Shoulder dystocia

Shoulder dystocia is the usual cause of a baby getting stuck in the birth canal during delivery. The baby’s shoulder gets hung up on the mother’s pubic bone and the obstetrician has only a short time window to relieve the situation before the baby, mother or both are seriously injured. Sometimes shoulder dystocia can be predicted, sometimes it cannot. Even if it can be predicted, shoulder-dystocia injuries cannot always be avoided. Sometimes medical malpractice is at the root of a shoulder-dystocia injury but sometimes the most skillful obstetrician cannot prevent a shoulder-dystocia injury. Consequently, it is relatively easy for a negligent obstetrician’s attorney to blow smoke into the jury’s eyes and it takes a skillful plaintiff’s lawyer to distinguish a negligent case of shoulder dystocia injury from an unavoidable one.

A Cincinnati Ohio jury awarded Dylan Nitzsche and his parents $1,630,000 last week over a shoulder dystocia injury. In a previous pregnancy, Dylan’s mom had gestational diabetes, a problem seen in about 5% of pregnancies. Because gestational diabetes causes macrosomia, i.e., a big baby, it is a strong risk factor for shoulder dystocia. Even though the obstetrician was notified of this history, he did not take proper precautions monitoring Dylan’s mother during the pregnancy and did not perform a Cesarean section, even though she had requested one. Instead the obstetrician performed a vaginal delivery and injured Dylan in a failed effort to maneuver him out.

Why was Dylan’s case negligence but other cases of shoulder-dystocia injury are not? For one, careful monitoring and treatment of gestational diabetes reduces the risk of macrosomia and subsequent shoulder dystocia. For another, even though some shoulder-dystocia injuries can occur prior to any manipulation during vaginal delivery so that even Cesarean section won’t prevent every single shoulder-dystocia injury, Cesarean section prevents many of the injuries and, in this case, with the mother’s prior history of gestational diabetes and her request for one, a Cesarean section should have been performed.

Was the award excessive? Dylan was five-years old at the time of trial, so it’s safe to assume that his injury is permanent. He will have a partially paralyzed arm forever. Imagine a childhood in which Dylan will be stared at by his peers and in which he can’t fully participate in sports or any other activity that requires use of both arms. The handicap will follow him throughout his life, which may affect his choice of livelihood and how he is viewed by potential employers. Hopefully, Dylan will have the character to overcome his disability, as many others have. If not, the money won’t mean much anyway. But if he can work his way through this problem, this award will help him make up for some of the financial losses and the pain that he will surely have.

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lawyer and physician
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