What you need to know about shoulder dystocia
29/06/20 | Birth Injuries
Any form of birth injury can be a traumatic experience for both mother and baby. In many cases, the signs or symptoms can be identified during antenatal care, helping prepare the medical professionals involved for any complications. For an injury like shoulder dystocia, this is more of a challenge.
While shoulder dystocia only affects approximately 1 in 150-200 births, the difficulty in predicting or preventing it makes speed and precision of the essence in protecting the wellbeing of the infant and the mother. In the majority of cases, this is well-executed by highly-trained professionals, with no long-term repercussions.
However, in certain cases, the injuries caused by shoulder dystocia can have long-term effects for the baby in particular, and sometimes this can be the result of a negligent delay or inappropriate actions by healthcare providers.
Here, we will discuss what shoulder dystocia is, the risk factors that make it more likely, how medical professionals should respond to it and the implications it can have for both mothers and their newborn babies.
What is shoulder dystocia?
Shoulder dystocia is when one or both of the baby’s shoulders gets stuck during birth, typically against the pelvis of the mother. One indicator of this is the “turtle sign”, which is when the baby’s head appears out of the birth canal, but then retreats back in shortly afterwards.
When shoulder dystocia occurs, speed is of the essence, as quick action will be essential to free the baby’s shoulder, minimising the risk of long-term damage to their arm or neck and preventing sustained oxygen deprivation.
As this is a fairly common form of birth trauma (estimated to affect between 0.2% and 3% of all vaginal births), obstetricians, midwives and other medical professionals should be well-trained in the necessary steps to reduce the risks involved with shoulder dystocia.
What causes shoulder dystocia?
Unfortunately, there are little-to-no signs of shoulder dystocia prior to birth, making it virtually impossible to predict whether it will happen in advance, or to prevent it from happening before or during birth. That is why a rapid response is critical when it is identified.
However, there are some risk factors associated with shoulder dystocia that make it more likely to occur, which can be observed both during antenatal care and early in labour. These include:
- If shoulder dystocia occurred in previous deliveries (there is a reoccurrence in 1 in 6 births)
- The mother has diabetes
- The mother’s Body Mass Index (BMI) is 30+
- If labour is induced
- The mother receives an epidural
- Having either a notably short or notably long second stage of labour (this is the stage where mothers push and give birth)
- The delivery is assisted by the use of forceps or ventouse
Fundamentally, shoulder dystocia is when there is a disproportion of the size of the baby and the size of the mother’s pelvis. Therefore, if it is expected that the baby will weigh over 5kg, or over 4.5kg if the mother has diabetes, the mother could be offered an early induced labour or a Caesarean section, in order to reduce the risk of shoulder dystocia.
However, this does not mean that having a smaller baby makes shoulder dystocia significantly less likely, as around 1 in 2 cases occurs in babies weighing less than 4kg.
How do medical professionals manage shoulder dystocia?
Obstetricians, midwives and other healthcare providers are highly trained in the management of birth injuries such as shoulder dystocia, and there are well-established actions they are expected to take when medical emergencies such as these occur.
These actions include:
- The McRoberts Manoeuvre – this is when the thighs of the mother are pushed outward and towards their chest, in order to widen the pelvis
- The Gaskin Manoeuvre – the mother is asked to position herself on all fours with an arched back, as this will widen the pelvis
- Suprapubic pressure – an attendant will attempt to manually dislodge the baby’s shoulder from against the mother’s pelvis, either by pressing down on their lower abdomen or, in more difficult circumstances, by placing their hand above the pubic bone and pushing the shoulder one side or the other
- Episiotomy – an incision may be made to enlarge the vaginal opening to ease the birth
- Asking the mother to stop pushing temporarily
These are among the most common and safest actions that are taken to manage shoulder dystocia noted during birth. In more extreme cases where there is no alternative, the medical professionals may also perform an emergency Caesarean section, or break the baby’s collarbone to release their shoulders.
These procedures may also require the involvement of multiple professionals, which can be intimidating to both the mother and their birthing partner. While this is to help ensure that the baby is born safely and promptly, when complications like shoulder dystocia occur, efforts should be made to explain what occurred to the mother for their peace of mind.
As noted, in the majority of these circumstances, the above techniques are performed swiftly and professionally, with little or no long-term harm affecting the mother or baby. However, if action is not taken as quickly as it should have been, this can result in significant harm to either patient, and the potential then for a claim to be made against the healthcare providers responsible.
What can be the short and long-term effects of shoulder dystocia?
While most cases of shoulder dystocia carry no long-term consequences for either the baby or the mother, this type of injury can carry significant risks, even if all reasonable actions are taken by the medical team at hand.
In around 10% of births complicated by shoulder dystocia, the baby will receive some degree of brachial plexus injury (BPI). BPI is when the nerves in a baby’s neck are stretched and damaged, which can result in a loss of movement in their arm. This can occur after only a small amount of force, making the margin of error for medical professional’s fairly small.
For this reason, Erb’s Palsy is a notable potential consequence of shoulder dystocia. This condition occurs when the nerves in the upper arm and shoulder area are significantly stretched resulting in reduced arm function and potentially total paralysis of the shoulder. In around 80% of cases, children born with Erb’s Palsy make a complete recovery in time, with 5% requiring surgery to repair the nerve damage.
However, for other children the harm can be permanent, leaving them with a significant disability for the remainder of their life. This can require the need for regular treatment throughout their life, adaptations being made to their home environment, and the emotional hardship of not being able to participate in certain physical activities like riding a bike.
As well as Erb’s Palsy and other forms of BPI, shoulder dystocia can also result in the baby suffering:
- Fractures of the arm or shoulder, which in most cases will heal in time
- Contusions and bruising of their arm, shoulder or neck
- Oxygen starvation during birth due to being stuck for an extended time in the birth canal – in moderate to severe cases, this can result in serious brain injury and potentially death
In addition, the mother may also suffer additional harm following shoulder dystocia, including:
- Vaginal tearing or tearing of the perineum
- Postpartum haemorrhage (heavier bleeding during and following birth, which may require surgery or a blood transfusion)
- Uterine rupture (where the uterus tears during labour)
Given the significant short and long-term effects which may follow from shoulder dystocia, if it is determined that these consequences are the result of an act of negligence, it is essential to reach out to a specialist medical negligence solicitor to investigate your case and help you to obtain the appropriate amount of compensation.
Negligence leading to or following shoulder dystocia
Hopefully the information above has helped you understand shoulder dystocia better and how medical professionals approach treating it. Due to the swift response and expertise of doctors, obstetricians, midwives and other specialists, this more often than not minimises the impact this condition has on both mother and baby.
Sadly though, this is not always the case. Although the best efforts cannot always prevent shoulder dystocia from having a long-term impact on a newborn, the impact can also be as a result of negligence, be it a failure to identify the problem by the medical team in a reasonable time, or inappropriate force applied during any of the manoeuvres we highlighted earlier.
Any injury to a newborn baby can have life-changing implications for the whole family, and if this is due to a preventable mistake by a medical professional, we believe those affected should have access to compensation, answers and justice.
At Gadsby Wicks, we are true specialists in all forms of birth injury claim. We devote the time and resources required to fully understand and investigate your case, and lead negotiations on your behalf to ensure the best possible outcome for your family.
If you would like to discuss a potential claim, get in touch with our team today to discuss how we can help you.
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Always consult your GP if you are concerned about your health and wellbeing, or speak to us if you require legal advice.