Shoulder dystocia is one of several birth complications that can lead to a traumatic childbirth experience. Traumatic childbirth is a cause of not only physical maternal injuries, but also risks to the infant and long-term mental and emotional harm. If the delivery of your baby was marred by birth complications that your medical care team failed to manage in accordance with the current standard of practice in obstetrics, you may be able to recover compensation. This compensation can be extremely helpful in assisting with treatment to repair the damage caused by maternal injuries, and in helping a family regain its financial footing after unexpectedly high medical bills. Call Erin Marshall Law in Albuquerque to schedule a review of your case. You can reach us at 505-218-9949.
What Is Traumatic Childbirth?
The American Psychological Association (APA) defines a traumatic childbirth as one involving “perceived or life-threatening” events, culminating in severe injury to mother or child, or the loss of the baby. That the APA has a formal definition of traumatic childbirth at all suggests something of the breadth with which traumatic childbirth can affect a woman’s life.
Mental and Emotional Impacts of Traumatic Childbirth
As the APA goes on to explain, up to 17% of people who have given birth may meet the clinical criteria for a definition of post-traumatic stress disorder (PTSD). The organization further notes that the symptoms of PTSD can make bonding with the newborn more difficult, introducing additional stressors and risk factors for the infant’s development as well as for the mother’s mental and physical health. Mother-infant bonding in the early days after birth is widely considered to be an important factor in a child’s overall well-being, so interference with this process can have significant health effects that are challenging to measure because, while there are general averages for babies overall, there is no established individual baseline for a newborn.
Long-Term Physical Consequences of Poorly Managed Birth Complications
Complicating the emotional and psychological recovery process is the fact that, for many women, the physical pain of a traumatic childbirth does not end with the baby’s delivery. One of the most severe complications associated with a traumatic childbirth is uterine rupture, a serious medical emergency that requires immediate intervention. Often, a major goal in managing a high-risk delivery involving complications such as shoulder dystocia is to prevent uterine rupture from occurring in the first place by effectively managing the delivery itself, usually by using manual or mechanical interventions to assist in repositioning the baby to dislodge the trapped shoulder from the mother’s pelvis.
The medical emergencies that may occur during labor can sometimes pale in comparison to the long-term consequences of traumatic childbirth. Women who go through a traumatic childbirth are more likely than their peers to experience long-term urinary and fecal incontinence, more likely to experience persistent pelvic pain, and may suffer from the development of excessive scar tissue. The extent of scarring can depend partly on the types of obstetric interventions used to assist in delivery, and the skill of the physician performing the maneuvers, a reality which underscores the importance of effective management by a patient’s medical team.
What Is Shoulder Dystocia?
Shoulder dystocia is a critical medical emergency for both mother and baby, and is not so much a condition as an event. Shoulder dystocia occurs when an infant’s shoulder becomes trapped against the mother’s pelvis during labor. Occasionally, both shoulders can become trapped at once.
Shoulder dystocia is strongly associated with traumatic childbirth, with the Cleveland Clinic pointing out that “dystocia” is a compound formed by the Greek “dys,” in the sense of difficult, and “tokos,” meaning birth. Although there are other causes of difficult births, individuals who experience traumatic birth due to shoulder dystocia are likely to have longer recovery periods than mothers who give birth without complications. They also have a higher lifetime incidence of certain long-term adverse health outcomes, such as pelvic pain and incontinence. Many of these sequelae are difficult to treat independently, so much of the guidance offered to clinicians emphasizes the importance of careful medical management to mitigate maternal injuries from shoulder dystocia.
Risks of Shoulder Dystocia
Shoulder dystocia is associated with several adverse outcomes for both mothers and infants. A brief review of some of the more common birth-related injuries caused by shoulder dystocia may help to clarify why proper case management is critically important in shoulder dystocia cases.
Risks to Mothers
A mother’s chances of traumatic birth injury increase dramatically when shoulder dystocia complicates the labor process. Effective management by the medical team is essential to protecting the health of the person in labor as well as that of the trapped infant.
Some of the most notable risks of shoulder dystocia for laboring mothers include:
- Uterine hemorrhage
- Injuries to sphincters (at the anus and/or urethra)
- “Obstetric” injuries (e.g., tears to the perineum, labia, etc.)
Many other maternal injuries are possible. Research available from the National Institutes of Health (NIH) suggests that some of these injuries may actually result from the obstetric interventions performed during delivery in attempts to dislodge the baby so that birth can progress. At Erin Marshall Law, we often work with expert witnesses who have experience in obstetrics to help determine whether a labor and delivery team’s procedures curing a traumatic childbirth conformed to the standard of practice.
Risks to Infants
Shoulder dystocia is associated with increased risks to infants as well as to the individuals going through labor. Outcomes vary, but the risks of severe injury in infants affected by shoulder dystocia may increase in direct relation to the amount of time the baby spends with one or both of their shoulders trapped against the mother’s pelvis.
Brachial Plexus Injury
A brachial plexus injury occurs when the network of nerves connecting the shoulder to the neck, called the brachial plexus, becomes damaged through overstretching. Symptoms include weakness and a reduction of motor control in the affected arm and hand. Certain types of trauma, such as from accidents, can cause brachial plexus injuries in adults, but it is a particularly common problem for infants with complicated births. A 2020 guide in American Family Physician (AFP) estimated that as many as 20% of infants who experienced shoulder dystocia during their births experienced some degree of brachial plexus injury. The prognosis for a brachial plexus injury depends on the degree of overstretching of an infant’s nerves. Physical therapy may help with more serious cases.
Hypoxic-Ischemic Encephalopathy
Hypoxic-ischemic encephalopathy (HIE) results from the loss (or sharp reduction) of blood and oxygen supply to the brain. Shoulder dystocia is one of several birth complications known to increase the risk of HIE.
Clavicle and Cranial Injuries
Both the entrapment of the shoulder (depending on angle) and the medical interventions attempted to assist in labor can lead to clavicle fractures as well as to cranial trauma, including life-altering or even fatal brain damage in some cases. The use of some tools, particularly forceps, can increase the risk of infant head trauma even when they prove effective in facilitating delivery. Many medical practitioners advocate the use of multiple techniques to resolve shoulder dystocia, partly to minimize reliance on obstetric tools.
Risk Factors for Shoulder Dystocia
ACOG calls shoulder dystocia an “unpredictable and unpreventable” emergency, and notes that most assessments performed before labor are poor predictors of shoulder dystocia risk. That said, there are at least two factors that are thought to be associated with an increased risk of shoulder dystocia:
- Fetal macrosomia
- Gestational diabetes
Gestational diabetes is often caught in routine screenings as part of prenatal care; careful management throughout the affected pregnancy is essential for the health of both mother and baby. Fetal macrosomia, a condition in which an infant is significantly larger than the average for their gestational age, can be more difficult to identify in advance, but for obvious reasons, it is associated with increased risk of traumatic birth overall.
Speak With a Maternal Injury Lawyer
Traumatic childbirth can leave lasting physical and emotional scars on both mother and baby. Shoulder dystocia is far from the only birth complication that can result in a traumatic childbirth, but it stands out as one that presents a genuine medical emergency and yet can often be treated effectively in the delivery room. The labor and delivery team’s management of the obstetric emergency often merits scrutiny. If you believe your medical care team’s poor management of shoulder dystocia led to an unnecessarily traumatic childbirth in your case, consider speaking with a New Mexico medical malpractice lawyer to discuss the specifics and review your legal options. Call 505-218-9949 to schedule a consultation with Erin Marshall Law.
