What Does Dystocia Mean & How Is It Medical Malpractice?
Dystocia refers to abnormal or difficult childbirth or labor. It occurs when there is an incoordinate uterine activity, abnormal fetal life or presentation, absolute or relative cephalopelvic disproportion, etc. Shoulder dystocia is a type of dystocia where the anterior of the infant cannot pass below the pubic symphysis or requires a significant amount of manipulation to pass. Shoulder dystocia, just like dystocia, occurs during childbirth or labor. And it is diagnosed when the shoulders of the infant fail to be delivered shortly after the fetal head. If the infant’s shoulder is unable to be freed within minutes, the infant will suffer irreversible brain damage or death.
In plain English; it’s a difficult delivery that can result in the child getting stuck and either suffering a shoulder separation or a brain injury.
Some signs to look for regarding shoulder dystocia are; the turtle sign– this is the appearance and retraction of the fetal head (much like a turtle going back into its shell) and a red puffy face indicative of facial flushing.
What Can My Physician Do About This Type of Complication?
When presented with this complication in the delivery room, there are a few procedures that can be done to try and ensure the safe delivery of the infant. It is reported that if the physician delivering the baby suspects shoulder dystocia, they are to follow the ALARMER mnemonic first before any of the listed procedures below, are followed. The ALARMER mnemonic stands for; Ask for help, Leg hyperflexion, Anterior shoulder disimpaction, Rubin maneuver, Manual delivery of posterior arm, Episiotomy, and Rollover on all fours. After the ALARMER is followed, here are some of the different types of procedures the obstetrician or physician can perform:
- McRoberts Maneuver – this involves hyper-flexing the mother’s leg tightly to her abdomen. This widens pelvis and flattens the spine in the lower back.
- Suprapubic Pressure (Rubin I) – the goal of suprapubic pressure is to decrease the fetal bisacromial diameter by adducting the anterior fetal shoulder. Pressure is applied to the suprapubic area in a downward fashion or a rocking motion from the fetal back toward the front
- Rubin II – posterior pressure on the anterior shoulder. This would bring the fetus in an oblique position with the head towards the vagina.
- Wood’s Screw – leads to turning the anterior shoulder to the posterior and vice versa.
- Jacquemier’s Maneuver – delivery of the posterior shoulder first. The forearm and hand are identified in the birth canal and gently pulled.
- Gaskin Maneuver – moving the mother to an all-fours position with the back arched, widening the pelvic outlet.
- Zavanelli’s Maneuver – pushing the fetal head back in, and performing a cesarean section or internal cephalic replacement by c-section.
- Intentional Fetal Clavicular Fracture – reduces the diameter of the shoulder girdle that requires to pass through the birth canal.
- Abdominal Rescue – hysterectomy facilitates vaginal delivery of the impacted shoulder.
- Maternal Symphysiotomy – makes an opening of the birth canal by breaking connective tissue between the two pubic bones, allowing the shoulders to pass through.
The ALARMER mnemonic goes from the least invasive to the most invasive procedures, reducing the harm to the mothers in the event that the infant is delivered with one of the earlier maneuvers. If these maneuvers are unsuccessful, then the skilled obstetrician is to begin performing the additional procedures.
The major concern regarding shoulder dystocia is the damage to the upper brachial plexus nerves. The brachial plexus nerves supply the sensory and motor components of the shoulder, arm, and hands. Moreover, excess tension may physically tear the nerve roots out of the neonatal spinal column and resulting in total dysfunction. The ventral roots (motor pathway) are the most prone to injury because they are in the plane of the greatest tension. Other concerns coming from shoulder dystocia are:
- Klumpke paralysis
- Erb’s Palsy
- Fetal hypoxia
- Fetal Death
- Cerebral Palsy
- Maternal postpartum hemorrhage
If Your Child Suffered An Injury After A Difficult Delivery, Contact Our Experienced Medical Malpractice Lawyers Today
Did you suffer from a difficult delivery or labor? Does your child suffer from any of the above conditions due to what you believe was caused by shoulder dystocia? Call us today at 202-393-3320 or click here to schedule a free, no-obligation consultation. We make it easy for you. And don’t forget to ask about our free resources and guides for parents after medical malpractice.
You may have had a normal, healthy pregnancy when all of a sudden upon delivery you are presented with the news that your baby was born with shoulder dystocia. You most likely weren’t prepared for a birth injury and are now trying to understand more about the injury and what caused it.
Shoulder dystocia (a brachial plexus injury) is when the baby’s shoulder becomes stuck during delivery, and an obstetrician uses too much force to get the infant out of the birthing canal. Sadly, this places force on the baby’s neck and shoulder, which causes the nerves to be pulled. Sometimes, in severe cases the nerves will separate from the neck into the shoulder, causing a serious birth injury that can adversely affect an infant’s shoulder, arms, and fingers. As medical malpractice lawyers, we want moms to know that this injury should have never happened in the first place.
If your child suffered from shoulder dystocia at birth in a Northern Virginia, D.C., or Maryland hospital, contact Donahoe Kearney to find out if you have a case. To pursue a medical malpractice case against the doctor or hospital involved, you should contact us today for a complimentary consultation at 202.393.3320 or reach us online at https://donahoekearney.com/contact.cfm.
Shoulder Dystocia and Medical Malpractice at a DC Hospital
Shoulder dystocia can sometimes occur at birth when the obstetrician or other hospital providers do not follow the rules of good patient care, or the hospital doctor, interns or residents do not recognize this complication and treat it as an obstetrical emergency. There are also certain risk factors, such as maternal diabetes or a fetus suspected of weighing more than 4,000 grams that make a baby more susceptible to shoulder dystocia during delivery. The hospital staff should test and be looking for these well-known risk factors.
Umbilical cord compression due to the baby getting “stuck” during delivery can also lead to a lack of oxygen for the baby, increased acidosis, and ultimately brain damage for the baby if the lack of oxygen to the brain is prolonged. That’s why the condition needs to be recognized and evaluated by experienced hospital staff so that actions can be taken to prevent or limit harm to the baby or mother.
Shoulder dystocia usually refers to when one of the baby’s shoulders is caught behind the mother’s pelvic bone after the baby’s head is delivered. This can lead to brachial plexus palsy, a permanent nerve injury that leaves the child unable to use that arm or extensive damage that prevents him from doing things normal kids do.
If your child has a permanent injury after birth or during his time in the neonatal intensive care unit, or NICU, call us today for a confidential, free consultation. We may be able to help your family get him the resources you need to provide for your child’s future medical care, therapy, rehab, occupational therapy, vocational training, and other things that can help him manage and cope with the effects of the injury.
The sooner you get started, the better – all parents want to help their child if they can, and so do we!
Just call us today at (202) 393 – 3320 or click here to order a copy of our free guide to medical malpractice so we can help get you answers today.
What Is Shoulder Dystocia And How Do I Know If It Was Malpractice?
Dystocia refers to abnormal or difficult childbirth or labor. It occurs when there is an incoordinate uterine activity, abnormal fetal life or presentation, absolute or relative cephalopelvic disproportion, etc. Shoulder dystocia is a type of dystocia where the anterior of the infant cannot pass below the pubic symphysis or requires a significant amount of manipulation to pass. Shoulder dystocia, just like dystocia, occurs during childbirth or labor. And it is diagnosed when the shoulders of the infant fail to be delivered shortly after the fetal head. If the infant’s shoulder is unable to be freed within minutes, the infant will suffer irreversible brain damage or death.
In plain English; it’s a difficult delivery that can result in the child getting stuck and either suffering a shoulder separation or a brain injury.
Some signs to look for regarding shoulder dystocia are; the turtle sign– this is the appearance and retraction of the fetal head (much like a turtle going back into its shell) and a red puffy face indicative of facial flushing.
What Can My Physician Do About This Type of Complication?
When presented with this complication in the delivery room, there are a few procedures that can be done to try and ensure the safe delivery of the infant. It is reported that if the physician delivering the baby suspects shoulder dystocia, they are to follow the ALARMER mnemonic first before any of the listed procedures below, are followed. The ALARMER mnemonic stands for; Ask for help, Leg hyperflexion, Anterior shoulder disimpaction, Rubin maneuver, Manual delivery of posterior arm, Episiotomy, and Rollover on all fours. After the ALARMER is followed, here are some of the different types of procedures the obstetrician or physician can perform:
- McRoberts Maneuver– this involves hyper-flexing the mother’s leg tightly to her abdomen. This widens the pelvis and flattens the spine in the lower back.
- Suprapubic Pressure (Rubin I)–
- Rubin II– posterior pressure on the anterior shoulder. This would bring the fetus in an oblique position with the head towards the vagina.
- Wood’s screw– which leads to turning the anterior shoulder to the posterior and vice versa.
- Jacquemier’s Maneuver– the delivery of the posterior shoulder first. The forearm and hand are identified in the birth canal and gently pulled.
- Gaskin Maneuver– moving the mother to an all-fours position with the back arched, widening the pelvic outlet.
- Zavanelli’s Maneuver– pushing the fetal head back in, and performing a cesarean section or internal cephalic replacement by c-section.
- Intentional fetal clavicular fracture– reduces the diameter of the shoulder girdle that requires to pass through the birth canal.
- Abdominal rescue– hysterectomy facilitates vaginal delivery of the impacted shoulder.
- Maternal symphysiotomy– makes an opening of the birth canal by breaking connective tissue between the two pubic bones, allowing the shoulders to pass through.
The ALARMER mnemonic goes from the least invasive to the most invasive procedures, reducing the harm to the mothers in the event that the infant is to be delivered with one of the earlier maneuvers. If these maneuvers are unsuccessful, then the skilled obstetrician is to begin performing the additional procedures.
The major concern regarding shoulder dystocia is the damage to the upper brachial plexus nerves. The brachial plexus nerves supply the sensory and motor components of the shoulder, arm, and hands. Moreover, excess tension may physically tear the nerve roots out of the neonatal spinal column and resulting in total dysfunction. The ventral roots (motor pathway) are the most prone to injury because they are in the plane of the greatest tension. Other concerns coming from shoulder dystocia are:
- Klumpke paralysis
- Erb’s Palsy
- Fetal hypoxia
- Fetal Death
- Cerebral Palsy
- Maternal postpartum hemorrhage
Did you suffer from a difficult delivery or labor? Does your child suffer from any of the above conditions due to what you believe was caused by shoulder dystocia? Call or email us for a confidential consultation at (202) 393-3200 and info@dkllp.com. Please watch our video on shoulder dystocia and do not forget to get your Free copy of Picking up the Pieces after Medical Malpractice: A Parent’s Guide for more information on how to cope after you suspect your child was a victim of medical malpractice.