Shoulder dystocia is an emergency that can happen during the end of the second stage of labor. It occurs when a baby’s head is delivered through the vagina but the shoulders get stuck inside the mother’s body. This creates risks for both mother and baby.
The major concern of shoulder dystocia is damage to the upper brachial plexus nerves. These supply the sensory and motor components of the shoulder, arm and hands. The damage happens when the nerves are stretched too much during birth. For nine in ten babies, brachial plexus damage gets better on its own but some babies have lasting damage.
There are two major types of brachial plexus injury – Erb palsy and Klumpke palsy. Erb palsy, the more common form of brachial plexus injury, affects the muscles of the upper arm and causes abnormal positioning of the scapula called “winging”. This results in a child having a humerus that is pulled in towards the body and internally rotated. Klumpke palsy involves lower lesions from nerve roots. In this injury, the elbow becomes flexed and the forearm opened up with palm upwards and a clawlike deformity of the hand. Sensation in the palm is diminished.
The incidence of shoulder dystocia rises with many factors including the size of the baby and maternal diabetes. The majority of brachial plexus injuries will resolve spontaneously over the course of several months to a year. Physical therapy is usually started within weeks of birth to help strengthen muscles where nerve supply has been damaged. For injuries that are permanent, there are two forms of therapy. Physical therapy can strengthen surrounding muscles to compensate for functional loss and improve the range of motion. Surgical therapy in the form of nerve grafting or muscle transposition may be undertaken. However, there is a lot of controversy as to these surgical procedures improving the outcome of those with brachial plexus injuries. Some orthopedic and neurosurgeons feel that there is little or no benefit to surgery.
A qualified obstetrician should be able to identify situations that raise the risk of shoulder dystocia and take steps to avoid it.
Our firm’s medical malpractice attorneys have been involved in numerous birth injury lawsuits for many years. If you or a loved one needs legal advice related to a birth injury, do not hesitate to call us at 609-641-6200.
As a partner with D'Arcy Johnson Day, Andrew D'Arcy has been involved in some of the nation’s most high-profile cases and investigations. His practice includes serious automobile accidents, medical malpractice, wrongful death and product defect cases. Andrew has been personally responsible for numerous multi-million dollar settlements and verdicts on behalf of his clients. He has been recognized by his peers as an "AV" rated attorney, the highest possible rating given by Martindale-Hubbell publication. Andrew has been named a "Super Lawyer" by New Jersey Monthly magazine each year consistently since 2013.