Shoulder Dystocia Injury During Birth

Filed under Birth Injury, Cerebral Palsy, Shoulder Dystocia

The Agbede Case

The parents were expecting the birth of their first baby. When the mother was at 28 weeks gestation (28 weeks into her pregnancy), she was diagnosed with gestational diabetes, a temporary diabetic condition caused by pregnancy. Her general obstetrician referred her to a maternal fetal medicine specialist because of her high risk diabetic condition. She underwent several obstetrical ultrasounds specifically to monitor the weight of the baby. Women who become diabetic in pregnancy run the risk of delivering a very large infant. This condition, called macrosomia, can be diagnosed prior to the delivery by ultrasound allowing the mother to undergo a C-section delivery. All of the sonograms indicated that this mother was likely to deliver a large baby. These sonogram reports were sent to both the specialist and the general obstetrician, making them aware of the patient’s potential to deliver a macrosomic infant. The last sonogram, however, was read as normal and no thought was given to explore the reason for this or to reorder the sonogram. Instead, the general obstetrician was given a completely normal sonogram report. Despite the previous series of sonogram reports indicating macrosomia, the obstetrician never questioned the last sonogram report and he attempted a vaginal delivery, never even suspecting the potential for the types of problems associated with the delivery of a large infant.

The chemically induced vaginal delivery was scheduled to take place on a week end evening when few back-up personnel would be at the hospital. As the fetus descended down the birth canal the baby got stuck. The very large baby’s shoulder bone got stuck behind the mother’s pubic bone, or pubic symphis. This is called a shoulder dystocia presentation. The obstetrician should recognize this condition by what is called the turtle sign – that is, the baby’s head comes out but then goes back in like a turtle’s head popping back into its shell. There are certain maneuvers the obstetrician should do to deliver a shoulder dystocia presentation and, just as importantly, there are certain things the obstetrician should not do. Once a shoulder dystocia is present, the obstetrician should not order fundal pressure, which is pressure on top of the woman’s belly. Fundal pressure causes the shoulder bone to become even more lodged under the mother’s pubic bone, thereby worsening the shoulder dystocia and making a difficult delivery even more difficult. The obstetrician should also refrain from pulling the baby’s head too hard, excessive traction, which will tear nerves in the baby’s shoulder and potentially cause a permanent nerve injury to the group of nerves in the baby’s shoulder called the brachial plexus group of nerves. (This injury is called Erb’s palsy.)

A danger with shoulder dystocia presentations is that the baby cannot get oxygen while stuck in the birth canal. Therefore, the obstetrician has precious little time to relieve the shoulder dystocia and safely deliver the baby before brain injury occurs. Obstetricians and obstetrical nurses are trained to utilize specific maneuvers to relieve a shoulder dystocia. Some of these maneuvers are the McRobert’s Maneuver, Rubin Maneuver, and Wood’s Screw.


Maneuver

Because the obstetrician wasn’t expecting a large baby, he apparently panicked and ordered nurses to administer the always wrong fundal pressure which only made the shoulder dystocia worse. Eventually, he summoned for outside help, but it took another obstetrician 15 minutes to get to the hospital to aid in the delivery. By the time the assisting obstetrician was able to deliver the baby, the baby had incurred severe brain damage from asphyxia and was permanently brain damaged, causing cerebral palsy.

The family realized immediately that something terrible had gone wrong during the birthing process and called Harry S. Cohen & Associates while the mother and child were still in the hospital. Harry S. Cohen & Associates was able to provide some degree of comfort and counseling for the parents in addition to a prompt case review and other legal advice during a very difficult time following the baby’s birth. Eventually, suit was filed and a long and arduous litigation ensued. Shortly before trial, the case concluded with a multimillion dollar settlement.

After the settlement, Harry S. Cohen & Associates set up a special needs trust for the child. The trust then funded the construction of a totally accessible home for the family so the child will be able to reside there for the entirety of his life. The trust also funds for a lifetime of necessary purchases to enhance the victim’s quality of life as much as money can, such as the periodic purchase of a van, constant therapies and a lifetime income.

Article Metadata



Publisher: Harry S. Cohen and Associates, P.C.