Frischman & Rizza

Shoulder Dystocia
Medical Malpractice Attorneys in Pennsylvania

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Pennsylvania shoulder dystocia medical malpractice attorneys Craig Frischman & Bernard Rizza

Quick Facts


In an uncomplicated delivery, the baby’s torso is typically delivered within 60 seconds or less of the head exiting the birth canal.  Shoulder Dystocia occurs when one of the baby’s shoulders become stuck behind the maternal pelvic bones, thereby preventing delivery. Shoulder Dystocia requires additional maneuvers by the obstetrician or midwife to deliver the baby’s body when normal gentle downward traction on the baby’s head and neck fails to release the baby’s shoulder from being stuck behind the mother’s pelvic bones.   

Although largely unpredictable and unpreventable, there are several well recognized risk factors for Shoulder Dystocia.  These risk factors can be broken down as follows: 

Maternal Risk Factors for Shoulder Dystocia

  • Diabetes

  • Post-Dates Pregnancy

  • Maternal Obesity (BMI of 30 or more)

  • Prior Shoulder Dystocia

  • Advanced Maternal Age

  • Abnormal Pelvic Anatomy

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Fetal Risk Factors

  • Macrosomia

  • Male Gender

Labor Risk Factors

  • Prolonged Active Stage of Labor

  • Vacuum or Forceps Assisted Delivery

  • Pitocin Assisted Labor

  • Epidural Anesthesia

Shoulder Dystocia is a clinical diagnosis that must be suspected when the baby’s head retracts back into the birth canal after having emerged.  This is commonly referred to as a “Turtle Sign.”  

Once Shoulder Dystocia is recognized, emergent intervention is required to safely deliver the baby.  Time is of the essence with Shoulder Dystocia and delivery should occur as quickly as can be safely accomplished.  The risk of fetal death or brain damage increases significantly if the baby’s torso is not delivered within 5 minutes of the head. 

The obstetrical staff must be prepared to immediately appreciate the presence of Shoulder Dystocia and proceed through a series of well-established steps to safeguard the mother and baby.  First, the mother will be instructed to stop pushing, the obstetrical staff will summon additional medical help, and then several time proven maneuvers to deliver the baby will be attempted.  

Although there is no specific order in which these additional delivery maneuvers are required to be instituted, most obstetricians begin with the McRobert’s Maneuver.  This is a non-invasive maneuver that involves the hyperflexion of the mother’s hips and knees against her abdomen. By positioning the mother’s hips and knees in this fashion, it creates room between the bones of the mother’s pelvis to permit the baby’s torso to emerge from the birth canal.  If the McRobert’s Maneuver fails to deliver the baby’s torso, suprapubic pressure will be applied.  If both of these non-invasive maneuvers fail, there are several other more invasive maneuvers (Rubin’s and Wood’s Screw) that require the placement of a hand into the birth canal so as to permit the internal rotation of the baby or the delivery of the baby’s posterior arm to enable delivery to occur. 

In addition to fetal death and brain injury, Shoulder Dystocia also poses risk of significant neurologic injury to the baby.  While fortunately rare (only occurring in an estimated 1-20 percent of all Shoulder Dystocia cases), injury to the baby’s Brachial Plexus can be caused by Shoulder Dystocia.  

The Brachial Plexus is a bundle of nerves that originate primarily in the cervical spine and control muscle movement of the shoulder and arm.  Brachial Plexus injuries to a newborn baby can be caused by excessive traction on the baby’s head and neck while attempting to deliver a baby whose movement though the birth canal has become impeded by Shoulder Dystocia.  A Brachial Plexus injury can range from minor to severe and its hallmark sign is weakness to one of the baby’s arms.  Current statics indicate less than 10 percent of Brachial Plexus birth injuries result in permanent neurologic impairment.  Fortunately, most Brachial Plexus injuries suffered by babies during delivery will resolve with time and conservative treatment.  However, in the most severe cases, surgery where a nerve graft or nerve transfer is performed might be necessary.

If you believe your child has suffered due to shoulder dystocia medical malpractice, you may be entitled to compensation. Call our Pennsylvania shoulder dystocia medical malpractice attorneys today.