The experienced birth injury attorneys of Passen & Powell have seen all types of birth injury cases, from brain injuries and cerebral palsy to direct physical trauma. The causes of birth injury can vary widely, but one of the most dramatic and frightening causes is the occurrence of shoulder dystocia during childbirth.
Shoulder dystocia is a technical-sounding term for a simple concept: during delivery, an infant’s shoulder “impacts,” or becomes stuck on, a portion of the mother’s pelvic region.
Shoulder dystocia at birth can have profound effects on both the infant and the mother. In 11 percent of shoulder dystocia cases, the mother experiences postpartum hemorrhage, at times severe. And 3.8 percent of mothers in shoulder dystocia cases suffer fourth-degree lacerations from childbirth, the most severe form of tearing, involving perineal muscles anus, and the muscles lining the rectum (and usually needing surgical repair). It is important to note that neither hemorrhage nor lacerations are prevented by the maneuvers designed to allow for natural birth.
In infants, shoulder dystocia can lead to a variety of birth injuries. The single most common effect in infants is brachial plexus palsy, a condition wherein the infant suffers injury to the network of nerves that conducts signals from the spine to the shoulder, arm, and hand. Brachial plexus palsy occurs in between four and fifteen percent of shoulder dystocia cases. Infants who suffer bracial plexus palsy from shoulder dystocia, like other infants who suffer bracial plexus palsy, can often recover. Up to ten percent of such cases, however, result in permanent injury or disability.
There are several risk factors associated with shoulder dystocia. First and foremost, in deliveries in which forceps or vacuum extraction has been tried without success, the infant is most likely to experience shoulder dystocia. Diabetes, whether gestational or preexisting, is another important risk factor for shoulder dystocia. A maternal pelvic anomaly, although rare, is also a risk factor.
Likewise, the infant’s birth weight is an important risk factor. When considering only infants born to mothers without diabetes, infants weighing between 5 pounds, 8 ounces (or 2,500 grams) and 8 pounds, 13 ounces (or 4,000 grams) have a shoulder dystocia rate of only .6 to 1.4 percent. In infants weighing between 8 pounds, 13 ounces and 9 pounds, 14 ounces, however, the shoulder dystocia rate increases to 5 to 9 percent.
In spite of the data demonstrating the risk factors for shoulder dystocia, physicians and delivery staff continue to be caught by surprise when this complication occurs. Because many cases of shoulder dystocia occur “with no warning,” physicians generally downplay the utility of planning for this contingency. Recognizing risk factors for this frightening and potentially disastrous occurrence, however, can enable obstetricians to respond quickly and effectively.
Physicians who act appropriately can take actions to minimize the effects of shoulder dystocia. There are, in fact, multiple procedures that can be used to manage dystocia when it occurs. Physicians can attempt the McRoberts maneuver (hyperflexing the mother’s legs to her abdomen in order to widen the pelvis), apply suprapubic pressure, rotate the infant internally, or deliver the posterier arm to reposition the infant, and collapse the infant’s shoulder width. Any of these techniques can allow for natural delivery of the child. Physicians can also attempt to enlarge the mother’s pelvis through rotation or flattening.
In extreme cases, however, none of these maneuvers will enable delivery. In such cases, physicians will at times resort to extreme measures, including intentionally breaking the infant’s shoulder, symphysiotomy (dividing the cartilage of the pubic symphysis) and the Zavanelli maneuver (pushing the baby’s delivered head back into the birth canal so that a c-section can be performed).
Preparing for the possibility that shoulder dystocia will occur is an important first step in preventing extreme measures, and extreme injuries. Becoming aware of the risk factors will enable obstetricians to prepare, respond rapidly, and, when necessary, opt for a caesarian section instead of natural delivery. Our birth injury attorneys urge physicians, and hospitals, to pay attention to the risk factors and to prepare for shoulder dystocia whenever possible.
For a free consultation with an experienced Chicago birth injury lawyer at Passen & Powell, call us at (312) 527-4500.