What Is Shoulder Dystocia?
Shoulder dystocia is an obstetric emergency that occurs during vaginal delivery when the baby's head has been delivered but one or both shoulders become lodged behind the mother's pubic bone, preventing the rest of the body from being delivered. It is one of the most feared complications in obstetrics because it requires immediate, skilled intervention to prevent serious injury to the baby, and the time available for that intervention is extremely limited.
Shoulder dystocia occurs in approximately one to two percent of all vaginal deliveries, though the rate is higher in deliveries involving large babies, maternal diabetes, maternal obesity, post-term pregnancies, and prolonged labor. While not every case of shoulder dystocia results in injury, the complication creates a high-risk situation that requires the delivering physician to respond quickly and correctly using well-established protocols.
How Shoulder Dystocia Causes Erb's Palsy
Erb's palsy is a condition caused by damage to the brachial plexus, the network of nerves that runs from the spinal cord through the neck and into the arm. When shoulder dystocia occurs and the delivering physician applies excessive lateral traction to the baby's head in an attempt to free the trapped shoulder, the nerves of the brachial plexus can be stretched, compressed, or torn. The result is weakness or paralysis of the affected arm, ranging from temporary weakness that resolves within months to permanent paralysis requiring a lifetime of therapy, surgery, and adaptive assistance.
The severity of the nerve injury determines the prognosis. Neurapraxia, the mildest form, involves stretching of the nerve without tearing and typically resolves within three to six months. Neuroma involves more significant nerve damage with scar tissue formation and may require surgical intervention. Rupture involves tearing of the nerve that requires surgical nerve graft repair. Avulsion, the most severe form, involves the nerve being torn away from the spinal cord and is generally not surgically repairable.
The Standard of Care for Managing Shoulder Dystocia
Obstetricians are trained in specific maneuvers for resolving shoulder dystocia safely. The McRoberts maneuver, which involves sharply flexing the mother's thighs against her abdomen to change the angle of the pelvis, is typically the first-line intervention. Suprapubic pressure, applied by a nurse or assistant to push the baby's anterior shoulder downward and out from behind the pubic bone, is often used simultaneously. If these maneuvers are unsuccessful, additional techniques include the Rubin maneuver, delivery of the posterior arm, the Gaskin maneuver involving repositioning the mother onto hands and knees, and in extreme cases, the Zavanelli maneuver involving pushing the baby's head back into the birth canal for emergency cesarean delivery.
The critical point is that these maneuvers are designed to resolve the shoulder dystocia without applying excessive force to the baby's head and neck. The standard of care specifically prohibits the use of excessive lateral traction because of the known risk of brachial plexus injury. When a physician resorts to pulling forcefully on the baby's head rather than employing the trained maneuvers, and the baby suffers a brachial plexus injury as a result, that constitutes a breach of the standard of care.
Was the Shoulder Dystocia Foreseeable?
In some cases, the claim extends beyond the management of the shoulder dystocia itself to the question of whether the physician should have anticipated the complication and offered a cesarean delivery instead. Known risk factors for shoulder dystocia include estimated fetal weight above 4,500 grams in non-diabetic mothers and above 4,000 grams in diabetic mothers, prior shoulder dystocia in a previous delivery, maternal gestational diabetes, and maternal obesity.
When multiple risk factors are present and the physician fails to discuss the option of cesarean delivery with the mother, or fails to document a thorough informed consent discussion about the risks of vaginal delivery, the physician's decision to proceed with vaginal delivery may itself constitute negligence if shoulder dystocia occurs and the baby is injured.
Documenting the Injury and Building the Case
Erb's palsy cases require detailed analysis of the prenatal records to identify risk factors that should have been recognized, the labor and delivery records to evaluate the management of the shoulder dystocia, and the newborn's medical records to document the extent of the nerve injury and the treatment provided. Expert testimony from an obstetrician specializing in high-risk deliveries establishes the standard of care and identifies the specific deviations. A pediatric neurologist documents the extent and permanence of the nerve injury. A life care planner projects the cost of therapy, surgery, and adaptive equipment the child will need throughout their life.
Recovery and Prognosis
The prognosis for children with Erb's palsy depends on the severity of the nerve injury. Children with milder injuries involving nerve stretching without tearing often recover significant function within the first few months of life, particularly with early physical therapy intervention. Children with more severe injuries involving nerve rupture or avulsion may have permanent limitations in the affected arm, including reduced range of motion, grip strength, and fine motor control. Some children require nerve graft surgery, tendon transfer procedures, or other orthopedic interventions to maximize function.
Regardless of the severity, affected children benefit from early and consistent physical and occupational therapy. The cost of this therapy, along with any surgical interventions and adaptive equipment needed, is a recoverable component of damages in a birth injury claim. Our attorneys ensure that these future costs are thoroughly documented and included in every damages calculation.
Getting Answers
If your child was diagnosed with Erb's palsy or another brachial plexus injury following a delivery complicated by shoulder dystocia, our Tampa birth injury attorneys can review the delivery records, consult with obstetric and neurological experts, and determine whether the injury was caused by preventable medical negligence. The evaluation is free and confidential, and there is no obligation to proceed.