Shoulder dystocia, when a baby’s shoulder becomes lodged behind the mother’s pubic bone during delivery, is a recognized obstetric emergency. It is also one that physicians are specifically trained to handle.
Typically, doctors perform a series of maneuvers in a specific progression when handling a case of shoulder dystocia. At no point in this progression should excessive force be used. In other words, a doctor should not forcibly remove the baby by pulling excessively on the head and neck.
Using excessive force during labor and delivery can cause, life-altering injuries to both the newborn and mother. One injury that could be caused by mishandling a delivery includes Erb’s Palsy. Erb’s Palsy is an arm paralysis caused by damage to the upper brachial plexus nerves
In this case, when our client’s baby’s shoulder became stuck, the physician did not rely on proper maneuvers. The doctor used excessive force on the baby’s head and neck, tearing five of the baby’s spinal nerves. The mother was injured too, suffering a severe fourth-degree laceration, the most serious type of vaginal tear.
Both were left with lasting pain, disfigurement, and emotional trauma from a delivery that should have been routine. The Townsley Law Firm represented the family and recovered over $1,500,000 in a settlement.
Shoulder Dystocia Has a Playbook. It Was Not Followed.
The defining fact of this case is that the emergency the physician faced was one with a known, well-rehearsed response. When a baby’s shoulder becomes impacted during delivery, the standard of care calls for a series of four maneuvers.
The first maneuver requires repositioning the mother to flatten and rotate the pelvis, increasing the pelvic opening. The second involves an assistant applying downward and lateral pressure just above the mother’s pubic bone to dislodge the impacted anterior shoulder from behind the pubic symphysis. The two maneuvers are successful, if performed correctly, in dislodging almost all shoulder dystocias.
If the first two techniques fail, a clinician reaches inside to rotate the baby’s shoulders, following a pushing and sweeping motion of the anterior and posterior shoulders.
None of these techniques require repeated, excessive force to deliver the baby. All these techniques are designed and practiced to open space and free the shoulder without applying dangerous traction, something the standard of care specifically warns against.
Excessive downward force on the baby’s head to pull the baby free should never be the method a clinician uses in delivery. That kind of traction stretches and can tear the brachial plexus, the network of nerves running from the spine through the neck and into the arm. When those nerves are torn, the muscles they control are left weak or paralyzed.
The physician’s choice to pull too hard rather than perform the proper maneuvers is the heart of the negligence found in this case. This was not an unavoidable complication of a difficult birth.
Two Patients, Two Injuries
The Baby: Permanent Erb’s Palsy
Erb’s Palsy is a form of brachial plexus injury affecting the nerves that control the shoulder and arm. Tearing five spinal nerves, as happened here, is a severe injury. Depending on the extent of the damage, a child with Erb’s Palsy may have limited movement, weakness, or partial paralysis of the affected arm, and may face a lifetime of physical therapy and, in some cases, reconstructive surgery. When the nerves are torn rather than merely stretched, the damage is often permanent.
For a newborn, this is an injury that will shape physical development, function, and daily life for years to come. In this case, the baby did not regain any function in her upper right extremity over the first seven months. She also underwent four surgical procedures to try and repair damage. In this case, our client was left with permanent and severe neurological deficiencies, which have dramatically affected the function of her right arm.
The Mother: A Fourth-Degree Laceration
A fourth-degree laceration is the most severe category of perineal tear that can occur during childbirth, extending through the tissues all the way into the anal sphincter and rectal lining. These injuries are serious, painful, and can lead to lasting complications including chronic pain, incontinence, and the need for surgical repair. Alongside the physical injury, the mother was left with disfigurement and emotional trauma from the delivery of her first-born child.
Both mother and baby carried lasting harm out of a single delivery that was mishandled in the critical moments when it mattered most.
