not reached, your lawyer will take the case to trial and fight for your family.
Going to Trial: During the trial, your birth injury lawyer will present all evidence and demonstrate how medical negligence caused your shoulder dystocia case. This may also involve calling expert witnesses to testify in support of your claim, whom your lawyer can recruit for you. Stalwart’s attorneys will also fight for the full scope of compensation needed to address your medical, financial, and emotional losses.
Advocating for Your Child’s Future
Working with a birth injury lawyer to recover damages incurred by medical malpractice is imperative for families affected by shoulder dystocia. The funds you obtain from a successful shoulder dystocia lawsuit provide the help and resources needed to ensure your child gets the best possible care and support throughout their life. While fighting for you and your child ensures you get the support you deserve, it also transcends financial compensation.
Taking legal action is also about holding negligent parties accountable and advocating for your child’s rights. Not only does this improve the quality of life for your entire family, but it sets precedents that help protect future mothers, children, and families from suffering from medical malpractice. The more survivors who speak up, the more lives are potentially saved from harmful birth injuries such as those that result from shoulder dystocia.
Overall, shoulder dystocia is a serious childbirth complication that can have significant medical and legal implications. By understanding the risk factors, potential complications, and legal aspects of this complication, families become empowered to make informed decisions about their rights and options. If you or your child has been injured by shoulder dystocia and you think the injury is the result of medical malpractice or negligence, contact our birth injury lawyers today.