Shoulder Dystocia

Shoulder dystocia is an obstetric emergency which occurs during fetal delivery. It has the potential to severely injure both mother and child. It describes a situation where the fetal head has been delivered but the shoulders have become stuck behind the mother's pelvic bone. Most shoulder dystocia situations are diagnosed when the baby's head delivers but the shoulders do not follow. If a shoulder dystocia occurs, any amount of traction placed on the baby's head can cause severe nerve injury. Shoulder dystocia is one of the most difficult obstacles that can occur during delivery, because it carries with it the potential for high risk complications.

Among the most common (and serious) shoulder dystocia injuries is a form of nerve damage known as Erb's Palsy. This results when a shoulder dystocia condition is mishandled, resulting in damage to the nerves connecting the neck and arm. These nerves are reffered to as the  "brachial plexus nerves" and emerge from the spinal cord, travel across the shoulder, along the arms, into the hand and ultimately, to the fingers tips. The injury which results to these nerves range from a stretching to a complete rupture, causing the shoulder dystocia victim to suffer a potentially permanent paralysis of the arm.

There are four major types of nerve injuries which can result from a shoulder dystocia:

• an avulsion meaning the nerve is torn from the spine.
• a rupture meaning the nerve is torn but not where it attaches to the spine.
• a neuroma meaning the nerve has tried to heal but scar tissue has grown around the injury placing pressure on the injured nerve praxis. While the nerve has been damaged, it has not been torn and improvement should be seen within 3 months.
• Neuropraxia is the mildest form of a nerve injury. Neuropraxia, the most common form of Erb's palsy is localized to the specific place where the injury occurs. It is a physiologic block of nerve conduction within an axon without any anatomical interruption. Many infants born with brachial plexus palsy have neuropraxia and sometimes recover within 4-6 weeks.

A properly trained obstetrician will identify any shoulder dystocia risks and take steps to avoid injury during the delivery. Increased risks of shoulder dystocia are linked to high birth-weight babies, obese mothers, and a long second stage of labor. Shoulder dystocia can be prevented by scheduling a caesarean section for high-risk mothers, and if shoulder dystocia occurs during birth, sixteen different maneuvers can free the trapped shoulder, ensuring safe delivery. Shoulder dystocia is a serious situation, but does not have to result in injury.

Unfortunately, medical mistakes do occur and in the case of shoulder dystocia, the mistakes can be lasting with conditions such as Erb's Palsy. If injuries have been suffered due to shoulder dystocia because of inadequate care, contact us and we will be able to review the case and determine if a shoulder dystocia claim is present.