An obstetrician or certified nurse midwife is a professional who is trained to handle all types of situations that may arise during the birthing process. One fairly unusual and often dangerous occurrence is shoulder dystocia. Shoulder dystocia during delivery is a medical emergency that must be handled carefully. The likelihood of shoulder dystocia increases if the mother naturally suffers from gestational diabetes, if labor has been induced, and if the mother has had previous deliveries with shoulder dystocia, or if the mother is obese. However, when the obstetrician fails to anticipate a difficult delivery, fails to use the industry-accepted procedures to correct the emergent problem, or acts rashly during the emergency and causes an injury, a Phoenix shoulder dystocia lawyer at Knapp & Roberts can help you receive full compensation for your loss.
What Is Shoulder Dystocia?
Shoulder dystocia occurs when the baby’s head has been delivered, but the anterior shoulder becomes lodged behind the mother’s pubic bone. This requires additional manipulation by the physician to remove the baby from the birth canal, and invasive emergency measures should manipulation techniques fail.
Shoulder dystocia happens during the second stage of labor as the uterine contractions push the baby into the birth canal: the baby’s head has come through the pelvis, but one or both of the shoulders get stuck behind the bony structure. This can happen for various reasons. A skilled medical provider should identify the risk factors for shoulder dystocia and take steps to address the problem before delivery. It’s also imperative that the provider and attending staff have a prescribed emergency protocol in place for unanticipated shoulder dystocia.
Shoulder Dystocia Risk Factors
An OBGYN and other medical providers who deliver babies should evaluate the pregnant mother for shoulder dystocia risk factors as the pregnancy approaches full term. Risk factors include:
A history of shoulder dystocia in a previous delivery
Excessive prenatal weight gain
The mother’s pelvis is unusually small
The baby is large relative to the mother’s pelvis
The baby is not in the usual position
Fetal macrosomia, or larger than average size. In infants with a birth weight over 8 pounds, 13 ounces, there is a 0.6 to 1.4 percent chance of shoulder dystocia. Between 5 and 9 percent of infants with a birth weight exceeding 9 pounds, 14 ounces will experience shoulder dystocia.
Maternal diabetes. Shoulder dystocia is more likely to occur in infants born to women with diabetes.
Pregnancy with multiples, including twins or triplets
Use of a vacuum extractor or forceps during delivery. When a medical professional uses these tools to help bring a baby out of the birth canal, this increases the chance of the shoulder becoming lodged behind the pubic bone.
Unless the delivery team corrects the dystocia quickly, the baby could suffer severe brain damage within minutes or develop permanent impairment due to brachial plexus injuries. The mother could experience vaginal tears or even die from hemorrhaging.
Therefore, when shoulder dystocia occurs, speed is imperative. Failure to provide adequate emergency assistance during labor when shoulder dystocia occurs could leave the physician, hospital and other responsible care providers open to legal action.
Anticipating And Overcoming Shoulder Dystocia For A Healthy Delivery
Prior to the beginning of labor, taking measurements of the mother’s pelvis and the baby’s size can alert the doctor to the possibility of shoulder dystocia and may indicate the need for a Caesarian delivery. If the problem has not been anticipated and vaginal delivery has progressed to the delivery of the baby’s head, a skilled practitioner and their staff must be familiar with several different maneuvers that can bring about a healthy delivery.
Time is of the essence in a delivery with shoulder dystocia, and the physician or midwife must act quickly and deliver the baby in six minutes or less, or the baby could suffer a lack of oxygen leading to damage to the central nervous system.
If the doctor or midwife panics and uses excessive and inappropriate force to try to pull the baby out, injury is likely.
Warning Signs of Shoulder Dystocia
Shoulder dystocia in infants is a preventable birth injury and is entirely avoidable when medical providers anticipate the possibility of the problem before it occurs. Doctors should evaluate pregnant patients based on common indicators such as gestational diabetes which often results in large babies, obesity in the mother, a larger than usual baby, a small pelvis in the mother, or a baby in an improper birth position during the days before delivery. The industry-accepted standard of medical care for delivering babies with a possibility of experiencing shoulder dystocia during vaginal birth is to deliver the baby through a scheduled C-section. Even if a doctor fails to anticipate a birth with shoulder dystocia, warning signs that appear during labor indicate a need for immediate medical intervention to prevent injury to the baby and/or the mother. These warning signs include:
Protracted labor, or abnormally slow dilation or fetal descent during active labor
An unusually short or long second stage of labor
A mother who has delivered the baby’s head but is unable to deliver the baby’s shoulders
More than a minute passes after the mother delivers the head without further progress in delivering the baby
When a medical provider accurately assesses an emergency case of shoulder dystocia during delivery, prompt action to address the problem through proactive medical intervention such as the “HELPERR” method is the accepted standard of care in the medical industry. When a doctor or provider fails to take swift, deliberate action according to protocol and the result is shoulder dystocia and related injuries, the doctor or the facility the doctor works for is liable for damages.
What is the HELPERR Method for Addressing Shoulder Dystocia?
Well-prepared medical providers in the labor and delivery field have a checklist nearby to refer to for emergency treatment for shoulder dystocia during childbirth. The pneumonic reference for the structured protocol steps for emergency action is HELPERR. HELPERR stands for the following:
H: Help—the OBGYN should call for help from other healthcare providers including an anesthesiologist and a neonatologist as well as for a team to bring in emergency delivery tools
E: Evaluate—the OBGYN should evaluate the mother for a possible episiotomy (a cut in the perineum to enlarge the vaginal opening to make room for rotation measures to move the baby out from under the pubic bone
L: Legs—the OBGYN may assess the possibility of delivering the baby through the McRoberts maneuver in which the mother presses her thighs up against the belly to rotate and flatten the pelvis. The father and/or medical personnel in the delivery room can help the mother with the leg position
P: Pressure—a healthcare provider may attempt to deliver the baby using suprapubic pressure, or external pressure against the lower belly, to try to dislodge the baby’s shoulder from under the pubic bone for delivery
E: Enter maneuvers—the doctor may perform a fetal rotation by reaching into the pelvis to physically turn the baby and dislodge the shoulder
R: Remove the posterior arm—the OBGYN may deliver one of the baby’s arms from the birth canal to help facilitate delivery (Jacquemier’s Maneuver)
R: Roll—the doctor may turn the mother into a hands-and-knees position to deliver the baby from a different angle (Gaskin Maneuver)
Only when the above industry-accepted standards for addressing shoulder dystocia fail does a doctor then take the following series of increasingly invasive corrective steps:
Intentionally fracture the baby’s clavicle (collarbone) to release the shoulders for delivery
Push the baby’s head back up the birth canal and then perform a C-section delivery
Perform a symphysiotomy, which is a procedure to enlarge the pelvic opening by cutting through the cartilage between the pubic bones
Taking the above deliberate, orderly steps to attempt a safe, swift delivery is the current standard of care in the medical industry. If a doctor deviates from this standard and it results in an injury to the baby or mother, they are liable for the damages.
Can the Reaction to Shoulder Dystocia Be Too Hasty?
Shoulder dystocia is an obstetrical emergency requiring prompt, deliberate action to protect the life of the baby and the mother. It’s almost always a traumatic birth experience for mothers who quickly realize that something is wrong but may not understand the problem. This may lead to panic in the laboring mother and a sudden hectic rise in the level of activity in the delivery room. When medical professionals are faced with shoulder dystocia during labor, they must remain calm and deliberate while also quickly and diligently working through the correct order of corrective method attempts to dislodge the baby’s shoulder for delivery. Each method requires a higher level of intervention, escalating to invasive methods such as internal maneuvers to physically rotate the baby, breaking the clavicle to dislodge the shoulder from the pubic bone, and if other methods fail—forcing the baby back up the birth canal for an emergency C-section. If medical providers experience an elevated level of alarm during attempts to correct shoulder dystocia, overly hasty management can lead to skipping steps and resorting to the most extreme or invasive methods.
It’s imperative that the providers adhere to the coordinated prescriptive action plan accepted by the medical community for addressing shoulder dystocia. If the provider fails to do so, they are liable for damages. In some injury cases, a lack of staff training and drills for emergencies like shoulder dystocia during childbirth leaves the facility liable for damages.
Possible Injuries To A Baby During Delivery With Shoulder Dystocia
The consequences of shoulder dystocia depend on how quickly the medical providers resolve the problem and on how the doctor is able to extract the child. If the doctor or midwife has failed to anticipate cephalopelvic disproportion and the baby has come through a difficult delivery, there is a possibility of other types of damage as well:
Difficulty breathing, necessitating resuscitation
Fractures of the infant’s collar bone (clavicle) or humerus
Brachial plexus injury or Erb’s Palsy, nerve damage in the shoulder causing weakness and restriction of motion in the shoulder and arm
Paralysis of the arm
Umbilical cord compression, which can cause a number of serious medical emergencies, including deprivation of oxygen to the baby’s brain;
The inability of the child’s chest to expand properly;
Severe brain damage in the baby;
Possible Injuries To The Mother
This delivery complication can cause injury to the mother as well as the baby, with possible effects including:
Tearing of the perineum
Fistula or a hole through the tissue between the vagina and the rectum
Is Shoulder Dystocia Preventable?
Some cases of shoulder dystocia in childbirth are preventable when medical providers identify the risk factors and take proactive corrective measures. If a woman has gestational diabetes, is obese during pregnancy, has a small pelvis, or has a larger-than-average baby, the doctor can prevent shoulder dystocia by:
Scheduling a C-section delivery
Inducing early labor
However, not all cases of shoulder dystocia are preventable because they are not always predictable. The majority of shoulder dystocia cases occur because the typical predictors were not a factor. Unpredicted shoulder dystocia during delivery is a medical emergency. A skilled medical provider must quickly identify shoulder dystocia and promptly address it with emergency treatment protocols according to the accepted medical standards.
Symptoms of Erb’s Palsy in Newborns
The most common medical injury in newborns with shoulder dystocia during deliver is Erb’s Palsy. Erb’s palsy is the weakness, loss of motor function, or reduced feeling in an arm, noticeable soon after birth in affected infants. Erb’s Palsy in newborns is caused by damage to the brachial plexus nerve. Early signs of Erb’s Palsy include:
Poor reflexes in one arm
Lack of movement in one arm and shoulder
Holding the arm tightly against the body
Weak grasp in one hand
The prognosis is good for the majority of babies suffering from Erb’s Palsy due to shoulder dystocia, but treatment is necessary to maximize recovery.
Treatment Of Erb’s Palsy Resulting From Shoulder Dystocia At Birth
If your baby is suffering from Erb’s palsy, he or she will require intensive physical therapy and exercises to improve the range of motion in the shoulder, elbow, hand, and wrist beginning at about three weeks of age, to prevent permanent joint contracture or stiffness. Sometimes surgery is an option in a younger child, but surgical complications are high.
Nevertheless, the injury may be permanent, and the child may never have full use of the arm and shoulder. The affected arm may always be smaller than the unaffected one, which in addition to functional problems can affect the child’s body image and self-esteem, necessitating psychological treatment in addition to physical therapy.
Compensation Available In A Shoulder Dystocia Lawsuit
Treatment for shoulder dystocia complications can be lifelong and costly. However, a successful lawsuit requires proving that a doctor or medical professional deviated from the standard of practice for their field. This means a medical professional must have acted contrary to a reasonable physician with the same background acting under the same circumstances. If a victim of shoulder dystocia, or their representative, can prove a medical professional was negligent, there are various damages that may be recovered. The amount of compensation available depends upon the type and severity of the injury.
Damages may include any of the following:
Any related medical bills;
Pain and suffering;
Scarring or disfigurement;
Diminished quality of life;
Out-of-pocket costs; and
Liable parties can include any number of healthcare entities, not just the delivering physician. A skilled should dystocia injury lawyer can help determine what party or parties may be responsible on a case-by-case basis.
Liability in Shoulder Dystocia Injuries
When a baby or mother suffers an injury due to unanticipated, incorrectly treated, or belatedly treated shoulder dystocia during childbirth, the injured victim shouldn’t be left holding the bag for expensive medical treatment and other damages. Instead, a Phoenix shoulder dystocia injury lawyer can investigate the circumstances of the injury and determine the liable party. In shoulder dystocia injury cases as well as other medical malpractice cases, proving liability requires showing the following:
That a medical provider/patient relationship between the parties existed at the time the injury occurred
That the provider owed a special duty of care to the patient to treat them at the industry-accepted standard for the condition
That they breached this duty and acted negligently
That the negligence directly caused the injury
That the injury victim suffered significant economic damages from the injury as well as pain and suffering
Once the attorney clearly demonstrates the above legal points of liability, the medical malpractice insurance of the liable party may offer an out-of-court settlement amount or the case could move forward into a lawsuit. Possible liable parties in shoulder dystocia injuries include:
The doctor or midwife
A member of the medical staff
The facility itself in the provider was an employee rather than an independent contractor with facility privileges
Laboring mothers deserve the highest standard of care when they are at their most vulnerable. When a provider fails to adhere to these standards, they must compensate the victim for damages, typically through their medical malpractice insurance.
Finding The Best Phoenix Shoulder Dystocia Injury Lawyer
If your doctor or midwife failed to anticipate a difficult delivery that could have been prevented by a timely Caesarian section, or if he or she mishandled a vaginal delivery and caused permanent injury to your child, you may be able to recover damages for the cost of medical treatment, physical and psychological therapy, and your child’s pain and suffering and diminished quality of life. Proving negligence can be difficult and requires a well-versed Phoenix personal injury lawyer, with access to medical professionals who can identify where the obstetrician or midwife breached the expected standard of care that resulted in the injury.
Free Medical Malpractice Case Analysis
In Phoenix, Scottsdale, and the surrounding area, you will find the experienced legal assistance you need at the Arizona law firm of Knapp & Roberts. Our highly skilled Phoenix medical malpractice attorneys are committed to justice for your child and to deterring carelessness and negligence by holding doctors, hospitals, and staff accountable when they fail in their duty to provide competent care to mothers and babies. We will fight for a recovery large enough to provide the best care for your baby, both now and in the future, so your child can achieve a happy and productive life after suffering this serious birth injury.
Call Knapp & Roberts today and tell us about your delivery and your baby’s injury. We will do a thorough case analysis at no cost to you, and will advise you as to your legal options. Your child deserves justice, and we will do everything the law allows to ensure it!
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