Washington DC Dystocia Attorney
The Rich Firm, PC attorneys have represented a number of clients suffering from dystocia due to abnormal deliveries. The term dystocia refers to a difficult or abnormal delivery and occurs in almost 20% of deliveries, whether due to fetal lie, breech presentation, abnormal uterine activity, or cephalopelvic disproportion. For the purposes of this discussion, we will focus on shoulder dystocia.
An unanticipated problem at birth, dreaded by obstetricians, shoulder dystocia is not uncommon when you consider that it occurs in 0.05% of deliveries in this country, affecting 20,000 births per year.
Shoulder dystocia refers to inability to deliver the shoulder after the head without delay, and is frequently the result of the anterior portion of the infant’s shoulder becoming lodged behind the mother’s pubic bone after delivery of the head. If dystocia results in a delay of delivery of the shoulders, it places the newborn at risk for cord entrapment, limitation of chest wall, and, should the problems with delivery persist, severe brain damage or death may occur within minutes if the fetal blood supply is compromised by compression.
Shoulder dystocia that occurs during birth is not anticipated, although a normal delivery typically results in the head emerging, and almost just as quickly, a retraction of the neck occurs and the cheeks of the infant will expand. At this point, the anterior shoulder may become entrapped by the maternal pubic bone, and if the physician is unable to free the shoulder within minutes, the infant may suffer irreversible hypoxic brain damage (lack of oxygen from compression of the blood supply) or death.
A common complication of shoulder dystocia is an injury of the nerves of the brachial plexus, which control function in the arm and hand. It the upper plexus is injured, the condition is known as Erb palsy, and lower plexus injuries are known as Klumpke palsy. Either condition may result in serious disability for a lifetime.
There are degrees and different definitions of shoulder dystocia, and the terminology reflects the complexity of management. If there is a time delay of less than 60 seconds between the delivery of head and shoulders, this may not be significant. However, should shoulder entrapment prevent delivery without intervention of the obstetrician, who must use special maneuvers to deliver the child, this is considered a true shoulder dystocia.Injuries may occur unavoidably or may be the result of the actions of the physician during the mother’s labor and delivery. Many studies have been conducted on management of this serious problem, but there is no consensus with respect to possible predictors of dystocia, prevention, avoidance of brachial plexus injury, or whether the injury is due to physician mismanagement or simply an unfortunate but inevitable result of this sequence in an otherwise normal delivery.
Although many physicians feel that shoulder dystocia is unpredictable and unavoidable even when care is at the highest level, the fact is that brachial plexus injuries will occur, and result in a lifelong debility. In fact, shoulder dystocia claims result in the second highest portion of obstetric malpractice payments, only exceeded by birth asphyxia claims.
Currently, babies who are large for dates, or have what is known as macrosomia, are at risk, and strategies that have been suggested have themselves resulted in many unnecessary caesarean sections, with attendant risks, complications, and higher economic cost. There are maneuvers to resolve shoulder dystocia when it occurs, but these techniques are not always successful with respect to elimination of injuries of the nerves to the arm or to other birth injuries. A tool has been developed to predict the risk of shoulder dystocia, and it is able to identify greater than 50% of women who will encounter dystocia during delivery. The question remains how to best manage this obstetrical urgency.
Consider Talking to an Experienced Washington DC Shoulder Dystocia Lawyer
If you or a family member has experienced this problem and would like to discuss the events of the delivery and any potential help with rehabilitation expenses and lifelong medical limitations, you should call for a consultation with one of our birth injury attorneys. We have several medical doctors on our staff, and they may be able to answer questions that remain unresolved for you.