 Shoulder
Dystocia is an obstetric emergency associated with the
potential to injure both mother and child. It occurs when
the baby's anterior shoulder becomes trapped behind the
mother's pubic bone and the baby cannot come out of the
birth canal. It is diagnosed when the infant's head delivers
but the shoulders and body fail to follow. Even the
slightest traction on the baby's head can cause injury to
the brachial plexus, which is the bundle nerves that
controls the arm. This nerve injury to a baby's arm is
called Erb's Palsy and can vary in severity from
slight stretching of the nerves causing weakness to rupture
of the nerves causing complete arm paralysis. If the
obstetrician recognizes the risk factors prior to the
commencement of labor and/or properly manages the delivery
when Shoulder Dystocia occurs, injury is avoided.These
risk factors for Shoulder Dystocia include: a previous
delivery of a baby weighing over 4000 grams; a history of
prior child who had Shoulder Dystocia; maternal and/or
gestational diabetes; Estimated Fetal Weight (EFW) over
4,000 grams (macrosomia); maternal obesity; gestational age
over 41 weeks; and a second stage of labor that lasts for
more than two hours. An obstetrician can identify those
patients at risk by taking a careful history from the mother
about prior deliveries and birth weights, by performing
ultrasound evaluation on all patients at risk for macrosomia
to estimate fetal weight, and by testing for gestational
diabetes with a glucose tolerance test.
The way obstetricians can prevent injury to patients at
risk for Shoulder Dystocia are to (1) perform a prophylactic
cesarean section for non-diabetic mothers whose fetuses have
an EFW over 4500 grams and to perform a prophylactic
cesarean section for diabetic mothers whose fetuses have an
EFW over 4000 grams, and (2) follow a structured and
practiced "plan or drill" for the management of Shoulder
Dystocia if it occurs unexpectedly during delivery. The most
important factor in the initial management of Shoulder
Dystocia is for the operator to immediately remove his or
her hands from the fetal head as soon as the diagnosis is
made and to not pull on the fetal head and neck until the
baby's shoulder is unstuck and freely able to exit and
deliver vaginally. There are approximately sixteen different
obstetrical maneuvers that can free the anterior shoulder so
the baby can be safely delivered. Proper use of these
maneuvers can prevent the traction on the fetal head that
injures the brachial plexus and causes Erb's Palsy.
Doctors can negligently cause an Erb's Palsy injury by
failing to perform appropriate prenatal testing to identify
patients at risk for shoulder Dystocia thereby avoiding a
vaginal delivery or, when it occurs during birth, by failing
to utilize appropriate maneuvers to dislodge the anterior
shoulder before continuing the vaginal delivery. It is the
excessive traction to the baby's head and neck by the
obstetrician that causes the injury to the brachial plexus.
If you feel that you or someone you know has been the
victim of such errors, search our national database for a
medical malpractice attorney serving your area by clicking
on the gold map to the left. For more information on
Shoulder Dystocia and Erb's Palsy, click on any of the
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