Shoulder Dystocia: When a Baby’s Shoulder Gets Stuck During Delivery

Shoulder dystocia is a serious birth complication that occurs when a baby’s shoulder becomes lodged behind the mother’s pelvic bone during vaginal delivery. This emergency requires immediate action from the medical team to prevent severe injury to the newborn. When healthcare providers fail to anticipate, prepare for, or properly manage shoulder dystocia, the results can include permanent nerve damage, brain injuries from oxygen deprivation, and other life-altering complications. Learning what happened during your child’s birth is the first step toward getting answers—and getting your family the support you deserve.

If your baby suffered injuries during a difficult delivery involving shoulder dystocia, you may have legal options. A birth injury attorney can review your medical records at no cost and help you understand whether medical negligence played a role in your child’s injuries. Because statute of limitations deadlines restrict how long you have to file a claim, it’s important to get answers sooner rather than later. Contact a birth injury lawyer today for a free, confidential case evaluation.

On this page:

• What is shoulder dystocia
• Warning signs and risk factors
• How shoulder dystocia happens
• Common birth injuries from shoulder dystocia
• When shoulder dystocia becomes malpractice
• Proper management procedures
• Long-term effects on children
• Filing a shoulder dystocia lawsuit
• Finding a birth injury attorney
• Frequently asked questions

What Is Shoulder Dystocia?

Shoulder dystocia is an obstetric emergency that occurs when, after the baby’s head has been delivered, one or both shoulders become impacted against the mother’s pubic bone. The anterior shoulder (the one facing toward the mother’s abdomen) typically becomes wedged behind the pubic symphysis, preventing normal delivery of the rest of the body.

This complication affects approximately 0.6% to 1.4% of all vaginal deliveries, though rates can be significantly higher in pregnancies with certain risk factors. The condition creates urgency because once the head is delivered, the umbilical cord can become compressed in the birth canal, cutting off the baby’s oxygen supply. Medical teams typically have only a few minutes to resolve the impaction before the risk of brain damage from oxygen deprivation increases substantially.

Shoulder dystocia is considered unpredictable in some cases—even pregnancies without identified risk factors can experience this complication. However, when healthcare providers fail to recognize warning signs, don’t properly prepare for the possibility in high-risk deliveries, or use excessive force or improper techniques when the complication occurs, preventable injuries can result.

The diagnosis is made clinically during delivery when normal downward traction on the baby’s head fails to deliver the anterior shoulder. The baby’s head may retract against the perineum immediately after delivery—a sign called the “turtle sign”—which indicates that the shoulders are impacted.

Warning Signs and Risk Factors for Shoulder Dystocia

While shoulder dystocia can occasionally occur in pregnancies without risk factors, certain conditions substantially increase the likelihood of this complication. Healthcare providers have a responsibility to identify these risk factors during prenatal care and labor, and to prepare accordingly.

Maternal Risk Factors:

Maternal diabetes, both pre-existing and gestational, significantly increases shoulder dystocia risk. Elevated blood sugar levels can cause the fetus to grow disproportionately large, particularly in the shoulder and trunk area. Women with diabetes face approximately two to four times the risk of shoulder dystocia compared to non-diabetic mothers.

Maternal obesity (BMI over 30) correlates with increased shoulder dystocia rates, as does excessive weight gain during pregnancy. Previous shoulder dystocia in an earlier pregnancy dramatically increases the recurrence risk—studies show recurrence rates between 10% and 25% for mothers who experienced this complication before.

Advanced maternal age, short stature, and certain pelvic bone structure variations also contribute to risk. Additionally, labor abnormalities such as prolonged first or second stage of labor can signal cephalopelvic disproportion that may extend to shoulder delivery.

Fetal Risk Factors:

Fetal macrosomia—when the baby weighs more than 8 pounds, 13 ounces (4,000 grams) at birth—is the most significant fetal risk factor. The risk increases substantially with babies weighing over 9 pounds, 15 ounces (4,500 grams). However, it’s important to note that most shoulder dystocia cases occur in babies of normal birth weight, and most large babies deliver without complication.

Post-term pregnancy (beyond 42 weeks gestation) increases macrosomia risk and consequently shoulder dystocia likelihood. Male infants face slightly higher risk than female infants, possibly due to differences in shoulder width relative to head circumference.

Labor and Delivery Risk Factors:

The use of vacuum extraction or forceps during delivery can increase shoulder dystocia risk, particularly when these instruments are used to overcome delivery resistance rather than simply guide a baby who is already descending well. Prolonged second stage of labor and labor induction, especially in women who haven’t given birth before, also correlate with increased rates.

If your healthcare provider identified these risk factors during your pregnancy but failed to discuss them with you or prepare for potential complications, that lack of informed consent and preparation could constitute negligence. A birth injury attorney can review whether your medical team took appropriate precautions given your specific circumstances.

How Shoulder Dystocia Happens During Delivery

Shoulder dystocia occurs when the dimensions of the baby’s shoulders exceed the capacity of the mother’s pelvic outlet. After the baby’s head emerges through the vaginal opening, normal delivery progression would have the shoulders rotating into position to pass through the pelvis. With shoulder dystocia, this rotation doesn’t occur properly, and the anterior shoulder becomes trapped.

The head delivers because it’s the widest part that must pass through the pelvis during most deliveries. However, in some babies—particularly those with macrosomia—the shoulder width (bisacromial diameter) may be disproportionately large compared to the head circumference (biparietal diameter). This creates a situation where the head can navigate the pelvis, but the shoulders cannot follow without intervention.

Several mechanisms can contribute to the impaction. The anterior shoulder may become lodged above the pubic symphysis (the joint at the front of the pelvis), while the posterior shoulder either enters the pelvis or remains above the pelvic inlet. Less commonly, both shoulders remain above the pelvic inlet, though this is typically associated with very large babies or significant cephalopelvic disproportion.

The position of the baby during labor can also influence shoulder dystocia risk. Babies in occiput posterior position (facing toward the mother’s abdomen rather than her back) during labor may be more prone to shoulder impaction, as this position can affect how the shoulders align for delivery.

Once the head delivers and the shoulders become impacted, time becomes critical. The umbilical cord is compressed between the baby’s body and the maternal pelvis, cutting off oxygen supply. Additionally, vagal stimulation from pressure on the baby’s neck can cause heart rate slowing. Medical teams generally have approximately 4 to 7 minutes to resolve the dystocia before the risk of permanent brain damage from oxygen deprivation becomes significant.

Understanding the mechanics of shoulder dystocia helps explain why proper management techniques are so important—and why the use of excessive traction or improper maneuvers can cause serious injuries even while attempting to resolve the emergency.

Common Birth Injuries Caused by Shoulder Dystocia

When shoulder dystocia occurs, the baby faces immediate risk from oxygen deprivation, and improper management techniques can cause mechanical injuries to the nerves, bones, and other structures. The most common injuries include:

Brachial Plexus Injuries

Brachial plexus injury is the most frequent complication of shoulder dystocia, occurring in approximately 4% to 40% of shoulder dystocia cases depending on severity and management. The brachial plexus is a network of nerves running from the spinal cord through the neck and into the arm, controlling movement and sensation in the shoulder, arm, hand, and fingers.

When excessive lateral traction (pulling) is applied to the baby’s head and neck during attempts to dislodge the impacted shoulder, these delicate nerves can stretch, tear, or even rupture completely. Erb’s palsy, which affects the upper brachial plexus nerves (C5-C6), is the most common form of this injury, resulting in weakness or paralysis of the shoulder and upper arm.

While some brachial plexus injuries from shoulder dystocia resolve within weeks or months, severe cases involving nerve rupture or avulsion (where the nerve root tears away from the spinal cord) can result in permanent disability requiring multiple surgeries and lifelong therapy. These severe injuries are often associated with excessive force during delivery rather than the shoulder dystocia itself.

Hypoxic-Ischemic Encephalopathy (HIE)

When shoulder dystocia prolongs delivery beyond several minutes, the compressed umbilical cord can deprive the baby’s brain of oxygen, resulting in hypoxic-ischemic encephalopathy. This form of brain damage can range from mild to severe and may lead to developmental delays, cerebral palsy, seizure disorders, and cognitive impairments.

The risk of HIE increases the longer the impaction persists. Medical teams must work quickly but carefully to resolve shoulder dystocia—excessive force can cause brachial plexus injury, but unnecessary delay can result in brain damage. This balance makes proper training and adherence to established protocols critical.

Clavicle and Humerus Fractures

Fractures of the clavicle (collarbone) or humerus (upper arm bone) can occur during shoulder dystocia, either from the impaction itself or from delivery maneuvers. While these fractures typically heal well without long-term consequences, they can indicate that excessive force was applied during delivery attempts.

Intentional fracture of the clavicle is actually one of the recognized maneuvers for resolving shoulder dystocia in extreme situations where other techniques have failed and the baby’s life is at immediate risk. However, unintentional fractures occurring during routine traction attempts may suggest improper technique.

Other Potential Complications

Additional injuries can include facial nerve palsy from pressure during delivery attempts, skull fractures in rare cases, cephalohematoma (blood collection under the scalp), and various soft tissue injuries. Mothers can also experience significant injuries during shoulder dystocia, including severe perineal tearing, postpartum hemorrhage, and uterine rupture in extreme cases.

If your baby suffered any of these injuries following a difficult delivery where the shoulder became stuck, consultation with a birth injury attorney can help you understand whether the medical team’s actions or inactions contributed to the harm. Not all injuries from shoulder dystocia constitute malpractice, but improper management certainly can.

When Shoulder Dystocia Becomes Medical Malpractice

Shoulder dystocia itself is not inherently malpractice—it’s a recognized complication that can occur even with excellent prenatal care and delivery management. However, medical negligence can occur at several points: during prenatal care, during labor, and during the management of the dystocia emergency itself.

Failure to Identify and Respond to Risk Factors

Healthcare providers have a duty to identify risk factors for shoulder dystocia during prenatal care. When significant risk factors exist—particularly the combination of maternal diabetes and suspected fetal macrosomia—physicians should discuss delivery options with the mother, including the risks and benefits of attempting vaginal delivery versus scheduling a cesarean section.

Failure to perform appropriate prenatal monitoring, such as growth ultrasounds in diabetic pregnancies, can constitute negligence. Additionally, when ultrasound estimates suggest fetal weight over 9 pounds, 15 ounces in diabetic mothers or over 11 pounds in non-diabetic mothers, the American College of Obstetricians and Gynecologists (ACOG) suggests that cesarean delivery may be considered to avoid the risks associated with shoulder dystocia.

If your healthcare provider failed to monitor fetal growth appropriately, didn’t inform you of shoulder dystocia risks despite clear risk factors, or proceeded with vaginal delivery without discussion of alternatives when the baby was known to be very large, these failures could constitute a breach of the standard of care.

Improper Labor Management

Negligence can also occur during labor itself. Delayed C-section when labor fails to progress normally, especially in the presence of macrosomia or other risk factors, can increase the likelihood of shoulder dystocia and subsequent injury. Excessive use of Pitocin to force labor progression, or prolonged attempts at operative vaginal delivery with vacuum or forceps when the baby isn’t descending properly, can set the stage for shoulder impaction.

When fetal distress develops during labor—indicated by concerning heart rate patterns—but the medical team doesn’t perform a timely cesarean delivery, any resulting shoulder dystocia and associated injuries may be preventable harm.

Improper Management of the Shoulder Dystocia Emergency

The most common basis for malpractice claims related to shoulder dystocia involves how the medical team responded once the complication occurred. Use of excessive lateral traction on the baby’s head and neck—pulling too hard in an attempt to dislodge the shoulder—is the primary cause of brachial plexus injuries.

ACOG and other medical authorities have established clear protocols for managing shoulder dystocia. These protocols emphasize specific maneuvers performed in a systematic order, avoiding excessive force. When healthcare providers panic, fail to follow established protocols, or use outdated or inappropriate techniques, preventable injuries can result.

Specific examples of negligent shoulder dystocia management include:

• Applying excessive downward traction rather than using approved rotational maneuvers
• Continuing to pull on the head when initial gentle traction doesn’t immediately resolve the dystocia
• Failing to call for additional help immediately when shoulder dystocia is recognized
• Not documenting attempts at various resolution maneuvers, suggesting panic rather than systematic approach
• Failing to consider or perform appropriate maneuvers such as the McRoberts maneuver, suprapubic pressure, or rotational techniques
• Delaying episiotomy when it might provide necessary additional room for internal maneuvers

Additionally, failure to have appropriate personnel and equipment immediately available for shoulder dystocia management in high-risk deliveries can constitute negligence. Delivery room staff should be trained in shoulder dystocia protocols, and high-risk deliveries should include preparation for this potential complication.

Proper Management and Delivery Procedures for Shoulder Dystocia

Understanding proper shoulder dystocia management helps illustrate why certain injuries may indicate negligence. The standard of care involves systematic implementation of established maneuvers designed to dislodge the impacted shoulder while minimizing injury risk.

Initial Response

When shoulder dystocia is recognized (typically when normal gentle downward traction fails to deliver the anterior shoulder), the delivering provider should immediately call for help. A shoulder dystocia emergency requires additional nurses, an anesthesiologist, a pediatrician or neonatologist for newborn resuscitation, and potentially additional obstetricians.

Simultaneously, someone should note the time. Tracking elapsed time helps the team maintain awareness of increasing urgency as minutes pass without delivery.

The HELPERR Mnemonic

Many facilities teach the HELPERR mnemonic for systematic shoulder dystocia management:

H – Help: Call for additional personnel immediately.

E – Evaluate for episiotomy: While episiotomy doesn’t directly resolve bony impaction, it can provide room for internal maneuvers. It’s not automatically performed but considered based on need.

L – Legs (McRoberts maneuver): The mother’s legs are hyperflexed back toward her abdomen, flattening the sacrum and rotating the pelvis to increase the pelvic outlet diameter. This simple maneuver resolves a significant percentage of shoulder dystocia cases and should be attempted first.

P – Suprapubic pressure: An assistant applies downward pressure just above the mother’s pubic bone, attempting to dislodge and rotate the impacted anterior shoulder. This pressure is applied in a specific direction and should never involve pushing on the top of the uterus (fundal pressure), which can worsen the impaction and cause uterine rupture.

E – Enter maneuvers (internal rotation): If external maneuvers fail, the provider’s hand enters the vagina to attempt rotational maneuvers. The Rubin maneuver involves pushing on the baby’s shoulder from behind to rotate it forward. The Woods screw maneuver rotates the baby’s shoulders in the opposite direction, attempting to free the impacted shoulder.

R – Remove the posterior arm: The provider reaches into the vagina, locates the baby’s posterior arm, and sweeps it across the chest and out, reducing the shoulder diameter and often allowing delivery to proceed.

R – Roll the patient: Rolling the mother onto her hands and knees (Gaskin maneuver or all-fours maneuver) uses gravity and pelvic dimension changes to facilitate delivery.

Last Resort Maneuvers

If these standard interventions fail, more aggressive maneuvers may be necessary, including intentional clavicle fracture (cleidotomy), symphysiotomy (cutting the cartilage of the pubic symphysis), or even Zavanelli maneuver (pushing the baby’s head back into the vagina and performing emergency cesarean section). These extreme measures are rarely necessary when earlier maneuvers are performed correctly.

Avoidance of Excessive Traction

Throughout all maneuvers, the cardinal rule is avoiding excessive traction on the baby’s head and neck. Studies have demonstrated that brachial plexus injuries correlate with the amount of traction force applied. Gentle traction may be applied to guide the baby once maneuvers have released the impaction, but pulling hard in an attempt to force the shoulder past the obstruction causes nerve damage without resolving the emergency.

If your medical records show that appropriate maneuvers weren’t attempted in proper sequence, or if the documentation is sparse (suggesting the team didn’t follow systematic protocols), this may indicate substandard care. An experienced birth injury lawyer can have your records reviewed by obstetric experts to determine whether proper procedures were followed.

Long-Term Effects on Children Injured During Shoulder Dystocia

The long-term impact of shoulder dystocia injuries varies dramatically depending on what injuries occurred and their severity.

Brachial Plexus Injury Recovery

Many mild brachial plexus injuries (neuropraxia, where the nerve is stretched but not torn) recover spontaneously within three to six months. Babies showing early improvement—regaining some movement within the first few weeks—generally have favorable prognoses.

However, more severe injuries involving nerve rupture or avulsion often result in permanent disability despite surgical intervention. Children with these injuries may require multiple surgeries, years of physical and occupational therapy, and adaptive equipment. Functional limitations can include inability to raise the arm above shoulder level, weak grip strength, and noticeable size differences between the affected and unaffected limbs as the child grows.

Some children develop secondary complications such as shoulder contractures, bone growth abnormalities, and chronic pain. These complications can necessitate ongoing medical care throughout childhood and into adulthood.

Brain Injury Outcomes

When shoulder dystocia results in oxygen deprivation severe enough to cause HIE, outcomes depend on the severity and extent of brain damage. Mild HIE may resolve with minimal long-term effects, though some children experience learning difficulties that become apparent during school years.

Moderate to severe HIE can result in cerebral palsy, intellectual disabilities, vision and hearing impairments, epilepsy, and significant developmental delays. These children typically require extensive early intervention services, special education, ongoing therapy, and potentially lifelong care and support.

Bone Fracture Healing

Clavicle and humerus fractures from shoulder dystocia generally heal well in newborns, often without specific treatment beyond gentle handling and pain management. Most babies experience complete healing within weeks, with no long-term functional impairment. However, parents should be informed of the fracture and given appropriate care instructions.

Emotional and Financial Impact on Families

Beyond the child’s physical injuries, families affected by shoulder dystocia complications often experience significant emotional trauma and financial strain. Parents may struggle with guilt, anxiety, anger at the healthcare system, and grief over their child’s injuries and lost potential.

The financial burden can be overwhelming. Medical expenses for severe birth injuries can reach into the millions of dollars over a lifetime, including hospitalizations, surgeries, therapy, assistive devices, home modifications, and special education needs. Many families require one parent to reduce work hours or leave employment entirely to coordinate care and provide support.

This is why understanding your legal rights is so important. While no amount of compensation can undo your child’s injuries, a birth injury settlement or verdict can provide the financial resources your family needs to access the best possible medical care, therapy, and support services for your child’s future.

Filing a Shoulder Dystocia Birth Injury Lawsuit

If your child suffered preventable injuries during a delivery complicated by shoulder dystocia, you may have grounds for a medical malpractice lawsuit. Understanding the process can help you make informed decisions about pursuing legal action.

Determining Whether You Have a Valid Claim

Not every shoulder dystocia case involving injury constitutes malpractice. To have a valid claim, you must establish four legal elements:

• Duty: The healthcare providers owed a duty of care to you and your baby (established by the doctor-patient relationship).
• Breach: The providers violated the standard of care—they failed to do something a reasonably competent healthcare provider would have done in similar circumstances, or they did something a reasonable provider wouldn’t have done.
• Causation: The breach of duty directly caused your child’s injuries. This is often the most complex element in birth injury cases, requiring expert testimony to establish that different actions would have prevented the harm.
• Damages: Your child suffered actual harm resulting in economic costs (medical expenses, future care needs) and non-economic damages (pain, suffering, diminished quality of life).

An experienced birth injury attorney will have your medical records reviewed by qualified medical experts—typically obstetricians and neonatologists—who can evaluate whether the standard of care was breached and whether that breach caused your child’s injuries.

Understanding the Statute of Limitations

Every state imposes time limits for filing medical malpractice lawsuits, called statutes of limitations. These deadlines vary by state, and birth injury cases often have special provisions.

Many states have “tolling” provisions for minors, meaning the statute of limitations clock doesn’t start running until the child reaches age 18, or it’s extended for a period of years into the child’s minority. However, some states impose absolute deadlines regardless of the child’s age.

Additionally, some states apply a “discovery rule,” which starts the limitations period when the injury was discovered or reasonably should have been discovered, rather than when the malpractice occurred. This can be important in cases where birth injuries aren’t diagnosed until months or years later.

Because these laws are complex and vary significantly by jurisdiction, it’s important to consult with a birth injury attorney as soon as possible after you suspect medical negligence may have played a role in your child’s condition. Waiting too long could bar you from pursuing compensation, regardless of how strong your case might be.

The Lawsuit Process

Birth injury lawsuits typically follow this general timeline:

Free Consultation: You’ll meet with a birth injury attorney to discuss what happened during your child’s birth. The attorney will ask detailed questions about your pregnancy, labor, delivery, and your child’s condition.

Medical Record Review: If the attorney believes you may have a case, they’ll obtain your complete medical records from the hospital, prenatal care providers, and specialists who treated your child.

Expert Review: Qualified medical experts review the records to determine whether the standard of care was violated and whether that violation caused your child’s injuries. This expert opinion is necessary to pursue the case.

Filing the Lawsuit: If experts confirm malpractice occurred, your attorney files a legal complaint in the appropriate court, initiating the lawsuit.

Discovery: Both sides exchange information through written questions (interrogatories), document requests, and depositions (sworn testimony). Medical experts from both sides may be deposed.

Settlement Negotiations: Many birth injury cases settle before trial. Your attorney negotiates with the defendants’ insurance company to reach a fair settlement that compensates your family for all damages.

Trial: If settlement negotiations don’t produce an acceptable result, the case proceeds to trial where a jury hears evidence and determines whether malpractice occurred and what compensation should be awarded.

The entire process typically takes two to four years, though complex cases can take longer. Your attorney should keep you informed throughout and explain each step as it occurs.

Potential Compensation

Birth injury settlements and verdicts can include compensation for:

• All past and future medical expenses related to the injury
• Physical therapy, occupational therapy, and speech therapy costs
• Assistive devices and technologies
• Home modifications for accessibility
• Special education needs
• Lost earning capacity (compensation for the child’s diminished ability to earn income as an adult)
• Pain and suffering
• Loss of enjoyment of life
• Parental lost wages for time spent caring for the injured child

The specific value of your case depends on the severity of your child’s injuries, the strength of evidence showing malpractice, the long-term care needs, and other factors unique to your situation. An experienced attorney can help you understand what fair compensation might look like in your case.

Most birth injury attorneys work on contingency, meaning they don’t charge upfront fees and only receive payment if they recover compensation for your family. This arrangement makes legal representation accessible even when families are already facing financial strain from medical expenses.

Finding a Birth Injury Attorney for Your Shoulder Dystocia Case

Choosing the right attorney can significantly impact your case outcome. Birth injury cases require specialized knowledge of both medical and legal issues, so it’s important to find a lawyer with specific experience in this area.

What to Look For

When evaluating potential attorneys, consider:

Experience with Birth Injury Cases: Look for attorneys who focus specifically on medical malpractice and birth injury cases rather than general personal injury lawyers. Ask how many shoulder dystocia or brachial plexus injury cases they’ve handled and what results they achieved.

Access to Medical Experts: Successful birth injury cases require testimony from qualified medical experts. Ask whether the attorney has established relationships with obstetricians, neonatologists, and other specialists who can review your case and potentially testify.

Resources to Handle Complex Litigation: Birth injury cases can be expensive to litigate, requiring extensive expert testimony, medical record analysis, and sometimes medical illustrations or life care plans. Ensure the firm has sufficient resources to fully develop your case.

Track Record of Settlements and Verdicts: While past results don’t guarantee future outcomes, an attorney’s history of obtaining favorable settlements and verdicts in birth injury cases demonstrates their capability and reputation.

Communication and Compassion: You’ll work closely with your attorney for several years. Choose someone who communicates clearly, returns calls promptly, and demonstrates genuine concern for your family’s situation rather than simply viewing you as another case file.

Questions to Ask During Your Consultation

• How many birth injury cases have you handled?
• Have you specifically handled shoulder dystocia cases resulting in brachial plexus injuries?
• Who will actually work on my case—you or an associate?
• How do you communicate with clients throughout the process?
• What medical experts would you use to review my case?
• Do you work on contingency? What percentage do you charge?
• What expenses might I be responsible for if we don’t win?
• How long do you expect my case might take?
• What do you see as the strengths and challenges in my potential case?

Taking the First Step

If you believe your child’s injuries from shoulder dystocia could have been prevented with proper medical care, don’t wait to explore your legal options. Most birth injury attorneys offer free initial consultations with no obligation. This consultation gives you an opportunity to learn whether you have a potential case and what your options might be.

Remember that pursuing a birth injury lawsuit isn’t about revenge—it’s about accountability and securing the resources your child will need for the best possible future. The compensation from a successful case can mean the difference between struggling to afford necessary care and having access to the therapies, equipment, and support services that can maximize your child’s potential.

Contact a qualified birth injury attorney today to discuss your situation and learn about your family’s legal rights.

Frequently Asked Questions About Shoulder Dystocia Birth Injury