Childbirth is a high-stakes event where every second and every decision matters. While most deliveries proceed without major complications, certain emergencies can arise that require immediate, expert intervention. One of the most frightening of these is shoulder dystocia.
Shoulder dystocia occurs when, after the baby’s head is delivered, one or both of the shoulders become wedged behind the mother’s pelvic bone (the pubic symphysis). It is a true obstetric emergency. Because the baby’s chest is compressed in the birth canal and the umbilical cord may be pinched, the baby is not receiving a steady supply of oxygen.
In the heat of this moment, the medical team’s reaction is everything. If the doctor or midwife panics or applies excessive traction, meaning they pull too hard on the baby’s head or neck, the results can be catastrophic and permanent.
The Turtle Sign: Recognizing the Emergency
Medical professionals are trained to identify the Turtle Sign. This happens when the baby’s head emerges from the birth canal but then immediately pulls back (retracts) against the mother’s pelvic bone, much like a turtle pulling its head into its shell.
This is the signal that the shoulder is stuck. At this point, the standard of care dictates that the provider must stop traditional pulling and immediately begin a series of specific, gentle maneuvers designed to reposition the baby or widen the pelvic opening.
The Danger of Excessive Traction
When a baby is stuck, the natural instinct of an untrained or panicked individual might be to pull harder to free the child. However, in obstetrics, pulling harder is never the solution for shoulder dystocia.
Applying excessive force to the baby’s head while the shoulder is anchored behind a bone creates a stretching effect on the delicate nerves in the neck. These nerves, known as the brachial plexus, control the movement and sensation of the arm, hand, and fingers.
The Levels of Nerve Injury
- Neuropraxia: The nerve is stretched but not structurally torn. While the arm may be temporarily paralyzed, the insulation of the nerve is intact, allowing for a full recovery in most cases.
- Axonotmesis (Partial or Full Tear): This occurs when the internal nerve fibers are damaged. Depending on whether the outer protective sheath remains intact, the nerve may or may not be able to regenerate. These injuries often require surgical exploration and physical therapy.
- Avulsion (The Most Severe): This occurs when the nerve is physically pulled out of the spinal cord. This is a permanent, catastrophic injury that often leads to lifelong paralysis of the affected limb.
Similar Post: What Are the Long-Term Impacts of Brachial Plexus Injuries in Newborns?
Preventable Injuries Caused by Improper Pulling
If a medical team fails to manage shoulder dystocia correctly and uses too much force, the baby may suffer from several life-altering conditions:
1. Erb’s Palsy
This is the most common result of excessive traction. It involves damage to the upper brachial plexus nerves. A child with Erb’s Palsy may have an arm that hangs limp, a “waiter’s tip” hand position, and an inability to lift their arm or bring their hand to their mouth.
2. Klumpke’s Palsy
This rarer condition involves damage to the lower nerves of the brachial plexus. It primarily affects the forearm and hand, often resulting in a claw-like appearance of the hand and a lack of fine motor control.
3. Bone Fractures
The force of pulling can also cause the baby's collarbone or upper arm bone to snap. While bones often heal more easily than nerves, these fractures are frequently a red flag that the doctor used inappropriate force during the delivery.
4. HIE and Brain Damage
If the team takes too long to resolve the dystocia or fails to perform an emergency C-section when maneuvers fail, the baby can suffer from Hypoxic-Ischemic Encephalopathy (HIE) due to prolonged oxygen deprivation.
What Should the Medical Team Have Done Instead?
Medical malpractice occurs when a provider deviates from the standard of care. For shoulder dystocia, the standard of care involves a specific set of maneuvers (often remembered by the acronym HELPERR):
- McRoberts Maneuver: Folding the mother’s legs back toward her chest to flatten the pelvis.
- Suprapubic Pressure: Applying pressure just above the mother's pubic bone to manually push the baby’s shoulder down and under the bone.
- Internal Rotation: The doctor reaches in to rotate the baby's body like a corkscrew.
- Delivery of the Posterior Arm: Reaching in to find the baby’s free arm and delivering it first to reduce the width of the shoulders.
If your doctor did not attempt these maneuvers and instead relied on pulling, or if they applied fundal pressure (pushing on the top of the stomach, which actually jams the shoulder further into the bone), they may be liable for medical negligence.
The Long-Term Cost of a Seconds-Long Mistake
A brachial plexus injury isn't just a weak arm. It can mean a lifetime of:
- Daily physical and occupational therapy.
- Multiple painful nerve graft or muscle transplant surgeries.
- Permanent disability and loss of earning potential.
- Emotional trauma for both the child and the parents.
Because these injuries happen in a matter of seconds, hospitals often try to claim they were unavoidable complications. However, detailed medical records and the nature of the injury itself often prove otherwise.
Similar Post: Low Apgar Scores And NICU Transfer: What They Can Mean For A Birth Injury Case
Hold Negligent Providers Accountable: Contact Anapol Weiss
No family should have to pay the price for a medical professional's panic or lack of training. If your child was born with Erb’s Palsy, a fractured arm, or any neurological deficit following a difficult delivery, you deserve answers.
At Anapol Weiss, we are leaders in birth injury litigation. With over 45 years of experience and headquarters in Philadelphia, our team knows how to dismantle the "unavoidable accident" defense used by hospitals. We work with the nation’s top obstetric experts to review delivery room records and determine if the force used on your child was excessive.
Why Families Trust Anapol Weiss:
- Decades of Experience: We have successfully handled complex shoulder dystocia and brachial plexus cases across Pennsylvania and nationwide.
- Billions Recovered: We fight for the maximum compensation to cover your child’s lifelong medical needs, surgeries, and therapies.
- Compassionate Advocacy: We handle the legal burden so you can focus on your child’s care.
- Contingency Fee Guarantee: You will never pay an hourly rate or upfront cost. We only get paid if we win your case.
Your child’s future depends on the actions you take today. Call us at 866-944-0553 or contact us online for a free, no-obligation consultation. Let us help you secure the justice and resources your family needs.
Our firm represents families nationwide, including Pennsylvania. If you reside in Philadelphia County, Bucks County, or Delaware County and believe your child suffered a baby birth injury, we can help.
Disclaimer: This blog is intended for informational purposes only and does not establish an attorney-client relationship. It should not be considered as legal advice. For personalized legal assistance, please consult our team directly.