What is shoulder dystocia?
Shoulder dystocia is defined as a delivery in which additional obstetric manoeuvres are required to deliver the baby's shoulders after the head has been delivered. It occurs in approximately 0.6–0.7% of vaginal deliveries. Without prompt and correct management it can cause:
- Brachial plexus injury (Erb's palsy or total plexus palsy) — from excessive lateral traction on the baby's head
- Hypoxic brain injury — from compression of the umbilical cord and inability to deliver the baby
- Fractured clavicle or humerus in the baby
- Maternal perineal injury and haemorrhage
What are the standard manoeuvres for shoulder dystocia?
RCOG Green-top Guideline 42 sets out the required response. Call for help immediately — senior midwife, obstetrician, neonatologist, and anaesthetist.
First-line manoeuvres:
- McRoberts manoeuvre — hyperflexion of the mother's thighs against her abdomen to widen the pelvis
- Suprapubic pressure — constant or rocking pressure over the pubic bone to dislodge the anterior shoulder
Second-line manoeuvres if first-line fails:
- Internal rotational manoeuvres — Woods screw and Rubin II to rotate the anterior shoulder out of impaction
- Delivery of the posterior arm
- All-fours (Gaskin) position
Last resort: Zavanelli manoeuvre — replacement of the baby's head into the uterus followed by caesarean section.
When is shoulder dystocia management negligent?
A claim arises when the midwife or obstetrician:
- Applied excessive lateral (sideways) traction to the baby's head — the single most common cause of brachial plexus injury in shoulder dystocia
- Failed to call for help promptly
- Failed to perform McRoberts and suprapubic pressure as first-line manoeuvres
- Performed internal manoeuvres incorrectly
- Caused injury through fundal pressure (pushing on the uterine fundus — contraindicated in shoulder dystocia)
- Failed to document the event and the manoeuvres used accurately
When is antenatal failure to identify shoulder dystocia risk negligent?
Risk factors — previous shoulder dystocia, macrosomia, maternal diabetes, prolonged second stage — should be identified antenatally and discussed with the mother. Failure to identify and communicate these risk factors, or to offer an elective caesarean section in high-risk cases, may give rise to a claim if shoulder dystocia occurs and causes harm.
How does Erb's palsy result from shoulder dystocia?
Erb's palsy — brachial plexus injury causing weakness or paralysis of the arm — is the most common injury sustained by babies from shoulder dystocia. See the dedicated guide on Erb's palsy claims.
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Frequently asked questions
Can I claim if my baby has Erb's palsy after shoulder dystocia?
Yes — if the Erb's palsy was caused by excessive lateral traction applied during the management of shoulder dystocia, rather than by the natural forces of labour. An independent obstetric expert will assess the contemporaneous records and the manoeuvres documented.
What if the records say the manoeuvres were performed correctly?
Contemporary records in shoulder dystocia cases are sometimes inaccurate or retrospectively completed. Expert obstetric assessment of the records, the injury sustained, and the clinical picture can identify inconsistencies.
Can I claim if shoulder dystocia was not anticipated despite risk factors?
Yes — if the failure to identify and communicate risk factors, or to offer elective caesarean section in an appropriately high-risk case, fell below the required standard.
Related guides
- Birth injury compensation
- Erb's palsy claims
- Pregnancy and gynaecology negligence claims
- Brain damage at birth claims
Sources & further reading
Primary statute, case law and regulator guidance referenced in this article.