Stuck In The Womb: Shoulder Dystocia Management

A potentially devastating complication of a routine vaginal delivery occurs with a shoulder dystocia. The shoulder dystocia happens when a mother delivers the baby’s head, but the shoulders remain stuck behind her pubic bone causing a delay or inability to deliver the rest of the body. Occurring in only 0.2 -3.0% of all live births, it has been defined as a prolonged head to body delivery time of >60 seconds or the need for ancillary obstetric maneuvers. Shoulder dystocia is considered an obstetrical emergency and requires immediate recognition and intervention.

Shoulder dystocia is a dangerous condition because if not relieved, it can lead to fetal death, and there is a significant risk of injury to the nerves in the baby’s neck from stretching or tearing. Damaged brachial plexus nerves cause brachial plexus palsy, Erbs’s palsy or Klumpke's paralysis. A damaged sternocleidomastoid muscle causes the head to be pulled down and to the left. Fetal hypoxia due to umbilical cord compression can lead to Cerebral Palsy. These injuries may be temporary or permanent for life.

How does Shoulder Dystocia happen?

Practitioners and nursing staff are not prepared to deal with this emergency by failing to recognize and institute measures to resolve it. Common malpractice plaintiff allegations include: failure to predict the risk of shoulder dystocia; failure to diagnose labor abnormalities, failure to deliver fetal shoulder without using facilitating maneuvers; failure to perform a cesarean birth; application of vacuum or forceps at a high station resulting in shoulder dystocia and an inappropriate use of traction. In addition, past and future pain and suffering endured by the injured child and family members’.

What should have been done to Prevent Shoulder Dystocia?

Once recognized by the provider, the nurse should immediately call for extra help. An experienced care provider must be present who is capable of performing all of the procedures and if necessary a cesarean section delivery. At least two Labor & Delivery Nurses are needed to assist with the maneuvers. Prompt summoning of a NICU Team/Neonatologist capable of neonatal resuscitation must be present to resuscitate a limp lifeless baby. In addition, the anesthesiologist may be needed for the STAT Cesarean Section delivery.
If the head to body delivery time is greater than 7 minutes, the fetus may develop irreparable damage and even fetal death may occur. Hire a Certified Legal Nurse Consultant (CLNC) who can quickly identify deficiencies in obstetrical practice standards and who will ultimately save you time and money.

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