|August 2006 · Vol. 18, No. 8
Shoulder dystocia: What is the legal standard of care?
It’s your job to educate the jury that, even in the best of hands, permanent brachial plexus injuries can occur
Women with gestational diabetes and/or a macrosomic fetus are at highest risk for shoulder dystocia
Even in women at highest risk, the odds of having an infant with permanent brachial plexus injury are roughly 1 in 450
Discuss and consider cesarean section for all women whose infants are estimated to weigh >5,000 g, or >4,500 g in women with diabetes
We lack evidence that any of the 4 main maneuvers is superior—or that they should be used in a specific sequence
The obstetrician has 4 to 6 minutes to resolve shoulder dystocia before the threat of central neurologic injury is significant
You must be able to show—years later—that you:
A new model may predict 50% to 75% of all women destined to have shoulder dystocia
Clinical Instructor in Obstetrics and Gynecology, Harvard Medical School, Newton-Wellesley Hospital, Newton, Mass
No matter how excellent the care you provide, you have good reason to worry about shoulder dystocia. It is one of the most difficult and frightening complications, and is essentially unpredictable and unpreventable. It can happen even in apparently routine deliveries, and can cause permanent injury to the child despite the best possible care by experienced obstetricians.
If permanent injury occurs after shoulder dystocia, it can also trigger a lawsuit that can last for years and end in a large jury verdict—even if you handled the case with textbook perfection. Lawsuits involving brachial plexus injuries following shoulder dystocia are now the second most common type of lawsuit in obstetrics, exceeded only by those due to neurologic damage from birth asphyxia.1 Brachial plexus injury is often difficult to defend in court and results in scores of millions of dollars in damages each year. The plaintiff is usually a lovely child with an obvious and permanent injury, and the defense is typically an undocumented claim that the obstetrician applied no undue force at delivery.(Sidebar)