An arm injury occurring at the time of a baby’s delivery is grounds for a common type of medical negligence claim in Ohio. “Shoulder dystocia” is the term used to describe when a baby’s shoulder gets stuck behind the mother’s pubic bone at the time of delivery. If the obstetrician, family practice physician or midwife applies excessive traction in the setting of a shoulder dystocia, severe nerve damage can render the arm functionally useless or impose other permanent limitations on use. Various types of arm injuries can result depending on the nature and extent of the nerve damage, including Erb’s palsy and Klumpke’s palsy.
The American Academy of Family Physicians (AAFP) reports that shoulder dystocia occurs in up to 1% of pregnancies where the infant weighs less than 8 lbs., 13 oz., and in up to 9% of pregnancies where the infant weighs 9 lbs., 14 oz. or greater at the time of delivery. Nerve damage occurs in 4 to 15% of deliveries where a shoulder dystocia is encountered, making it one of the most common birth injuries. Most of those nerve injuries resolve within 12 months. However, in as many as 9% of those cases, a permanent arm injury results from the nerve damage.
A permanently damaged arm can have devastating consequences, impacting the ability to earn a living, limiting the ability to perform many common activities and resulting in loss of independence, emotional trauma and throbbing pain. Further, when severe, this birth injury can require multiple surgeries to maximize use and hours of expensive physical therapy.
When investigating a potential medical malpractice claim arising out of an arm injury following a shoulder dystocia, Mishkind Kulwicki Law’s experienced nurse legal consultants ask several questions. First, did the caregiver explain delivery options to a patient who was at increased risk for a shoulder dystocia? Risk factors include abnormal pelvic anatomy, gestational diabetes, post-dates pregnancy, shoulder dystocia in prior pregnancy, estimated excessive fetal birth weight (macrosomia), delivery assisted with forceps or vacuum, and excessive time for certain key phases of labor.
Second, was the physician or midwife adequately trained to handle a shoulder dystocia? Shoulder dystocia is a medical emergency that requires planning and practice. The caregiver has only minutes to relieve the dystocia before permanent brain injury or death occurs. An important medical study shows that practitioners who participate in training drills are better equipped to respond to such an emergency.
Finally, based on a careful review of the records and interviews with the mom and others who observed the delivery, did the caregiver undertake appropriate efforts to relieve the shoulder dystocia once it was encountered? The practitioner is usually alerted to the shoulder dystocia by what is called the “turtle sign,” where the baby’s head retracts into the vaginal canal. At this point, according to the AAFP, “
Instead, practitioners should employ one or more steps designed to free the stuck shoulder and safely deliver the baby. These steps, sometimes denoted by the acronym HELPERR, include call for Help, evaluate for Episiotomy, draw Legs into the McRoberts position (towards the chest), apply suprapubic Pressure, Enter maneuvers to attempt to rotate the baby, Remove the posterior arm, and Roll the patient. More extreme maneuvers are also available. Panicking, applying excessive traction and/or failing to timely and properly perform the steps necessary to relieve a dystocia are grounds for a medical negligence claim.
