Shoulder Dystocia During Delivery: When Can Medical Negligence Cause a Birth Injury?

Shoulder dystocia is a delivery complication that occurs when a baby’s head is delivered but one or both shoulders become lodged behind the mother’s pelvic bone. The situation can develop suddenly and requires prompt, coordinated action by the delivery team. Although many babies recover without lasting harm, shoulder dystocia can cause serious injuries when the baby’s body is subjected to excessive force or the medical team fails to respond appropriately.

Some shoulder dystocia injuries are unavoidable complications. Others may result from mistakes in recognizing the emergency, choosing appropriate delivery techniques, or applying excessive traction to the baby’s head and neck. These actions can injure the nerves that control movement in the arm and hand, and severe cases can involve additional trauma.

For California families whose newborns suffer preventable injuries during delivery, understanding how shoulder dystocia should be managed can help clarify whether medical negligence played a role. The California medical malpractice attorneys at Kalfayan Merjanian, LLP help families evaluate potential birth injury claims and understand their legal options when a delivery complication causes lasting harm.

What Is Shoulder Dystocia, and Why Is It an Emergency?

During a typical vaginal delivery, the baby’s head emerges first, followed by the shoulders and the rest of the body. With shoulder dystocia, the shoulders do not deliver normally after the head emerges. The baby may become stuck when a shoulder is caught against the mother’s pelvic bone or, less commonly, because both shoulders are lodged.

The complication requires immediate attention because the baby’s body cannot be delivered in the usual way. If delivery is prolonged, pressure on the umbilical cord or other factors may interfere with oxygen delivery. The risk depends on the circumstances, including how long the obstruction lasts and whether other complications develop.

Shoulder dystocia is not always predictable, and the condition sometimes occurs in pregnancies without recognized risk factors. However, certain factors, including maternal diabetes, a larger-than-average baby, a history of shoulder dystocia, and some labor patterns, can increase the risk.

The fact that shoulder dystocia happens does not automatically mean that a healthcare provider made a mistake. The important questions are whether the medical team appropriately assessed the circumstances, recognized the emergency, used accepted delivery techniques, and responded to any resulting injuries.

Should Healthcare Providers Recognize the Risk of Shoulder Dystocia Before Delivery?

Although shoulder dystocia cannot always be predicted, prenatal care and labor management can help providers identify situations in which the risk may be elevated. Providers may consider factors such as the mother’s medical history, gestational diabetes, previous delivery complications, and estimates of fetal size. When significant risk factors are present, the medical team should discuss appropriate delivery planning with the patient. Depending on the circumstances, that discussion may include the risks and benefits of vaginal delivery and cesarean delivery.

Estimating a baby’s size before birth is not exact, and a larger estimated fetal weight does not automatically mean a cesarean delivery is necessary. Clinical decisions depend on the overall circumstances and applicable medical guidance. The standard of care does not require providers to predict every shoulder dystocia event.

However, a failure to consider important risk factors or discuss reasonable delivery options may raise concerns in some cases. A review of the prenatal records, ultrasound findings, labor progress, and decisions made before delivery can help determine whether the medical team appropriately prepared for the possibility of complications.

How Should a Delivery Team Respond When Shoulder Dystocia Occurs?

Once shoulder dystocia is recognized, the delivery team must act promptly and coordinate its efforts. Providers generally use specific maneuvers designed to change the baby’s position or increase the available space for delivery, rather than relying on force to pull the baby through the obstruction.

Common techniques include the McRoberts maneuver, which involves repositioning the mother’s legs to help change the angle of the pelvis, and suprapubic pressure, which applies pressure above the pubic bone to help release the trapped shoulder. Depending on the situation, trained providers may use additional maneuvers to rotate the baby’s shoulders or deliver the posterior arm.

The appropriate technique depends on the circumstances, and the team may need to use more than one maneuver. Effective management also requires clear communication, awareness of elapsed time, and appropriate assistance from other members of the delivery team.

Certain actions can increase the risk of injury. For example, applying excessive downward or sideways traction to the baby’s head and neck can stretch the nerves that run from the neck into the shoulder and arm. Fundal pressure—pushing down on the top of the uterus—is generally avoided in shoulder dystocia because it can worsen the obstruction and increase the risk of injury.

A medical negligence claim may arise if providers use inappropriate techniques, apply excessive force, fail to respond to the obstruction, or otherwise depart from accepted standards of care. Determining whether a particular maneuver was appropriate requires

How Can Excessive Traction Cause a Newborn’s Nerve Injuries?

One of the most recognized injuries associated with shoulder dystocia is brachial plexus injury. The brachial plexus is a network of nerves extending from the spinal cord through the neck and into the shoulder, arm, and hand. These nerves transmit signals that control movement and sensation.

When a baby’s shoulder becomes trapped, excessive traction on the head and neck can stretch or damage these nerves. The severity can range from temporary nerve dysfunction to serious damage involving nerve tearing or separation from the spinal cord.

A newborn with a brachial plexus injury may have weakness or limited movement in one arm. The baby may not move the affected arm normally, have difficulty bending the elbow, or show differences in reflexes between the arms. Some injuries improve over time, while others require surgery, physical therapy, occupational therapy, or long-term follow-up.

The location and severity of the nerve damage affect the child’s prognosis. In serious cases, the injury can lead to lasting weakness, reduced range of motion, muscle imbalance, or impaired use of the hand and arm.

Not every brachial plexus injury proves that excessive traction occurred. These injuries can sometimes happen even when providers follow appropriate procedures. The medical and legal review must examine the delivery record, the maneuvers used, the documented forces and circumstances where known, and the nature of the newborn’s injury.

Can Shoulder Dystocia Cause Other Birth Injuries?

Although brachial plexus injuries are an important concern, shoulder dystocia can be associated with other complications. For instance, a difficult delivery can result in fractures of the collarbone or upper arm. These injuries often heal, but they still require medical assessment and treatment. In more serious cases, a prolonged or complicated delivery may contribute to oxygen deprivation and brain injury, particularly if the baby experiences significant problems with oxygen delivery or resuscitation.

The potential consequences vary considerably. Some babies recover fully from delivery-related injuries, while others need extensive treatment or experience permanent disabilities. The presence of a serious outcome, by itself, does not establish that medical negligence occurred.

When a newborn suffers an injury after shoulder dystocia, providers may need to evaluate the baby promptly, document neurological findings, assess arm movement and reflexes, and investigate signs of other trauma. Delays in identifying an injury can interfere with timely treatment and planning for rehabilitation.

How Can Families Determine Whether Shoulder Dystocia Was Managed Negligently?

A suspected shoulder dystocia birth injury requires more than a review of the final diagnosis. The key issue is whether the healthcare providers’ actions met the applicable standard of care and whether a departure from that standard caused or contributed to the injury.

An investigation may examine whether the team recognized shoulder dystocia promptly, which maneuvers were attempted, whether those techniques were appropriate, whether excessive traction or prohibited pressure was used, and how the team responded to signs of fetal distress. Prenatal risk assessment and delivery planning may also be relevant.

Important records can include labor and delivery notes, fetal heart rate monitoring, nursing documentation, medication records, neonatal examinations, and any imaging or nerve studies performed after birth. These materials can help establish a timeline and identify questions that require further evaluation.

Qualified medical experts can assess whether the delivery team followed accepted practices and whether a different response would likely have prevented or reduced the injury. For example, experts may evaluate whether excessive traction caused nerve damage or whether a failure to manage a complication appropriately contributed to oxygen deprivation.

A successful claim generally requires proof of negligence and causation. An injury occurring during shoulder dystocia is not enough on its own, because the complication can cause harm even when the medical team responds appropriately.

What Compensation May Be Available for a Shoulder Dystocia Birth Injury?

When medical negligence causes a birth injury, a child and family may face expenses and challenges that continue long after delivery. Depending on the injury, treatment may include specialist care, surgery, physical and occupational therapy, assistive equipment, and ongoing assessments of development and function.

A birth injury claim may seek compensation for past and future medical expenses, rehabilitation, and other reasonably necessary care. If the injury causes lasting impairment, the claim may also need to account for future support needs and the effect of the disability on the child’s life. Eligible claims can also include legally recoverable non-economic damages.

The value of a claim depends on the evidence, the nature and severity of the injury, the treatment required, and the child’s long-term prognosis. A careful assessment should consider the full impact of the injury rather than focusing only on the initial hospital stay.

California medical malpractice claims are subject to specific deadlines and rules, including special provisions that can apply when the injured person is a child. Families should seek legal guidance promptly to understand which deadlines apply to their circumstances.

How Can a Birth Injury Attorney Help?

Shoulder dystocia can be a frightening emergency, and families may not know whether a newborn’s injury resulted from an unavoidable complication or an error during delivery. Reviewing the medical records and consulting qualified experts can help clarify what happened and whether the care met accepted standards.

Kalfayan Merjanian, LLP, helps California families investigate suspected birth injuries and pursue accountability when preventable medical errors cause harm. If your child suffered a brachial plexus injury, fracture, or other serious complication during a shoulder dystocia delivery, contact the firm to discuss your concerns and learn about your family’s legal options.