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Shoulder Dystocia Explained

Steve Wagner

Shoulder dystocia is defined as a difficulty in birth that happens when the anterior shoulder of the baby gets stuck behind one of the mother’s pelvic bones during normal vaginal delivery. In a year, shoulder dystocia is experienced by more than 20,000 women during delivery in the United States and gives rise to a host of health problems to both the mother and the baby. In fact, shoulder dystocia is considered as a medical emergency as fetal death can occur due to compression of the umbilical cord.

The most common complication resulting from shoulder dystocia is brachial palsy, which occurs in about 20% of shoulder dystocia infants with about 10% resulting in permanent injury and dysfunction. In other words, about 400 babies are born each year in the U.S. with permanent brachial plexus injury due to shoulder dystocia deliveries. Other complications that can occur to the baby are fracture of the clavicle or humerus, Erb’s palsy, and contusions or bruises to the baby’s body, most occurring as a result of forced extraction. The most feared complication is fetal hypoxia (caused from cord compression and a lack of oxygen) leading to irreversible neurological damage and sometimes even death. For the mother the complications include excessive blood loss, lacerations of the vagina and rectum, uterine rupture, and post-natal depression.

There are several ways the risk for shoulder dystocia can be increased. These are:

  1. Fetal macrosomia: Fetal macrosomia or a clinically large fetus is by far the biggest risk factor for shoulder dystocia. The vast majority of dystocia cases occur in babies with an excessively large birth weight. More often than not, the large birth weight can be attributed to Gestational Diabetes in the mother. In fact, there is a fourfold increase in the risk of suffering a shoulder dystocia if you have GS.
  2. Induction, labor augmentation and instrumental delivery: All of these things, while sometimes necessary, tend to be drastically overused in the labor and delivery wards of our American hospitals. Having your birth interfered with by drugs or instrumentation often interferes with the natural process of the fetus’ descent into the birth canal. If interfered with, baby’s position can become misaligned, increasing the risk of shoulder dystocia.
  3. Maternal obesity: Shoulder dystocia occurs three times more often in obese or overweight women. If a mother gains excessive weight during pregnancy or is obese, it is likely that her birth will be more difficult, put more stress on her body, and can subsequently stress the baby.
  4. Birth Position: Lying flat on your back to deliver can significantly increase your risk of shoulder dystocia because it works against the natural flow of gravity in birth. When the mother lies flat on her back, the baby has to be pushed up through the birth canal, rather than an easier, downward position. The stress of pushing up can cause a malposition in the baby and sometimes cause a dystocia. Many hospitals encourage mothers to lie flat on their backs in the beds because it is easier to keep them on the monitors and much simpler for the doctors who are delivering the babies.
  5. Previous shoulder dystocia: There is a 15% chance of shoulder dystocia recurring if it has happened in a previous delivery. Once a shoulder dystocia has occurred, pursuing vaginal delivery again is possible, but options should be researched for ways to avoid this complication.

Shoulder dystocia is one of the most feared complications of a normal vaginal delivery. If you think that you or your infant has suffered due to medical negligence, then do not hesitate to contact one of our shoulder dystocia attorneys today. Our experienced team of personal injury lawyers can help you make up for your financial losses, however unique the medico-legal aspects of your case may be, by bringing your claims to justice.

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