What Is Shoulder Dystocia?

Most parents picture the moment their baby arrives: the first cries, the relief, the joy. But when a delivery takes a sudden and unexpected turn, it's terrifying.

Sometimes, these moments are truly unpredictable or unavoidable. But sometimes, they're not. Sometimes, the risk factors were there, and the medical team missed something they shouldn't have.

At Hodes Milman, we've spent over 30 years helping families pick up the pieces after a traumatic birth. If your child is now facing serious medical needs and your family is left emotionally reeling, you deserve answers and support.

With more than $200 million recovered for our clients, we're here to help you understand what went wrong and what options you may have moving forward. Call us today at (949) 640-8222 or fill out our simple online form today.

"I would like to extend my sincere appreciation for the exceptional legal support Mr. Dan Hodes provided throughout my case. His professionalism and attention to detail gave me confidence at every stage. The outcome exceeded my expectations, and it was clear that his dedication and expertise played a major role in achieving it. I truly value his guidance and would not hesitate to recommend him to anyone seeking high-quality legal representation."

Nada E. | Client

The Challenge of Shoulder Dystocia in Childbirth Explained

Shoulder dystocia is a childbirth complication that happens when, after a baby's head is delivered, one or both of their shoulders become stuck behind the mother's pelvic bone. This makes it difficult for the rest of the baby's body to be delivered safely.

It's a medical emergency that requires immediate action. When handled correctly, many babies recover without lasting harm. But if doctors don't respond quickly or use improper techniques, the baby can suffer serious injuries, including nerve damage, broken bones, or a lack of oxygen.

Shoulder dystocia doesn't happen in every birth, but when it does, it can be frightening and, in some cases, completely preventable.

How Common Is Shoulder Dystocia?

The chance of shoulder dystocia is overall rare. However, the overall rate depends on factors like the baby's size and the mother's health.

For babies born at an average weight, between 5 pounds, 8 ounces and 8 pounds, 13 ounces , the rate is slightly lower, occurring in about 0.6% to 1.4% of deliveries.

However, for larger babies, those weighing more than 8 pounds, 13 ounces, the risk can rise significantly to 5% to 9%, and sometimes even higher.

The chances of shoulder dystocia also increase when the mother has diabetes. Because these risk factors are often known before delivery, medical teams are expected to be on alert and fully prepared.

Even though shoulder dystocia is not extremely common, it's a known medical emergency that doctors and nurses should be trained to handle. When they follow the proper steps quickly and carefully, many cases can be managed without long-term harm. But when medical professionals fail to act appropriately, the outcome can be serious.

What Causes Shoulder Dystocia?

Shoulder dystocia doesn't have one single cause, but it often doesn't happen completely out of the blue. There are several well-known risk factors that doctors and nurses should be watching for.

When medical professionals take the time to identify and plan around these risks, many cases of shoulder dystocia can be avoided or safely managed. But when they fail to recognize these signs or respond appropriately, this is medical malpractice.

Here are some of the most common risk factors for shoulder dystocia:

• Large Baby (Macrosomia): One of the biggest risk factors is when the baby is larger than average, a condition known as macrosomia. Macrosomia is typically diagnosed when a baby weighs more than 8 pounds, 13 ounces at birth. Larger babies may have broader shoulders or more body fat, which makes it harder for them to pass through the birth canal safely.
• Maternal Diabetes (Gestational or Pre-Existing): Women with diabetes are up to six times more likely to experience shoulder dystocia. Babies of diabetic mothers often have more fat in their upper bodies, which can increase the chances of getting stuck.
• Past History of Shoulder Dystocia: If a mother has had shoulder dystocia in a previous birth, the chances of it happening again go up significantly.
• Maternal Obesity: Obesity is a risk factor for both macrosomia and shoulder dystocia. Obese women are more likely to have high birth weight babies, especially if there's excessive weight gain during pregnancy.
• Overdue Pregnancy: The longer a pregnancy goes past the due date, the more time the baby has to grow. Babies born two weeks or more overdue are at greater risk for macrosomia and shoulder dystocia.
• Multiple Previous Pregnancies: Birth weight often increases with each pregnancy. That means moms who have had several children may be more likely to deliver a larger baby.
• Male Babies: Male babies tend to weigh more than female babies and are statistically more likely to experience shoulder dystocia, especially if they weigh over 9 pounds, 15 ounces.

Having one or more of these risk factors does not mean shoulder dystocia will definitely happen. But it does mean that the delivery team must be alert, prepared, and ready to act.

Unfortunately, medical negligence during delivery can lead to birth injuries, especially when:

• A baby is allowed to remain stuck in the birth canal for too long.
• Assisted delivery tools like vacuum extractors or forceps are misused.
• Excessive force is used to pull the baby from the mother's pelvis.

If you suspect that your child was harmed due to poor planning or mistakes during delivery, you're not without options. At Hodes Milman, our attorneys have over three decades of experience standing up for families in situations just like yours.

Call us today at (949) 640-8222 or fill out our online form for a free, no-obligation consultation. We'll listen to your story, explain your legal options, and help your family take the first step toward justice.

Signs of Shoulder Dystocia

The condition typically becomes apparent during delivery - and it's considered a medical emergency the moment it's recognized. While it can't always be predicted ahead of time, there are several clear signs that trained medical professionals are taught to watch for.

Here are some of the most common signs of shoulder dystocia:

• "Turtle Sign": This is often the first and most noticeable sign. After the baby's head is delivered, it may seem to retract back toward the mother's body, much like a turtle pulling its head into its shell. This happens because the baby's shoulders are stuck behind the pubic bone.
• Failure of the Shoulders to Deliver After the Head: Normally, the shoulders follow the head quickly. If there's a delay of more than a minute, or the body doesn't follow with a strong push, shoulder dystocia may be the reason.
• One Arm Delivered, the Other Stuck (Fetal Elbow Sign): Sometimes, only one arm of the baby is delivered, while the other remains trapped inside the birth canal.
• Lack of Head Rotation: After the baby's head emerges, it usually turns slightly to help the shoulders pass through. If the head remains facing straight forward without rotating, it may be a sign the shoulders are stuck.
• Slow Progression or Sudden Stop During Second Stage of Labor: If labor seems to be going well and then suddenly stalls, especially after the head is out, this could indicate that the shoulder is blocking the delivery.

Complications Caused by Shoulder Dystocia: Why Prompt Recognition Is So Important

The longer a baby remains stuck in the birth canal, the higher the risk of serious complications, including nerve damage, oxygen deprivation, or injury to the mother.

Medical professionals are trained to recognize these warning signs and act quickly using specific maneuvers designed to free the shoulder safely. When they do, many cases can be resolved without lasting harm. But if they hesitate, fail to recognize what's happening, or use excessive force, the baby may be left with long-lasting complications, such as:

• Brachial Plexus Injury (Including Erb's Palsy and Total Plexus Palsy): The brachial plexus is a group of nerves near the baby's neck that controls movement and feeling in the arm and hand. If these nerves are stretched or torn during a difficult delivery, the baby may lose the ability to move part, or all, of their arm.

• Fractured Collarbone: The collarbone is one of the most commonly broken bones during difficult deliveries. If too much force is used to free the baby's shoulder, the bone can snap.

• Fractured Upper Arm Bone: Like the collarbone, the bone in the upper arm can break if pressure is applied improperly.

• Oxygen Deprivation (Hypoxic-Ischemic Encephalopathy): If shoulder dystocia blocks the baby's chest or neck, it can restrict the flow of oxygen-rich blood to the brain. Even a few minutes without enough oxygen can lead to hypoxic-ischemic encephalopathy (HIE), a serious brain injury that may cause developmental delays, learning disabilities, cerebral palsy, or other long-term issues.

The complications aren't just limited to the baby. During a shoulder dystocia emergency, the mother may suffer:

• Tears or lacerations of the cervix or perineum.
• Postpartum hemorrhage (heavy bleeding).
• Injury to the pelvic bones or joints (like symphysis pubis separation).
• In rare cases, a ruptured uterus, which is life-threatening.

These injuries can cause lasting pain, infection, or complications in future pregnancies.

Shoulder Dystocia Treatment

When shoulder dystocia happens during delivery, it is a true medical emergency. Every second matters.

Fortunately, doctors and nurses are trained to respond with specific techniques, but only if they recognize the situation quickly and use the right maneuvers correctly.

The HELPERR Approach

Most labor and delivery teams follow a standardized set of steps known as the HELPERR mnemonic:

• H - Call for Help: As soon as shoulder dystocia is suspected, additional staff should be brought in immediately.
• E - Evaluate the Need for Episiotomy: An episiotomy (a small surgical cut to widen the vaginal opening) may give the doctor more room to rotate the baby.
• L - Legs (McRoberts Maneuver): The mother's legs are bent sharply toward her belly. This flattens the lower spine and opens the pelvis, often helping to free the baby's shoulder. This is typically the first maneuver used.
• P - Suprapubic Pressure: Gentle but firm pressure is applied just above the mother's pubic bone to try to shift the baby's shoulder. This is done in combination with the McRoberts position and is sometimes called the Rubin I maneuver.
• E - Enter Maneuvers (Rubin II or Woods Screw): The doctor places fingers into the birth canal to rotate the baby's shoulder from the inside. The goal is to reduce the width of the shoulders or shift the baby into a better position for delivery.
• R - Remove the Posterior Arm: By carefully delivering the baby's lower arm first, the doctor can often reduce the baby's shoulder width and make it easier to deliver the stuck shoulder.
• R - Roll the Patient (Gaskin Maneuver): The mother is helped onto her hands and knees. This position may change the angle of the baby's shoulders and allow for an easier delivery.

How Hodes Milman Can Help Your Family

Knowing what shoulder dystocia is and how it happens is just the first step; protecting your family's future often means taking informed legal action to hold those responsible accountable.

While shoulder dystocia doesn't happen often and isn't always avoidable, medical professionals have a duty to be prepared. They need to spot the warning signs early, respond promptly, and apply the proper techniques to protect your baby's safety.

At Hodes Milman, we've spent over 30 years standing up for families whose babies were harmed by medical negligence. Our firm has helped recover more than $200 million for clients and handle the legal process so you can focus on your child's care.

If your baby was injured during delivery, you have rights and options. Call us anytime at (949) 640-8222 or fill out our quick online form for a free, confidential consultation.