Your baby could be injured before you’ve even had a chance to hold them for the first time.
Most babies are born head first. Once the head emerges, the rest of the body—including the shoulders—must pass through the mother’s pelvis. On occasion, the shoulders could become stuck behind the pelvis, which makes it difficult for the baby and the mother to complete the delivery.
This can lead to a condition called shoulder dystocia, which is an obstetric emergency. Dystocia is when normal delivery of the baby’s head does not lead to delivery of the shoulders.
Shoulder dystocia can result in injuries to both the baby and the mother. The baby might suffer brachial plexus injuries or hypoxia. The mother could experience damage to the bladder, anal sphincter or rectum, or post-partum hemorrhage.
One question that some mothers ask after delivering a baby with shoulder dystocia is, “Are my baby’s injuries caused by medical malpractice?” It’s a scary thought, and no parent wants to think about the fact that their baby was injured when it could’ve been prevented.
Causes and diagnosis of shoulder dystocia
Shoulder dystocia is rare; however, one of the main risk factors is the baby’s size. The Cleveland Clinic reports that shoulder dystocia is observed in only about 0.6% to 1.4% of babies who are between 5 pounds, 8 ounces and 8 pounds, 13 ounces at birth. However, for babies who weigh more than 8 pounds, 13 ounces, the rate increases to between 5% and 9% of births.
Aside from the size of the baby relative to the size and shape of the mother’s pelvis, there are no real risk factors for shoulder dystocia, and there is no way to predict to whom it will happen.
In most cases, the condition is not observable until after the baby’s head is delivered. The head could emerge and then pull back in toward the vagina and perineum.
The doctor should diagnose shoulder dystocia if three conditions are present:
- The baby’s head delivered but the mother isn’t able to push out the shoulders.
- There has been at least one minute from the time of the head emerging and the body has not.
- The baby needs medical intervention to deliver successfully.
However, the doctor can and should observe certain factors that could raise the likelihood of shoulder dystocia:
- Fetal macrosomia, which is a baby who weighs more than 8 pounds, 13 ounces. You can’t weigh a baby on a scale prior to birth, but ultrasounds can provide a fairly accurate estimate of a baby’s weight while still in the womb.
- The baby is not positioned properly for a smooth exit from the birth canal.
- The mother’s pelvic opening is too narrow to accommodate the size of the baby.
- The mother’s labor positioning limits the space in her pelvis.
However, though shoulder dystocia could happen to anyone, there are some risk factors that the doctor should look for before delivery. These include:
- Gestational or pre-existing diabetes
- Birth after 40 weeks gestation
- Mother older than 35
- Shoulder dystocia in a previous pregnancy
- Overweight mother or excess weight gain during pregnancy
- Abnormal pelvic structure
- Mother is short (height)
- Pregnancy is twins or other multiples
Treating shoulder dystocia
An obstetrician has ways of anticipating shoulder dystocia before it happens or as it’s happening. If it begins to happen, the obstetric team in the delivery room will leap into action to get the baby out fast. First, they might try interventions or maneuvers like changing the position of the woman’s body in order to widen the pelvis. They might want to reposition the baby in order to free their shoulders.
An episiotomy is an incision in the perineum that makes the vaginal opening larger. The doctor might perform this procedure in order to allow the baby’s shoulders to pass through.
The McRoberts maneuver
The doctor might press the woman’s legs against her abdomen, which can flatten and rotate the pelvis. This is usually performed by two people—either a doctor and nurse or a support person—with one on either side of the birthing woman, each holding one leg. This maneuver has been shown to be successful in releasing the shoulders.
The Gaskin maneuver is another technique that doctors use to treat shoulder dystocia. This would mean that the mother turns onto her hands and knees to better position her pelvis for delivery.
Pressure applied to the woman’s abdomen above the pubic bone could cause pressure on the baby’s shoulder that rotates it enough to deliver.
Entry or arm maneuvers
The doctor might attempt an internal rotation by reaching into the vagina to turn the baby. Alternately, they could try to remove one of the baby’s arms from the birth canal in order for it to be easier for the shoulders to pass through.
If all else fails...
If none of these methods are successful, the doctor might intentionally break the baby’s clavicle (collarbone) to get the shoulders through. Alternately, they might push the baby’s head back into the uterus and perform an emergency Cesarean section. They might also make an incision between the mother’s pubic bone to enlarge the pelvic opening.
Complications associated with shoulder dystocia
Shoulder dystocia injuries to the mother
- A mother might experience postpartum hemorrhage, or heavy bleeding after birth.
- Sever tearing between the vagina and anus (perineum).
- Separation of pubic bones.
- Uterine rupture, or tearing of the uterus during labor.
- Rectovaginal fistula, or an abnormal connection between the vagina and rectum.
Shoulder dystocia injuries to the baby
The most common injury associated with shoulder dystocia is brachial plexus palsy. This is when the nerves from the baby’s spinal cord, and through their neck and arm, are damaged. Nerve damage could lead to weakness and paralysis.
Your baby could also be affected by a rare disorder that affects their eyes and face, fractures to the collarbone or arm bone, or a compressed umbilical cord. If the umbilical cord becomes flattened, it could cut off the baby’s oxygen or blood flow. Though rare, this could result in brain injury or death.
Claims for medical malpractice for shoulder dystocia
Medical malpractice is a form of personal injury law used when a patient’s injury or illness was caused by the medical professional’s negligence.
There are three primary ways this presents for shoulder dystocia injuries:
- The doctor should have been able to predict that shoulder dystocia was likely based on the woman’s risk factors.
- The risk factors should have been an indication that a C-section would be a safer method of delivery.
- The baby’s permanent brachial plexus injury was caused because the doctor pulled too hard when trying to deliver the baby and did not follow the standard of care by following alternative procedures or methods.
If you believe that your or your baby’s injuries are the result of negligence by medical professionals, there are a few steps you can take to preserve and further a lawsuit. First, get a second opinion. Find a physician outside the group or hospital where you delivered your baby and ask them whether the injuries suffered are the result of negligence in not anticipating or treating shoulder dystocia. Next, seek medical help for whatever resulting injuries you or your baby are experiencing.
Finally, seek the guidance of an experienced birth injury lawyer. Your lawyer will work with medical, financial and actuarial experts to determine whether and how much you should be compensated in damages for your losses related to a shoulder dystocia injury.