When Seconds Matter: Navigating the High-Stakes Complications of Shoulder Dystocia
Ashley Davis, BSN, RN, RNC-OB, C-EFM
Medical-Legal Expertise & Strategic Case Support | Defense Medical Exam Observers | Audit Trail Analysis | Experienced RN, crunchy mom & off-road enthusiast
As an experienced labor and delivery nurse, I’ve seen firsthand how unpredictable deliveries can be — and one of the most critical, time-sensitive complications we face is shoulder dystocia.
Picture this: labor is progressing well, and the baby’s head has just delivered. Everyone is breathing a sigh of relief—until the baby’s shoulder gets stuck behind the mother’s pelvic bone. That’s shoulder dystocia. It’s a rare but high-risk complication during vaginal delivery, requiring quick and skilled intervention to avoid severe outcomes for both mother and baby.
While it’s rare — happening in about 0.2-3% of deliveries — its impact can be significant.
Risk Factors
While shoulder dystocia can happen in any delivery, some factors increase the risk:
But here’s the catch: Even in the absence of these risk factors, shoulder dystocia can still occur, making constant vigilance essential in the delivery room.
How Do We Identify It?
When a shoulder dystocia occurs, it’s usually recognized after the baby’s head delivers but the body doesn’t follow. There’s often the "turtle sign"—where the baby’s head retracts slightly, signaling that the shoulders are stuck. This is a red flag for immediate action.
Consequences & Legal Implications
If not resolved quickly, shoulder dystocia can lead to serious outcomes, such as:
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For mothers, it can result in severe tearing, postpartum hemorrhage, and other complications.
From a legal perspective, understanding whether the risk factors were identified and managed appropriately and whether proper maneuvers were executed, can be the deciding factor in a medical malpractice case. This is where my role as a legal nurse consultant comes into play.
How I Add Value to Birth Injury Cases Involving Shoulder Dystocia
My team can assist with analyzing how or if negligence occurred, which often requires a deep understanding of both medical protocols and deviations from standard care.
Thorough Medical Record Review: I go beyond surface-level reading. I look for red flags — inconsistent documentation, delayed interventions, and missed warnings that could indicate negligence so you’re prepared, no matter what side you’re on.
Building Timelines That Matter: In birth injury cases, seconds count. I create detailed chronologies that lay out the delivery step-by-step, identifying exactly when things started to go wrong.
Expertise in Standard of Care: I know what protocols should have been followed and can highlight deviations in care that attorneys can use to build their case.
Medical Research Support: Need peer-reviewed studies or evidence to back up your claims? I’ve got you covered with the latest research on shoulder dystocia outcomes and proper interventions.
Birth injury cases, especially those involving shoulder dystocia, require more than just good lawyering — they demand in-depth medical knowledge. This isn’t just about documents — it’s about understanding what should have happened versus what went wrong and spotting the gaps that could be the difference between winning and losing a case.
If you’ve got a birth injury case involving shoulder dystocia on your desk (plaintiff or defense), I’m here to help you turn those records into a powerful case strategy. Let’s dive into the details and make sure every missed opportunity is uncovered — because when it comes to your client’s case, every second matters.
Shoulder dystocia is unpredictable, but the response doesn’t have to be. Want to ensure your case has the medical insight it needs? Let’s talk about how I can help.