Shoulder Dystocia Mismanagement: How Medical Errors Can Cause Birth Injuries

Childbirth is supposed to be a time of joy, supported by attentive and skilled medical care. But when emergencies like shoulder dystocia arise, every second counts, and how medical professionals respond can mean the difference between a safe delivery and lasting harm.

Shoulder dystocia is a serious complication that requires fast, experienced intervention. When mishandled, it can result in permanent injury to the baby, the mother, or both. If you or your child suffered preventable harm due to the mismanagement of shoulder dystocia, our birth injury attorneys can review your case for free. You may be entitled to take legal action.

What Is Shoulder Dystocia?

Shoulder dystocia is a serious childbirth emergency that occurs during vaginal delivery when the baby’s head is delivered, but one or both shoulders become stuck behind the mother’s pubic or tailbone. This prevents the rest of the body from being delivered with gentle guidance alone.

It is also defined as any delivery where more than 30 seconds pass between the head and body being delivered, or when the provider must perform specific maneuvers to free the baby’s shoulders.

Although considered an obstetrical emergency, shoulder dystocia is a relatively common complication. Obstetricians, midwives, and obstetrical nurses are trained to manage it in ways that minimize the risk of injury.

When handled correctly, most babies are delivered without lasting harm or with only temporary injuries that fully heal. However, improper management, such as using excessive force, traction, pulling, or twisting of the baby’s head or neck, can cause a severe nerve injury known as a brachial plexus injury. This may lead to long-term dysfunction, disability, or disfigurement of the shoulder, elbow, arm, or hand. 

Common Causes and Warning Signs

While shoulder dystocia can sometimes be unpredictable, in many instances, there are known risk factors and warning signs that increase the risk of shoulder dystocia. Qualified healthcare providers are often able to anticipate the risk before or during labor, and that’s exactly why these cases are rarely just “accidents.”

Several well-known risk factors should raise concern for shoulder dystocia. These include both prenatal and labor-related factors:

Prenatal Risk Factors:

• Large baby (fetal macrosomia), often estimated by ultrasound
• Gestational diabetes
• Type 1 or Type 2 diabetes
• Previous shoulder dystocia in an earlier delivery
• Prior history of large babies
• Maternal obesity before pregnancy
• Excessive weight gain during pregnancy
• Inadequate pelvic size
• Short stature (under 5’2”)

During Labor Risk Factors:

• Induction of labor
• Prolonged active labor (cervix dilating between 6 cm and 10 cm)
• Arrest of dilatation
• Prolonged pushing (over 3 hours for first-time mothers, over 2 hours for repeat deliveries)
• Use of vacuum or forceps
• Use of Pitocin
• Use of an epidural
• Failure of the baby to descend (arrest of descent)

When these red flags are present, responsible care means being prepared, through close monitoring, a strategic delivery plan, and having a C-section team on standby if vaginal delivery becomes unsafe for the mother or baby. In many situations, the standard of care also requires discussing the option of an elective C-section to help minimize the risk of injury.

How Should A Shoulder Dystocia be Managed if it Occurs?

A shoulder dystocia can be frightening for parents, but healthcare providers are trained to follow a specific, step-by-step protocol to ensure the safest possible outcome.

Typical management steps include:

• Announce the shoulder dystocia once the fetal head delivers, but the body does not follow.
• Stay calm and maintain an environment free of chaos or panic.
• Call for additional help; nurses will either use the intercom or verbally call “Shoulders.”
• Flatten the head of the bed to optimize positioning.
• Perform the McRoberts maneuver; nurses position themselves on each side of the mother, pushing her legs back to hyperflex the hips and create more space in the pelvis. Most shoulder dystocias resolve at this step.
• Apply suprapubic pressure if needed, using a fist or the heel of the hand just above the pubic bone. Note: Pressure applied on top of the belly is an improper technique.
• Attempt additional maneuvers if the baby still does not deliver, such as:
  • Rotational maneuvers to reposition the baby’s shoulders
  • Delivering the posterior arm first
  • Performing an episiotomy to widen the birth canal
• Consider an intentional clavicle fracture; in rare cases, breaking the baby’s collarbone can free the shoulder. This typically heals quickly.
• Proceed to C-section if all else fails, with a team member gently guiding the baby back up the birth canal to facilitate surgical delivery.

What Happens When It’s Mishandled

The safe resolution of shoulder dystocia depends on calm, decisive action and skilled technique. When the prescribed steps are not followed, the baby’s brachial plexus nerves can suffer permanent injury. Common errors include:

• Failing to recognize and announce the shoulder dystocia
• Not recommending a C-section despite clear risk factors or labor complications
• Not summoning additional nursing staff
• Improper positioning of the mother for the McRoberts maneuver
• Applying improper fundal (top of belly) pressure
• Performing maneuvers incorrectly
• Using excessive force, pulling, traction, or twisting during delivery attempts

Mismanagement can lead to a severe and permanent brachial plexus injury, such as Erb’s palsy or Klumpke’s palsy. These injuries often cause lasting dysfunction, disfigurement, and disability in the affected arm. Many children require extensive therapy and, in some cases, surgical intervention to regain as much function as possible.

These are not inevitable birth risks; they are frequently the result of poor clinical judgment or failure to follow established protocols. In such cases, the conduct may constitute medical negligence.

When Shoulder Dystocia Becomes Medical Negligence

Not every birth injury related to shoulder dystocia is the result of malpractice. Some complications occur despite reasonable care. However, when healthcare providers fail to recognize risk factors or respond appropriately, their actions, or inaction, may rise to the level of negligence.

Studies show that shoulder dystocia is often underreported, and in many cases, providers omit the term entirely from the medical chart.

Negligence may be involved if the provider:

• Ignored or failed to prepare for known risk factors, such as fetal macrosomia or a history of shoulder dystocia
• Used excessive force, traction, pulling, or other improper delivery techniques that increased the risk of injury
• Failed to convert to a C-section despite clear signs that vaginal delivery was unsafe
• Did not ensure experienced personnel were present for a known high-risk delivery
• Failed to communicate effectively during a critical stage of labor and delivery

In such cases, poor medical decisions or a lack of timely action can lead to life-altering harm. Families facing these outcomes deserve clear answers and accountability.

Compensation for Shoulder Dystocia Birth Injuries

When a child is injured due to mismanaged shoulder dystocia, the consequences can last a lifetime. A medical malpractice lawsuit can provide financial relief to help your family move forward and ensure your child gets the care they need.

Potential damages may include:

• Medical expenses for surgeries, rehabilitation, and long-term care
• Ongoing therapy and assistive services to support development
• Pain and suffering experienced by the child
• Loss of future earning potential if the injury causes permanent disability
• Emotional distress and psychological toll on the parents
• Home or vehicle modifications and other disability-related costs

Given the complexity and high stakes involved, it’s crucial to work with a birth injury attorney who has the resources, medical knowledge, and trial experience to fight for full compensation.

Contact Morgan & Morgan Today

If your baby was injured during delivery due to mismanaged shoulder dystocia, don’t wait to seek answers. You may not have been given the full story. Even if no one told you a shoulder dystocia occurred, weakness or limited use of your newborn’s arm could be a sign of it. At Morgan & Morgan, we understand the devastating impact these cases can have, and we’re here to help.

Contact us today for a free case review. If medical negligence played a role in your child’s injury, our experienced birth injury attorneys may be able to fight for the justice and compensation your family deserves.