A brachial plexus injury that occurs to an infant during the birthing process can occur when a baby’s shoulders are too big to descend down the birth canal. The term “dystocia” is a general obstetrical term that means a difficult birth, typically caused by a large or awkwardly positioned fetus, by smallness of the maternal pelvis, or by failure of the uterus and cervix to contract and expand normally.
More specifically, “shoulder dystocia” refers to the obstetrical complication and emergency that arises when a shoulder of the infant is incapable of passing freely below the pubic symphysis or requires significant physical manipulation to pass below the pubic symphysis. It is diagnosed when the shoulders fail to deliver shortly after the fetal head. It can be diagnosed, on occasion, by the presence of the “turtle sign” referring to the presentation and retraction of the infant’s head from the mother’s vagina. Shoulder dystocia is an obstetrical emergency and fetal death can occur if the infant is not delivered in a timely fashion. The death of the infant is caused by the partial or total occlusion of the umbilical cord within the birth canal.
A child can avoid permanent injury if the shoulder dystocia is appropriately and timely addressed by the Doctor and/or Midwife. There are certain maneuvers that are available to the Doctor and/or Midwife that can successfully release the shoulder of the infant. If the proper maneuvers are employed, the impacted shoulder can be dislodged without injury. However, due to panic or poor training, injuries result from the Doctor’s and/or Midwife’s failure to employ the appropriate maneuvers and in the proper sequencing of these maneuvers. Further, the Nurses involved in the deliver can also deviate from their standard of care and cause or contribute to cause this permanent neurologic injury to the child.
In evaluating a brachial plexus case, it is imperative that the attorney fully understand the maneuvers available to the medical practitioner and how they should be employed during these obstetrical emergencies. The following maneuvers and medical interventions are available to the medical practitioner in an effort to successfully deliver the impacted shoulder without permanent injury:
- McRoberts maneuver
- suprapubic pressure
- Rubin II
- Wood-Screw maneuver
- Reverse Wood-Screw
- Rubin II Maneuver with Wood-Screw maneuver
- Posterior arm delivery
- Gaskin Maneuver
- Episiotomy
- Intentional Clavicle Fracture
- Zavanelli Maneuver
- Symphysiotomy
- Cesarean Section
Problems arise and injuries occur often when an Obstetrician and/or Midwife fails to employ the maneuvers in the right sequence and to cycle through them twice before resorting to other approaches. What often happens, is that the Obstetrician and/or Midwife fails to use the right maneuvers and instead simply applies too much downward traction in an attempt to deliver the impacted shoulder. This moderate to severe downward traction applied by the Obstetrician or Midwife, stretches the brachial plexus never roots and can actually cause them to be ripped out of the spinal column. When the nerve roots are ripped from the spinal column, this is known as an avulsion. Even if the nerves are not avulsed, they can be stretched causing a permanent neurologic injury in the child. However, if the nerves are not too severely stretched, they can recover with time. However, severely stretched and avulsed nerves will often not fully recover and will require surgical intervention in an attempt to mitigate the damage and attempt to allow for better range of motion. Often, the pediatric and plastic surgeons will perform a nerve transfer surgery and/or a muscle and tendon release in an attempt to allow for better range of motion and sense of touch and feel.
It is also important to understand that Shoulder dystocia can be caused by one or more risk factors that can present and be identified during the prenatal period, as well as, the labor and delivery periods. Your attorney must understand the medicine in order to accurately evaluate where the medical practitioner’s failure or failures occurred. It may be that your deliver should never have been attempted vaginally, but rather by way of cesarean section. Two of the major risk factors during the prenatal period are gestational diabetes and maternal obesity. Obstetrical practitioners debate as to which one of these factors is a greater risk factor for the possibility of a shoulder dystocia occurring during delivery. The reason these risk factors are so concerning is that it can affect the development of the fetus. A child can become macrosomic and therefore too big to descend down the birth canal. Therefore, it may be that a child should have been delivered by way of cesarean section. These issues can be fully investigated by obtaining the prenatal records and test results. Moreover, risk factors can result from medical interventions taken during the labor process itself. Therefore, you must have an attorney that fully understands what records to obtain and what issues should be highly scrutinized leading up to the ultimate manual or instrument assisted delivery. If the attorney is not well versed in the medicine, they may miss the fact that the delivery should never have been attempted vaginally.
A permanent brachial plexus injury will seriously interfere with the growth of the child’s arm and will forever result in the partial or complete loss of use of the affected extremity. The child, throughout his or her life, will realize a significant interference in their enjoyment of life. The child will also experience a reduction not only in their work life expectancy, but also a significant decrease in their life earnings. Their physical disability will result in their need for specialized equipment and possible permanent orthotics. If their injury is the result of negligence, then the injured child is entitled to financial compensation to offset their lost income, future and past medical bills, past and future pain and suffering, the loss of their enjoyment of life and for their disfigurement. All of these damages are recognized by Illinois law and the injured child is entitled to recover for these damages in the face of negligence. All jurisdictions in the United States recognize these damages in various ways.
When you are seeking an attorney to litigate your child’s case, you must make sure that he or she is well versed in the medicine. Moreover, they must have extensive experience in litigating medical malpractice claims because the process is very complicated. Further, you need to make sure that the attorney utilizes extremely reputable experts that are highly experienced in the medical-legal issues involved in the case. The experts must be highly skilled and honest so that you are fully aware of the issues in the medical malpractice case or if there is really a legal case that should be brought to court. It is important to recognize that when undertaking to prosecute a medical practitioner for malpractice, it is imperative that your expert is reputable and honest. All of the aforementioned considerations should be in the back of your mind when seeking an attorney to represent you in your medical malpractice claim.