Shoulder Dystocia Birth Injury Guide

What Is Shoulder Dystocia?

Shoulder dystocia is a birth complication that occurs during delivery when the baby's anterior shoulder becomes lodged behind the mother's pubic bone after the head has emerged. When this happens, the baby cannot be delivered using routine delivery maneuvers, and the obstetrician must perform specific emergency maneuvers to free the shoulder.

Shoulder dystocia is a medical emergency. The longer it takes to resolve, the greater the risk of permanent injury to the baby — particularly brachial plexus injury (damage to the nerves that control the arm and hand) and brain damage from oxygen deprivation.

How Shoulder Dystocia Causes Birth Injury

Brachial Plexus Injury (Erb's Palsy)

The brachial plexus is a network of nerves that runs from the spinal cord through the neck and into the arm. When excessive traction or pulling is applied to the baby's head during a shoulder dystocia delivery, these nerves can stretch, tear, or rupture — resulting in Erb's palsy (weakness or paralysis of the upper arm) or Klumpke's palsy (weakness or paralysis of the lower arm and hand).

While some brachial plexus injuries resolve spontaneously within months, others cause permanent disability requiring nerve graft surgery, tendon transfers, and lifelong therapy.

Brain Damage from Oxygen Deprivation

If the shoulder dystocia is not resolved quickly, the baby may be deprived of oxygen. The umbilical cord can be compressed between the baby's body and the mother's pelvis, cutting off blood flow. Prolonged oxygen deprivation can cause hypoxic-ischemic encephalopathy (HIE), cerebral palsy, and permanent brain damage.

Fractures

In some cases, the baby's clavicle (collarbone) or humerus (upper arm bone) may fracture during delivery — either as a result of the shoulder dystocia itself or as a consequence of the maneuvers used to resolve it. While many fractures heal without complications, some require surgical intervention.

Risk Factors for Shoulder Dystocia

Obstetricians should identify risk factors for shoulder dystocia before delivery, including:

• Fetal macrosomia: A larger-than-average baby (over 4,000-4,500 grams)
• Maternal diabetes: Increases the risk of macrosomia and shoulder dystocia
• Post-term pregnancy: Delivering after 40 weeks increases baby size
• Prior shoulder dystocia: History of shoulder dystocia in a previous delivery
• Prolonged labor: Especially the second stage of labor
• Operative vaginal delivery: Use of forceps or vacuum extraction

When these risk factors are present, the obstetrician should consider whether a cesarean section is indicated to avoid the risk of shoulder dystocia. Failure to recommend a C-section when risk factors are present may constitute negligence.

Proper Management of Shoulder Dystocia

The standard of care for managing shoulder dystocia includes specific maneuvers, typically performed in order:

1. McRoberts maneuver: Hyperflexing the mother's hips to flatten the sacrum and rotate the pubic symphysis
2. Suprapubic pressure: Applying pressure above the pubic bone to rotate the baby's shoulder
3. Rubin maneuver: Rotating the baby's anterior shoulder internally
4. Woods' corkscrew maneuver: Rotating the posterior shoulder to anterior
5. Delivery of the posterior arm: Reaching in and delivering the posterior arm first

Maneuvers that should never be used include:

• Excessive traction (pulling) on the baby's head — this is the primary cause of brachial plexus injury
• Fundal pressure (pushing on the top of the uterus) — this can worsen the impaction

When Shoulder Dystocia Constitutes Medical Malpractice

Shoulder dystocia malpractice claims typically involve one or more of the following:

• Failure to anticipate: Not identifying risk factors (macrosomia, diabetes, prior history) that should have prompted a C-section recommendation
• Improper delivery technique: Applying excessive traction or fundal pressure instead of the standard maneuvers
• Delayed C-section: Not performing a timely cesarean when shoulder dystocia cannot be resolved
• Inadequate team response: Not having the right personnel (neonatologist, anesthesia) available for a high-risk delivery
• Failure to document: Not properly documenting the time of shoulder dystocia diagnosis and maneuvers performed

Statute of Limitations for Shoulder Dystocia Claims

Under CPLR § 208, the statute of limitations for birth injury claims involving infants is tolled until the child's 18th birthday — but cannot extend beyond the child's 10th birthday in most cases. This means families may have up to 10 years from the date of birth to file a shoulder dystocia malpractice claim, but earlier filing is always recommended.

Why Choose MDLaw

MDLaw Firm has extensive experience handling shoulder dystocia and brachial plexus injury cases in New York. Our team works with board-certified obstetricians and pediatric neurologists to review delivery records and identify where the standard of care was breached. We handle all birth injury cases on a contingency fee basis.

If your child suffered a brachial plexus injury, Erb's palsy, or brain damage during a shoulder dystocia delivery in New York, contact MDLaw Firm at 347-524-5777 for a free consultation.