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Shoulder Dystocia

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Continuing with my review of different types of birth injuries, this blog looks at shoulder dystocia.

What is Shoulder Dystocia?

Shoulder dystocia occurs when a baby’s shoulders become stuck on their mother’s pubic bone during labour, after the head is delivered.  In normal deliveries, after the head is delivered, both the head and body will turn sideways so that the baby’s shoulders can pass through the pelvis; however,    if the baby is large, not in the best position or the mother’s pelvis is small, shoulder dystocia may occur.

How to detect and deal with Shoulder Dystocia? 

Doctors and midwives should be alert to the risk of shoulder dystocia, especially if the risk factors mentioned earlier are apparent.  The obvious symptom is that the baby’s delivery is not progressing as it should; in particular, where the baby seems to be progressing and then retracting in the birth canal.  A red puffy face may also be an indicator that the baby is stuck.

In these circumstances, the medical staff need to act quickly to prevent any long term injury to baby.

Mum should be told to stop pushing, immediately.  Additional medical professionals may be summoned to assist and Mum may be put into a different birth position; for example, with assistance from the medical staff, knees bent and legs pulled up as high as possible.   Pressure may also be applied to Mum’s tummy (above the pubic bone) to help release the baby’s stuck shoulder.

These measures commonly resolve the situation.  If not, the baby’s position may need to be physically manipulated (by hand) and an episiotomy may be needed to physically assist the baby out.

If these measures do not work, other emergency measures may be required.  For example, an experienced doctor may need to break the baby’s collar bone or a caesarean section may be needed.

Shoulder Dystocia Injuries?

If the baby is not delivered quickly, as a result of shoulder dystocia, it may suffer from oxygen deprivation.  This is because, at this stage of the delivery, the umbilical cord is squashed alongside the baby in the birth canal meaning that less oxygenated blood reaches them.

Shoulder dystocia often causes injury to the baby’s nerves, particularly, the brachial plexus nerves which supply the sensory and motor components of the shoulder, arm and the hands.  This type of injury is more commonly known as Erb’s palsy  The reason for this type of injury is not known, but it is thought that the stretching of the nerves and, in extreme cases, tearing of the nerves is caused by the force of the contractions and, if applicable, physical application of pressure by medical staff.

Clinical Negligence Claims

Clinical negligence claims in this area focus on whether the medical staff correctly identified the risk and symptoms of shoulder dystocia and how the delivery was managed thereafter.  Sadly, despite comprehensive training, shoulder dystocia is not always identified by healthcare professionals and, in these circumstances, attempting to deliver a baby in a routine manner by pulling can cause severe injury.  The level of compensation for injuries sustained because of a failure to properly manage  shoulder dystocia is often in the hundreds of thousands of pounds.

If you think you, or your child, may have suffered an injury as a result of negligent medical treatment and would like to speak with a member of the Lester Morrill clinical negligence team, please call on 0113 245 8549 or contact us by email at help@lmlaw.co.uk .

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