Obstetrics is filled with high-risk situations. Shoulder dystocia is a fetal condition that may occur when the infant’s head is outside of the body, but his or her shoulder cannot pass through the birth canal. The person performing the delivery has to use specific techniques to help the infant’s shoulder get out of the body. This is an obstetrical emergency because the infant can die during the delivery due to compression of the umbilical cord and loss of blood flow and oxygen. In some cases, the infant may suffer severe and crippling damage to the nerves that pass through the shoulder and provide sensation and motor function to the arm, forearm, and hand.

Shoulder dystocia case
A woman from Oregon gave birth to her third child in 1999. Although that child was large and her delivery was complicated by shoulder dystocia, the physician did not tell the mother of this problem. The baby did not suffer any injuries from the delivery. When the mother became pregnant with her fourth child, a different obstetrician was aware of the shoulder dystocia but did not discuss the risk of another shoulder dystocia situation or the possibility of having a cesarean section due to the increased risk. This doctor was not available when the patient went into labor, and the on-call physician did not have medical records that detailed the previous shoulder dystocia or the clinical tests that indicated the fourth fetus was large. The patient was still unaware of the prior shoulder dystocia event. A shoulder dystocia occurred during the delivery of the fourth child which resulted in damage to the child. The infant had a limited range of motion of his right arm. The jury gave an award of $1.9 million in this 2014 case. (1)

How shoulder dystocia happens
What do we learn from this case? There are actions by healthcare providers that contribute to shoulder dystocia. Not telling the mother her third child had shoulder dystocia prevented her from telling a physician unfamiliar with her about the problem. Here are other factors.

• Failure to take into account the risk factors for shoulder dystocia (a large infant, a diabetic mother, a history of having a previous infant with shoulder dystocia)

• Failure to recognize the risk of shoulder dystocia and to perform a cesarean section

• Allowing a woman with a suspected large fetus to be pregnant for more than one week past her due date
• Damage to the nerves from improper delivery technique

Experts needed for a shoulder dystocia case

• obstetrician
• pediatric neurologist (for permanency)

See other blog posts on this subject: Part 1, Failure to recognize the fetus is in distress, and Part 2, Delay in performing cesarean sections. Part 4 focuses on prevention.

(1) Bobbi Klutschkowski and Kevin Klutschkowski, personally and as GAL for Braedon Klutschkowski, a minor v. Peacehealth, Amy McCarthy et al, Lane County (OR) District Court, Case No. 160615518

Med League supplies well qualified obstetrical expert witnesses as well as experts for other types of medical malpractice cases. Contact us for help with your next case.