Shoulder dystocia medical negligence compensation claims arise as a result of a condition that is feared by gynaecologists due to its unpredictability and the severe injury that may be caused to the infant if it is not managed properly. The condition occurs during childbirth, when an infant’s shoulder becomes trapped and lodged behind the mother’s pubic bone. It should be distinguished from mere difficulty with delivery of the shoulder which does often occur due to the mother’s position on the delivery bed and requires only a positional change to resolve the problem. Healthcare professionals involved in childbirth should be aware of the risk factors and should take care to properly manage any developing situation.
Good management of potential shoulder dystocia should involve;
- Early recognition or raised levels of suspicion as a result of:
- large baby
- late delivery
- obese mother
- maternal diabetes
- previous history
- extended labour
- Appropriate staff being involved in the event of any suspicion which may include:
- senior midwife
- 2nd midwife
- senior obstetrician
- anaesthetist
- paediatrician
There are a number of injuries that a child can suffer as a result of shoulder dystocia. including;
- Neurological damage as a result of a reduction in oxygen being delivered to the infant’s brain.
- Skeletal injury usually involving fracture of the clavicle or humorous.
- Brachial plexus injuries caused as a result of damage to a network of nerves running from the infants neck, across the shoulders to the tips of the fingers specifically;
- Klumpke's Palsy which is a paralysis of the thoracic nerves often causing the hand to be limp with immovable fingers.
- Horners syndrome caused by damage to the sympathetic nervous system which causes the eyelid to droop and the affected pupil is smaller than in the other eye.
- Complete Brachial Plexus Palsy which occurs when all five nerves of the brachial plexus are affected resulting in paralysis of the entire arm often associated with Horners syndrome.
- Erbs palsy which is caused by paralysis of the fifth and sixth cervical nerves resulting in the arm being turned towards the body and the hand is turned backward with no movement at the elbow.
Accepted medical protocol exists to relieve the problem and may include:
- applying pressure over the mother's pubic area
- cutting a deep episiotomy
- repositioning the mother
- breaking the baby's clavicle bone on purpose
- performing an emergency caesarean section
- performing the McRobert's manoeuvre
- applying traction in a horizontal plane to avoid damaging the brachial plexus
- manoeuvring and changing the position of the baby
- breaking the mother's pelvic bone
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