Opinion: Heartbreak of Shoulder Dystocia Sometimes Requires Courtroom Wisdom

Shoulder dystocia, an emergency that can occur during delivery of a baby, sometimes leads to a heartbreaking outcome.

“Dystocia” means “obstructed childbirth.” Shoulder dystocia occurs when the head is delivered in a vaginal birth, but the shoulder fails to pass through in the normal manner.

“Shoulder dystocia can be one of the most frightening emergencies in the delivery room,” wrote doctors Elizabeth G. Baxley and Robert W. Gobbo (“Shoulder Dystocia,” American Family Physician, April 2004)

Shoulder dystocia does not always result in serious, permanent damage to mother or child. There are many delivery room procedures doctors can use to overcome the challenge of dystocia and complete delivery. Many times, those procedures result in a healthy mother and healthy baby.

Sadly, however, sometimes shoulder dystocia babies experience severe, permanent injuries. The most common complication is brachial plexus injury. The upper brachial plexus nerves control the shoulders, arms and hands. If the obstetrician rotates the baby’s head to facilitate delivery, those nerves can be stretched or torn. Even when a brachial plexus injury does occur, it will often heal without causing permanent damage. However, total permanent dysfunction of the shoulder, arm and hand is a possible outcome of brachial plexus injury due to shoulder dystocia.

Shoulder dystocia can also result in a baby’s death, if the umbilical cord is compressed within the birth canal for a lengthy period of time after the dystocia occurs.

I have reviewed some of the literature and have discovered that certain points are repeated religiously by the doctors who write on this subject. It is not possible for a doctor to predict or prevent shoulder dystocia, they say. There are inherent risks involved in all births, despite the best efforts of doctors and hospitals to minimize them, they also say.

However, when shoulder dystocia results in permanent injury or even death, in addition to asking whether the doctor could have predicted or prevented the dystocia, another fair question is whether the doctor and other delivery room personnel responded to the emergency in the best possible way. That is an extremely complicated question to answer.

• Did the doctor and hospital evaluate the risk factors of mother and fetus that increase the likelihood of shoulder dystocia?

• If the mother was obese and/or diabetic, was she advised of the increased risk and encouraged to lose weight and/or properly treat her diabetes?

• Were hospital personnel trained in responding to shoulder dystocia (e.g., were they drilled on the HELPERR and/or ALARMER mnemonics)?

• In the presence of increased risk factors, were the doctor and other personnel alert to the heightened risk and ready to respond quickly if an emergency occurred?

• Of the many delivery techniques that have been identified for shoulder dystocia, did the doctor use the techniques that were most appropriate for the circumstances?

• Did the doctor rotate the baby’s head in an attempt to complete delivery? If so, did he/she limit it to low to moderate traction in line with the axis of the fetal spine?

• Did the doctor use a vacuum extractor or forceps during delivery? The use of such equipment significantly increases the likelihood of a debilitating injury. Was the use justified?

Who can answer such questions? I certainly cannot. Can you? It is impossible for the typical parents of a permanently injured child to determine the answers to such questions.

That’s what makes dealing with shoulder dystocia so complicated and vexing. In many personal injury situations, such as a drunk driving accident or a manufacturer that knew its product was unsafe but marketed it anyway, it is clear who is to blame. However, in the case of permanent injuries or death due to shoulder dystocia, not only must parents deal with loss and heartbreak, but also with the unanswered questions.

To find answers, sometimes it is necessary to seek the wisdom of our justice system. With an attorney’s help, parents can obtain medical records from the doctor and hospital and have those records analyzed by experts on delivery room procedures. If that analysis raises questions about the care that was provided — such as failure to evaluate risk factors, failure to receive or provide training, failure to respond quickly, or failure to use the proper techniques — the information should be submitted to a judge and jury to reach objective conclusions.

A close bond can form between an obstetrician and expecting persons. Many doctors are outstanding professionals who provide their patients with the best possible treatment. Parents don’t want to consider the possibility that their doctor or hospital failed them. But they cannot simple ignore the devastating harms and losses they and their child have experienced. They need to know. They need answers.

The doctor, hospital, parents and child, as well as the attorneys on both sides, all have personal and emotional connections to such a case. Every one of them is human and capable of mistakes. In such situations, we present the facts to a judge and jury and rely upon the wisdom of the courts to provide the answers.

That wisdom is especially needed when complicated, heartbreaking shoulder dystocia has caused permanent injury or death.