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Shoulder Dystocia Injuries - Maryland Injury Lawyers Blog

Posted on behalf of Goldberg Finnegan, LLC on Jan 30, 2012 in Medical Malpractice

The medical malpractice department at Goldberg Finnegan handles a wide variety of cases. One of the types of cases they handle are when a baby is diagnosed with a permanent shoulder dystocia injury. A shoulder dystocia injury affects the nerves and causes permanent or partial paralysis the arm, hand or fingers. It occurs where, during delivery, the baby's head emerges but the shoulder is stuck behind the mother's pubic bone. In most cases the obstetrician or midwife can remedy the situation through one or more quick and standard maneuvers. However, when those maneuvers are not done correctly, many different birth injuries could result. The most immediately concerning injury is lack of oxygen to the baby's brain-with the pressure of labor exerted on the neck and body for a sustained amount of the time, the child could develop permanent neurological injuries that could lead to cerebral palsy.

The other problem is an injury to the baby's shoulder nerves when the obstetrician or midwife attempts to complete the delivery. Treated incorrectly, the baby may suffer from Erb's palsy or a brachial plexus injury.

Anatomy
The brachial plexus is a series of nerves that run from the spinal column to the hand, arm, shoulder and neck. It is divided into roots, trunks, divisions, cords and branches. Injury at different areas of the brachial plexus will result in differing levels of disability.

Risk Factors for Shoulder Dystocia
Doctors, nurses and midwives should be prepared to encounter shoulder dystocia with all of their patients; however, there are several risk factors that increase the likelihood. These include a large baby and/or small mother, gestational diabetes, obese mother, mother with a small pelvis, and a prior pregnancy involving shoulder dystocia. These injuries may also occur when forceps or vacuums are used for delivery.

Causes of Shoulder Dystocia Injuries
Shoulder dystocia injuries are often caused by health care providers who panic when the baby gets stuck in the birth canal. It is entirely foreseeable that obstetricians and midwives will encounter this situation, so they should be able to perform the proper delivery techniques in a timely and appropriate manner. Instead, some of them ignore their training and pull, twist or tug on the baby improperly to try to free him from the birth canal. Because of that motion, the nerves in a baby's shoulder may be severely or even irreparably damaged. Damage may occur in four ways:

  • Avulsion: the nerve root is ripped out of the spine
  • Rupture: the nerve is torn but is still attached to the spine
  • Neuroma: a torn nerve heals incorrectly and with scar tissue
  • Neuropraxia: the nerve is stretched, though not torn

Proper Delivery Techniques

  1. Health care provider should reposition mother's legs during delivery to widen the birth canal (called the McRobert's maneuver)
  2. Health care provider should apply gentle pressure to mother's lower stomach (suprapubic pressure)
  3. Health care provider can try to gently turn the baby inside the birth canal (rotational maneuvers)
  4. Health care provider can break the child's clavicle or collar bone
  5. Health care provider can perform an emergency cesarean section

Life-Long Effects of Shoulder Dystocia Injuries
Shoulder dystocia can cause a range of nerve injuries for the baby. The most serious is complete paralysis of the arm. Other types of nerve injuries include Erb's palsy, where victims lose movement of their arms below the elbow, and their arms stay close to the body with the palm facing backward. Klumpke's palsy is the paralysis of the fingers or hands.

Treatment
Ten percent of these nerve injuries may resolve or may improve within six months of birth. In some cases, therapy or extremely expensive surgery can resolve the injury. However, these injuries can be permanent and have lasting effects on the child's quality of life.

Contact Us
If you or a loved one has suffered a shoulder dystocia injury at birth, contact us at 1.888.213.8140.

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