At Sommers Roth & Elmaleh in Toronto, we have been helping families affected by medical errors, including the failure to diagnose serious medical conditions, for more than 40 years. We are extremely technically proficient and very knowledgeable about Canada’s medical system and how it interacts with the law. We have an excellent record of obtaining substantial financial compensation for our clients and are well-regarded and respected as leaders in the field.
In addition to being passionate advocates for our clients’ rights, we are equally passionate about educating our clients and regularly provide them with the resources they need to better understand what may have happened to their child, and what they can do to move forward.
This week, we look at 25 facts about shoulder dystocia, including factors that may help predict it, how to properly address it during delivery, and what legal recourse parents can have if it is not.
- Shoulder dystocia is a complication that occurs during delivery when one or both of the baby’s shoulders become lodged in the birth canal, often because the baby is proportionately too large to fit through.
- It can also occur when a baby is positioned in such a way that it makes it difficult for them to exit the birth canal, such as face-first or feet-first.
- Indicators of shoulder dystocia during delivery are that the baby’s face may be red and puffy face once the head is visible, and what is known as the ‘turtle sign’, which is when the head appears and then retracts back into the birth canal.
- Due to time sensitivity, doctors may panic in a delivery involving shoulder dystocia and pull or maneuver the baby too strenuously, resulting in injury to the baby.
- When attempting to free the baby from the birth canal, physicians may cause injuries such as brachial plexus palsy, broken bones, and facial injuries.
- Neonatal brachial plexus palsy occurs when the network of nerves that sends signals from your spinal cord to your shoulder, arm and hand (the brachial plexus) becomes injured through excessive stretch, resulting in numbness or weakness or even permanent loss of movement in the arm on that side.
- Horner’s syndrome is an injury characterized by facial asymmetry most often in the eyes. The affected eye can have a smaller pupil, a droopy eyelid or elevated lower lid, and the iris may be a lighter colour than the non-affected eye.
- Shoulder dystocia also presents possible health implications for the mother, such as hemorrhaging, uterine rupture and lacerations.
- Shoulder dystocia occurs in approximately 1 in every 200 births
- Shoulder dystocia is more likely to occur in births where one or more of the following factors are present:
- Maternal diabetes
- Prolonged labour and delivery
- Induced labour
- Maternal obesity
- Epidural use
- Fetal macrosomia (a newborn with a birth weight of 8 lbs., 13 oz. or higher)
- Past deliveries with shoulder dystocia
- In cases where one or more of the previously listed factors are present, it is advisable that the medical team take steps that will better enable them to handle shoulder dystocia should it occur.
- These steps can include ensuring additional staff members are on hand at the time of delivery, preparing additional anesthetic, and selecting an OB-GYN with experience in treating shoulder dystocia.
- It is critical that doctors and staff react quickly if shoulder dystocia occurs because once delivery has begun, the baby cannot breathe properly until their entire body has been fully delivered.
- There are recommended procedures in place if shoulder dystocia occurs during delivery, and if executed properly, they can help prevent injury to both the baby and the mother.
- The McRoberts maneuver involves hyper flexing the mother’s legs tightly against her abdomen, which allows for rotation of the pelvis and can assist in releasing the baby’s shoulder from where it is stuck.
- If that maneuver is unsuccessful on its own, pressure can be applied to the lower abdomen (also known as suprapubic pressure) to facilitate freeing the shoulder.
- It is critical not to pull on the baby’s head or limbs, but rather to use gentle pressure to reposition the baby so that it can be delivered safely. Aggressively pulling or shifting the baby is the primary cause of injuries in these types of cases.
- In some instances, an episiotomy may provide more room to maneuver the baby through the birth canal.
- When injury results, treatment may be possible where the brachial plexus nerves are ruptured rather than torn completely. In cases of rupture, a nerve graft may help to repair the damage caused. If the nerve has been torn completely, this treatment will not be an option.
- Other methods may help to restore some function, such as aggressive physiotherapy and occupational therapy, or surgical intervention.
- In cases of injury due to shoulder dystocia, victims may be entitled to compensation where doctors failed to recognize common risks or failed to take the necessary steps to address the issue once it became apparent.
- In addition to compensation for the injuries themselves, there may also be an entitlement to special damages to address past and future income loss, necessary home modifications, attendant care services or even the purchase of a new home closer to necessary medical services.
- If you think you or your child suffered injuries related to shoulder dystocia, you may have grounds for a lawsuit that could allow you to receive compensation to provide financial security for yourself and your family.
- Many children with obstetrical brachial plexus palsy caused by shoulder dystocia are treated in Toronto’s Hospital for Sick Children (Sick Kids) Brachial Plexus Clinic (a subdivision of plastic surgery)
- Sick Kids Brachial Plexus clinic is headed Dr. Howard Clarke (a plastic surgeon), Dr. Kristen Davidge and Dr. Sevan Hopyan. It has been around for over 30 years. The Brachial Plexus Programme at the Hospital for Sick Children is the largest in Canada and developed both the Active Movement Scale and the ‘Cookie Test’.
At Sommers, Roth & Elmaleh, our goal is to protect the rights of children and parents whose lives have been impacted by shoulder dystocia resulting from the medical team failing to properly prepare in situations where it is more likely, or failing to follow the steps that can help to facilitate the birth without injury. Over the years, our lawyers have won some of the largest medical malpractice awards in Canadian history for our clients. We offer contingency fee agreements. Call us at 1-844-777-7372 or contact us online for a free consultation.
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