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Medical Errors in the Management of Shoulder Dystocia

Shoulder dystocia is one of the most feared complications of pregnancy. A shoulder dystocia occurs when, after delivery of the baby's head, the baby's shoulder gets lodged behind the mother's pubic bone. Medical errors in managing shoulder dystocia can lead to permanent injury or death for the baby.

When a shoulder dystocia occurs, the doctor must act quickly to complete the baby's delivery. If the baby is not delivered within a matter of minutes, the baby will suffer irreversible brain damage or death due to lack of oxygen. However, the doctor also must take care not to pull too hard on the baby's head in an effort to achieve delivery. Excessive traction applied by the physician can lead to damage to the nerves that run from the spine to the shoulder, arm and hand -- a brachial plexus injury. Many times, these injuries are temporary and resolve completely within days or weeks. However, when the disruption to the nerves is more severe, the injury can be permanent. Brachial plexus injuries can result in complete loss of use of the affected arm.

Mothers who have experienced a shoulder dystocia with a previous pregnancy, who have gestational diabetes, who have experienced excessive weight gain during their pregnancy, or who are known to be carrying very large babies are all at increased risk for shoulder dystocia. Physicians should be aware of these risk factors, and should always estimate the weight of the baby before delivery.

There are a number of maneuvers available to physicians to allow them to safely deliver a baby after a shoulder dystocia has occurred. Unfortunately, many doctors have had limited experience performing these maneuvers and are unprepared to efficiently perform them when needed. Additionally, some doctors fail to promptly recognize when a shoulder dystocia has occurred and persist in applying traction to the baby's head instead of resorting to the appropriate maneuvers.

Not all brachial plexus injuries suffered at birth are due to medical malpractice. An experienced medical malpractice attorney can review the case and help ascertain whether medical negligence played a role in the injury.

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