Shoulder Dystocia During Labor and Delivery
The birth of a child is a joyous event. But sometimes things can — and do — go wrong during labor and delivery. One complication is “shoulder dystocia,” which occurs when the baby’s head is delivered, but the shoulders get stuck inside the mother’s pelvis.
Shoulder dystocia (dystocia means slow or difficult birth) is unpredictable and unpreventable because it occurs after labor has already begun. When it does happen, however, it is a medical emergency.
If a doctor does not respond to shoulder dystocia immediately during labor and delivery, both mother and baby can suffer serious injuries. In the worst case scenario, a newborn may even die. In cases where appropriate and swift action is not taken, it can be the basis for a medical malpractice claim.
Shoulder Dystocia Risk Factors & Treatment
Shoulder dystocia can happen during any woman’s labor and delivery. However, a pregnant woman may be at a higher risk when:
- She has diabetes or is obese.
- She is carrying more than one baby.
- The baby is very large.
- She gives birth after the baby’s due date.
- The baby is in a breech position.
- She previously gave birth to a large baby or suffered a shoulder dystocia during a prior birth.
- Labor is induced.
- She has an epidural to help with pain during labor.
- The doctor uses tools like forceps or a vacuum to help the baby through the birth canal.
In most cases of shoulder dystocia, the baby is delivered safely and the mother is fine. The doctor may use one of the following procedures to deliver the child:
- Pressing the mother’s thighs against her belly.
- Applying pressure to the mother’s lower belly.
- Turning the baby’s shoulder while still inside the mother.
- Cutting a wider vaginal opening (episiotomy).
Complications from Shoulder Dystocia
When shoulder dystocia occurs, the mother and baby usually do not experience any permanent damage. Most complications are appropriately treated and managed.
Sometimes, however, the mother may suffer temporary heavy bleeding after birth, and can also experience tearing of the uterus, vagina, cervix, or rectum.
Meanwhile, the baby can also suffer complications, such as contusions and fractures. Other more serious injuries include:
- Fetal asphyxia – This is a lack of oxygen to the baby’s brain during delivery. In the most severe cases, fetal asphyxia causes brain damage and possibly death.
- Brachial plexus injury – This is caused by the stretching of the brachial plexus, a group of nerves originating in the spinal cord in the neck and traveling down the arm. Erb’s Palsy, a paralysis and lack of sensation in the arm, is the most common form of brachial plexus injury during delivery.
According to the American Academy of Orthopaedic Surgeons, approximately one or two in every 1,000 babies will have brachial nerve damage. It is usually caused when the newborn’s neck is stretched to the side during a difficult delivery.
Doctors and hospitals have been held liable for malpractice in cases of brachial plexus injuries. One of the largest verdicts was in 2010, when a jury awarded $56 million against a New York hospital for a family whose child suffered permanent nerve damages.
