Shoulder dystocia typically arises during a vaginal delivery when, after the baby’s head has been delivered, its shoulder becomes impacted against the mother’s pubic bone, thereby impeding the delivery of the baby’s body.
When shoulder dystocia occurs, there is an increased risk of injury to both the mother and her baby. If a shoulder dystocia is not properly managed, the baby can suffer potentially permanent neurologic injuries, such as a brachial plexus injury. Compression of the umbilical cord, which is frequently associated with shoulder dystocia, can quickly lead to fetal asphyxia and hypoxic-ischemic encephalopathy.
Although the occurrence of shoulder dystocia is not exclusively dependent upon the size of the baby, the risk of shoulder dystocia is considered to be much greater when the baby is large. Babies who weigh more than 4,000 grams at term – about 8 pounds or more – are considered large or “macrosomic.”
Studies have shown that the risk of shoulder dystocia is as much as 11 times greater when the baby weighs more than 4,000 grams, and the risk of shoulder dystocia is as much as 22 times greater in the vaginal deliveries of babies who weigh more than 4,500 grams.
The risk of shoulder dystocia is also much greater in babies who are delivered post-term or post-dates, that is, beyond 40 weeks of gestation.
Despite the increased risk of shoulder dystocia associated with macrosomia, it is estimated that more than half of all deliveries in which shoulder dystocia occurs involve babies who weigh less than 4,000 grams. Thus, in any vaginal delivery, the safe and careful obstetrician will always be on the alert and plan for a shoulder dystocia and will have a detailed plan for managing a shoulder dystocia, should it occur.
A safe and careful obstetrician’s plan for managing shoulder dystocia will likely include a number of obstetrical maneuvers, which are intended to relieve the shoulder dystocia without causing further injury to the infant. Such obstetrical maneuvers to manage a shoulder dystocia typically include the McRobert’s maneuver, suprapubic pressure and the cutting of an episiotomy as first-line measures. An episotomy typically will be cut in order to create more space for the baby to pass below the pubic bone and for the obstetrician to perform any necessary fetal manipulation maneuvers.
When a shoulder dystocia occurs, an unsafe and careless practitioner may pull or twist on the baby’s head and neck. Such pulling and twisting of the baby’s head and neck will stretch and sometimes tear the nerves in the brachial plexus, resulting in Erb’s or Klumpke’s Palsy injuries.
The Law Firm of Dugan, Babij, Tolley & Kohler, LLC has extensive experience in representing families whose loved ones have been injured as a result of medical malpractice associated shoulder dystocia.