During childbirth, the shoulder of the child may get trapped behind the pubic bone of the mother. This complication, known as shoulder dystocia, may harm the mother and the child if it is not promptly addressed. Shoulder dystocia can result in brachial plexus injuries, which affect nerves that connect the spinal cord to the shoulder, arm, and hand. Although treatment usually resolves conditions related to brachial plexus injuries, such as Erb’s palsy, some children may suffer permanent consequences.
Risk factors for shoulder dystocia may include diabetes, an overweight mother, the presence of twins or other multiples, and fetal macrosomia, which simply means that the fetus is very large. Sometimes it arises in connection with the use of assistive instruments such as forceps or vacuum extractors, the use of oxytocin to induce labor, or the use of epidural anesthesia for pain relief. A doctor who observes abnormalities around the pelvis of an expectant mother should be alert to the risk of shoulder dystocia.
Past History, Greater Risk
A mother who previously suffered from shoulder dystocia during childbirth may be more likely to experience it again. This may mean that a doctor should advise a C-section for them.
Consequences of Shoulder Dystocia
Both mothers and babies may suffer serious harm from shoulder dystocia. Among other problems, mothers may suffer uterine rupture, perineal tears, and severe bleeding. Meanwhile, in addition to brachial plexus injuries, babies may suffer broken arms, clavicle fractures, or oxygen deprivation, which can cause brain damage. Permanent physical and mental disabilities may result. In rare cases, complications of shoulder dystocia can threaten the life of a baby.
Treatment for Shoulder Dystocia
A doctor who identifies a risk of shoulder dystocia may want to arrange for extra staff to be available during labor and delivery. This can allow the medical team to respond promptly if shoulder dystocia occurs, minimizing complications. Doctors typically go through a routine known as HELPERR when shoulder dystocia develops:
Help: Notify appropriate staff members about the emergency and get assistance.
Evaluate: Consider whether the staff should conduct an episiotomy, which involves cutting into the perineum to create space to deal with the obstruction.
Legs: Bring the legs of the mother toward her stomach, which flattens and rotates the pelvis so that the baby’s head can move more smoothly.
Pressure: Apply suprapubic pressure in an effort to rotate the shoulders of the baby so that the shoulders can potentially move around the obstruction.
Enter: Rotate the baby manually to allow the shoulders to move around the obstruction.
Remove: Carefully bring one of the arms out of the birth canal, without using so much force that the arm is broken.
Roll: Move the mother onto her hands and knees to change the shape of the pelvis.
Doctors do not need to go through these steps in this particular order. They should adjust their strategy according to the circumstances. If the HELPERR routine does not resolve shoulder dystocia, doctors may implement "maneuvers of last resort."
Maneuvers of Last Resort
These measures may include general anesthesia, deliberate clavicle fracture, or abdominal surgery.
Compensation for Medical Malpractice Involving Shoulder Dystocia
Although shoulder dystocia is not an easy condition to handle, obstetricians and other medical providers involved in labor and delivery need to meet a professional standard of care. They must check for risk factors of shoulder dystocia during a pregnancy and prepare a strategy for dealing with this complication if the risk is high. Doctors should be trained in responses to the emergency, such as the HELPERR techniques, and they should understand their alternatives if HELPERR techniques do not work. Failing to identify a risk of shoulder dystocia, develop a plan for it, or promptly respond to it can cause serious, sometimes permanent harm. A family can sue a medical provider for malpractice if their errors in handling shoulder dystocia caused injuries and disabilities.
To prove malpractice, a patient would need to show that a doctor did not take the precautions that a competent doctor would have taken in their situation. This usually requires presenting expert testimony from professionals in the same medical field. If a patient establishes liability, they can recover compensation for any medical costs related to the complications of shoulder dystocia, including any costs of future treatment. Damages also can account for the pain and suffering endured by the mother and the baby.