Shoulder Dystocia Lawyer in Massachusetts

Shoulder Dystocia as an Obstetrical Emergency

Shoulder dystocia occurs when the baby’s head delivers but one or both shoulders become lodged behind the mother’s pubic bone, preventing the delivery of the body. It is an obstetrical emergency requiring immediate, skilled intervention. The response must be rapid, each minute of delay increases the risk of fetal oxygen deprivation, and must follow established protocols designed to free the lodged shoulder without injuring the baby or the mother. When shoulder dystocia is managed with improper technique, permanent birth injuries to the baby can result. Attorney Jeffrey C. Lavey represents families affected by shoulder dystocia birth injuries throughout Massachusetts.

The Standard of Care for Shoulder Dystocia Management

Obstetrical training establishes specific maneuvers for managing shoulder dystocia. The HELPERR protocol, Call for Help, Evaluate for Episiotomy, Legs in McRoberts position, Pressure applied suprapubically, Enter for internal maneuvers (Rubin II, Woods screw), Remove the posterior arm, Roll the patient, provides a sequential approach to freeing an impacted shoulder without applying traction to the fetal head. The critical prohibition is against applying excessive downward traction to the fetal head, which is the mechanism by which brachial plexus injury (Erb’s palsy) occurs.

Birth Injuries From Improper Shoulder Dystocia Management

Brachial plexus injury, Erb’s palsy, is the most common injury resulting from improper shoulder dystocia management. The brachial plexus nerves that control arm movement can be stretched, torn, or avulsed when excessive traction is applied to the head during a shoulder dystocia delivery. The resulting weakness or paralysis of the affected arm may be temporary, partially resolving with physical therapy and surgery, or permanent. Hypoxic-ischemic encephalopathy can result from prolonged oxygen deprivation when the delivery is significantly delayed. Clavicle and humerus fractures can also occur.

Anticipating and Preparing for Shoulder Dystocia

While shoulder dystocia cannot always be anticipated, certain risk factors, macrosomia (large baby), gestational diabetes, prolonged second stage of labor, and prior shoulder dystocia, are associated with increased risk. A practitioner who identified these risk factors and did not discuss the implications with the patient or have a management plan ready may be departing from the standard of care. Attorney Lavey evaluates both the anticipation of shoulder dystocia risk and the management of the emergency in every shoulder dystocia birth injury case.

Pursuing a Shoulder Dystocia Malpractice Claim

Shoulder dystocia malpractice cases require expert obstetrical review of the delivery records, which should document the maneuvers performed, the time elapsed between the head delivery and the body delivery, and the position and traction applied. Attorney Lavey obtains complete delivery records and works with qualified obstetrical experts to evaluate whether the shoulder dystocia was managed according to the standard of care.

Frequently Asked Questions