Shoulder Dystocia

During childbirth there are various factors that can put a baby and mother at risk for serious, permanent health issues, including shoulder dystocia.

What is shoulder dystocia?

This is an obstetrical emergency that occurs when a fetus’s anterior shoulder gets stuck behind the mother’s pubic bone, preventing the fetus from passing through the birth canal.

Shoulder dystocia is one of the most common obstetrical complications, occurring in about 2% of vaginal deliveries.

Diagnosing and reporting criteria among hospitals varies. Therefore it is somewhat difficult to establish a true case rate of shoulder dystocia deliveries.

While fetal size is not the only important factor, shoulder dystocia is more common in male and full-term babies because both tend to be larger than female or premature newborns.

Shoulder dystocia is caused by many interconnected factors such as the size of the fetus and its shoulders, the size of the mother and the shape of her birth canal, and the presence of maternal diabetes.

OB-GYN Expert Witness Dr. Paul Sinkhorn has the experience that you need to examine your case if your client’s child experienced a shoulder dystocia-related complication during childbirth, or if your client is a physician who was involved in a delivery complicated by shoulder dystocia.

Shoulder Dystocia Potential Complications

The risk of certain birth injuries increases when shoulder dystocia occurs during childbirth.

A lack of experience may lead some doctors to apply excessive force during childbirth in response to shoulder dystocia, where such force typically may cause or contribute to injury of the baby.

The most common infant complications resulting from shoulder dystocia are:

• Erb’s and Klumpke’s Palsies: A newborn’s neck is stretched to one side during a difficult delivery, causing temporary or permanent nerve damage to the brachial plexus nerves after they exit from the spinal cord. The brachial plexus nerves connect the brain to the arms and hands, and when the nerves are damaged, this can result in weakness or paralysis of the arm/hand.

• Cerebral Palsy: A difficult or prolonged delivery involving shoulder dystocia can potentially result in decreased oxygen supply to the newborn’s brain, potentially damaging neurologic structures that control movements of the body. Prolonged delivery, compression of the umbilical cord, and excessive trauma can all deprive the infant’s brain of oxygen during childbirth.

If your client has a child with these complications, the symptoms may be associated with shoulder dystocia during childbirth. It is also important, though, to understand that every case of shoulder dystocia does not cause injury to the infant or mother, nor does every case of brachial plexus injury or cerebral palsy connote negligent medical care.

How is Shoulder Dystocia Addressed at Delivery?

The safety of the mother and baby are both threatened during shoulder dystocia, so the delivery is treated as an obstetrical emergency.

A newborn could potentially suffer brain damage from oxygen deprivation if shoulder dystocia is not properly identified and handled.

There is a limited window of time to act and respond to shoulder dystocia in order to preserve fetal oxygenation.

When shoulder dystocia is initially encountered during delivery, the first step is to determine the exact position of the fetus within the maternal pelvis. Often extra helpers are summoned.

Excessive urgency or overly aggressive handling of the fetal head and neck is studiously avoided, as hyperextension of the fetal neck may cause serious injury to the baby.

The obstetrician will then use a series of maneuvers to reduce the dystocia, including flexion of the maternal thighs onto her abdomen, delivery of the posterior fetal arm before the anterior shoulder, careful rotation of the fetal head and shoulders within the birth canal, and pressure on the mother’s suprapubic area to dislodge the impacted shoulder.

It is most important that the birth attendants stay calm and do not panic and make rushed decisions during a delivery complicated by shoulder dystocia.

Every case of shoulder dystocia and fetal injury is different, some clearly involving negligence, and some cases being defensible.

OB-GYN Expert Witness Dr. Paul Sinkhorn can examine these difficult cases and give an experienced opinion whether proper technique and care were rendered.

Contact us on our website today to see how we can help you and your client with their shoulder dystocia injury case.