What is shoulder dystocia?
Shoulder dystocia occurs when a baby’s head has been delivered but one of the shoulders becomes stuck behind the mother’s pubic bone, delaying the birth of the baby’s body. If this happens, intervention will usually be needed to release the baby’s shoulder. In most cases, such intervention will enable the baby to be born promptly and safely. However, sometimes, injury can occur and when it does it is usually serious and long standing. In some cases, such injury is preventable and would give rise to a claim for compensation.
How can injury occur?
Usually, shoulder dystocia occurs unexpectedly during childbirth and so it is difficult to predict when it will happen. However, certain risk factors increase the likelihood of shoulder dystocia occurring:
- a previous history of shoulder dystocia
- maternal diabetes
- maternal body mass index (BMI) of 30 or more
- induction of labour
- prolonged labour – in either first or second stage
- labour that is an assisted vaginal birth (ie the use of forceps or ventouse)
- large birth-weight baby
Shoulder dystocia is a medical emergency and once identified must be acted upon and dealt with as quickly as possible to prevent long-term injury. It is imperative that the baby’s shoulder is released so that the baby can begin to breathe. Certain manoeuvres must be performed in order to release the shoulder swiftly. If these are unsuccessful, surgery may have to be performed but such surgery is complicated and difficult.
What injuries can occur?
There can be significant perinatal morbidity and mortality associated with the condition.
For the mother, the incidence of postpartum haemorrhage and/or third and fourth-degree perineal (vaginal) tears is significantly increased. Postpartum haemorrhage is a medical emergency. Perineal tears could include a tear that extends to the mother’s back passage potentially causing debilitating and long-term injury.
For the baby, the nerves of the neck can be excessively stretched causing a brachial plexus injury. This can range from a mild injury to a more severely debilitating one, causing permanent loss of function. In extreme cases, the baby may suffer neurological injury caused by receiving inadequate oxygen during delivery. Sadly, neonatal death can also occur.
Medical negligence associated with shoulder dystocia could include:
- Not acting upon the diagnosis of shoulder dystocia quickly enough;
- Failing to detect the problem, causing a delay in diagnosis;
- Incorrect management of the dystocia – examples can include the use of excessive force and/or inappropriate use of traction and/or inappropriate use of the manoeuvres to treat the dystocia;
- Failing to appropriately assess the mother in advance of labour to determine the risk of shoulder dystocia occurring e.g. obesity, maternal diabetes, gestational diabetes, previous birth involving this condition.
- Failing to assess the health and development of the baby to determine the risk of shoulder dystocia occurring e.g., large size, wide frame;
- The failure to plan for a potential shoulder dystocia delivery by offering the mother an induction or elective C-section;
- Carrying out unnecessary medical intervention when attempting to dislodge the shoulder e.g. performing an episiotomy when one was not required.
- Mismanagement of episiotomy.
Comment
At Nelsons we have a team of expert clinical negligence lawyers who are skilled in the assessment of claims for compensation involving any sort of obstetric injury including shoulder dystocia. If you or someone you know has been affected by the condition and wish to consider a claim for compensation, please get in touch with us so we can assess your claim and advise you on how best to proceed.
How can Nelsons help
Carolle White is a Legal Director and Chartered Legal Executive in our expert Medical Negligence team, which is ranked in Tier One by the independently researched publication, The Legal 500, and Commended in The Times Best Law Firms 2024. Carolle specialises in high-value and complex medical negligence cases and inquests.
If you require any advice in relation to the subjects discussed in this article, please do not hesitate to contact Carolle or another member of the team in Derby, Leicester, or Nottingham on 0800 024 1976 or via our online enquiry form.
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