Shoulder Dystocia is an obstetric emergency associated with the potential to injure both mother and child. It occurs when the baby’s anterior shoulder becomes trapped behind the mother’s pubic bone and the baby cannot come out of the birth canal. It is diagnosed when the infant’s head delivers but the shoulders and body fail to follow. Even the slightest traction on the baby’s head can cause injury to the brachial plexus, which is the bundle nerves that controls the arm. This nerve injury to a baby’s arm is called Erb’s Palsy and can vary in severity from slight stretching of the nerves causing weakness to rupture of the nerves causing complete arm paralysis. If the obstetrician recognizes the risk factors prior to the commencement of labor and/or properly manages the delivery when Shoulder Dystocia occurs, injury is avoided.
These risk factors for Shoulder Dystocia include: a previous delivery of a baby weighing over 4000 grams; a history of prior child who had Shoulder Dystocia; maternal and/or gestational diabetes; Estimated Fetal Weight (EFW) over 4,000 grams (macrosomia); maternal obesity; gestational age over 41 weeks; and a second stage of labor that lasts for more than two hours. An obstetrician can identify those patients at risk by taking a careful history from the mother about prior deliveries and birth weights, by performing ultrasound evaluation on all patients at risk for macrosomia to estimate fetal weight, and by testing for gestational diabetes with a glucose tolerance test.
The way obstetricians can prevent injury to patients at risk for Shoulder Dystocia are to (1) perform a prophylactic cesarean section for non-diabetic mothers whose fetuses have an EFW over 4500 grams and to perform a prophylactic cesarean section for diabetic mothers whose fetuses have an EFW over 4000 grams, and (2) follow a structured and practiced “plan or drill” for the management of Shoulder Dystocia if it occurs unexpectedly during delivery. The most important factor in the initial management of Shoulder Dystocia is for the operator to immediately remove his or her hands from the fetal head as soon as the diagnosis is made and to not pull on the fetal head and neck until the baby’s shoulder is unstuck and freely able to exit and deliver vaginally. There are approximately sixteen different obstetrical maneuvers that can free the anterior shoulder so the baby can be safely delivered. Proper use of these maneuvers can prevent the traction on the fetal head that injures the brachial plexus and causes Erb’s Palsy.
Doctors can negligently cause an Erb’s Palsy injury by failing to perform appropriate prenatal testing to identify patients at risk for shoulder Dystocia thereby avoiding a vaginal delivery or, when it occurs during birth, by failing to utilize appropriate maneuvers to dislodge the anterior shoulder before continuing the vaginal delivery. It is the excessive traction to the baby’s head and neck by the obstetrician that causes the injury to the brachial plexus.
To discuss your suspected medical malpractice birth injury contact a New Jersey medical malpractice lawyer at Andres & Berger P.C., for a free consultation.
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