Shoulder Dystocia Claims*

The brachial plexus is a network of nerves running from the neck through the shoulder and into the arm and hand. If excessive force is used to free a stuck shoulder, these nerves can stretch or tear.

• Mild injuries may resolve with time and physiotherapy.
• Severe injuries, such as Erb’s Palsy, can cause permanent weakness or paralysis in the arm and hand.
• In extreme cases, avulsion (complete tearing of the nerve from the spinal cord) can occur. This type of injury will not heal without surgery, and full function may never return.

• Clavicle (collarbone) fractures are relatively common in cases of shoulder dystocia. They may be an intentional part of medical management, used to free the shoulder in an emergency.
• Humerus (upper arm bone) fractures can occur if the arm is forcefully manipulated.
• Most fractures will heal in time, but they can cause short-term pain and distress and may contribute to longer-term mobility issues if not managed properly.

• If shoulder dystocia delays delivery for several minutes, the baby may suffer oxygen deprivation.
• Lack of oxygen can cause hypoxic-ischemic encephalopathy (HIE), a form of brain injury.
• HIE can lead to long-term disability, including cerebral palsy, cognitive impairments, and developmental delays.
• Quick and skilled intervention is critical to avoid this outcome.

• Shoulder dystocia does not only affect babies. Mothers can suffer serious injuries too.
• Severe perineal tearing is common. Some women experience third- or fourth-degree tears affecting the anal sphincter.
• This can result in lifelong problems with continence and pelvic floor function.
• In rare cases, post-delivery haemorrhage can be life-threatening.

Many of these injuries are preventable. With proper risk assessment and skilled management, the risks of shoulder dystocia should be reduced or eliminated. If harm occurred to your baby or to you due to poor management of shoulder dystocia, you may be entitled to take legal action.

For a claim to succeed, it must be shown that the standard of care provided fell below what is reasonably expected of a trained healthcare professional. In legal terms, this is referred to as a breach of duty. It must also be proven that this breach caused or contributed to the injury. This is called causation.

Shoulder dystocia can give rise to claims in several ways:

Failure to Recognise and Manage Risk Factors

• Certain maternal and foetal risk factors are known to increase the likelihood of shoulder dystocia.
• These include maternal diabetes, previous large babies, obesity, a history of shoulder dystocia, prolonged second stage of labour, and suspected large foetal size (macrosomia).
• A failure to monitor for or address these risks may constitute negligence, especially if a safer delivery option such as a planned caesarean section was not discussed.

Inadequate Intrapartum Monitoring

• During labour, continuous monitoring is critical.
• If signs of obstructed labour or foetal distress are missed or ignored, opportunities to intervene safely may be lost.
• Delay in recognising shoulder dystocia when it occurs is also a frequent source of claims.

Improper Management During Delivery

• Once shoulder dystocia is recognised, specific obstetric manoeuvres should be performed. These include the McRoberts manoeuvre, suprapubic pressure, and rotational manoeuvres.
• Excessive force applied to the baby’s head or neck, instead of following safe protocols, greatly increases the risk of brachial plexus injury and fractures.
• Failure to call for help immediately or to follow the accepted HELPERR protocol may also amount to negligence.

Inadequate Counselling and Consent

• Women must be fully informed of material risks relating to their labour and delivery.
• Where significant risk factors are present, it is negligent not to advise on the risk of shoulder dystocia or to discuss delivery options such as caesarean section.
• Informed consent is a legal right. Failure to obtain it may lead to a claim.

• It is important to note that not every injury arising from shoulder dystocia indicates negligence.
• In true emergencies, a clinician may have to act decisively to save the baby’s life, accepting some risk of injury.
• However, if that emergency arose from earlier failings in care or if excessive force was used unnecessarily, there may still be grounds for a claim.

If you are unsure whether what happened to you or your baby was negligent, it is always worth seeking expert legal advice. At Crimmins Howard Solicitors, we have extensive experience guiding families through these difficult questions with care and clarity.

A successful claim hinges on robust, well-documented evidence. Key elements include:

• Maternal medical records: These should include antenatal notes, growth scans, risk factor assessments, and any discussions about the mode of delivery.
• Labour and delivery records: Crucial for understanding how labour progressed, the timing and nature of interventions, and whether appropriate monitoring and escalation occurred.
• CTG traces: Continuous monitoring of the baby’s heart rate can reveal missed signs of distress or prolonged second-stage labour.
• Detailed delivery notes: These document whether and how shoulder dystocia was recognised and managed. They should also detail which manoeuvres were used and when help was summoned.
• Neonatal records: These provide insight into the baby’s condition at birth, any injuries sustained, and the need for resuscitation or intensive care.

Shoulder dystocia cases require input from independent medical experts to establish:

• Breach of duty: Did the healthcare professionals involved meet the standard expected of a reasonably competent practitioner in the same circumstances?
  An obstetrician will typically review the antenatal and intrapartum care to assess whether key risk factors were identified and managed properly, and whether delivery was conducted safely.
• Causation: Did that breach of duty cause or materially contribute to the injury?
  For example, if excessive force was used when safer manoeuvres could have been performed, this would strongly support causation.

Irish courts often look to national and international clinical guidelines, such as those issued by:

• The Institute of Obstetricians and Gynaecologists
• The Royal College of Obstetricians and Gynaecologists (RCOG)

Failure to follow accepted guidelines on the management of shoulder dystocia or the recognition of risk factors can be strong evidence of negligence.

Evidence may also include:

• Notes on antenatal counselling
• Documentation of discussions about delivery options
• Consent forms or the absence thereof

If a woman was not properly counselled about the risks of shoulder dystocia and the option of a caesarean, this omission can form a separate basis for a claim.

At Crimmins Howard Solicitors, we work closely with respected medical experts to ensure our clients’ cases are built on solid, persuasive evidence. We understand that families need answers as much as they need compensation, and we leave no stone unturned in helping them achieve both.

Compensation in shoulder dystocia claims is tailored to the specific needs of the injured child and their family. Key categories include:

• General damages: These compensate for pain, suffering, and loss of amenity experienced by the child. The extent of injury and the long-term impact on quality of life are carefully considered.
• Special damages: This is where the practical realities of living with an injury are addressed. It may include:
  • Costs of medical treatment, surgery, or specialist therapies (physiotherapy, occupational therapy, etc.)
  • Cost of mobility aids or orthopaedic equipment
  • Home adaptations if necessary (for example, to accommodate limited arm function)
  • Educational supports or specialised equipment for learning
  • Psychological counselling for both the child and family members
• Future care needs: In serious cases, where permanent injury results in ongoing disability, compensation must cover:
  • Professional care services
  • Loss of future earning capacity
  • Costs of future surgeries or technological aids

Courts will consider:

• The severity and permanence of the injury (partial or complete brachial plexus injury, associated complications such as Erb’s palsy or cerebral palsy)
• The likelihood of recovery or improvement with treatment
• Expert evidence on the impact of the injury on day-to-day life and future opportunities
• Expert financial reports quantifying future care costs and loss of earnings

In Ireland, serious shoulder dystocia claims involving lifelong injuries can result in significant compensation awards, sometimes running into several million euro where extensive care and adaptations are required.

In Ireland, the standard time limit for initiating a medical negligence claim is two years less one day from the date of knowledge of the injury. The date of knowledge is the point at which you became aware, or ought reasonably to have become aware, that negligence caused the injury.

Different rules apply when the injured party is a child. For shoulder dystocia claims involving brachial plexus injuries, Erb’s palsy, or other birth-related harm, the time limit does not start to run until the child reaches the age of 18. The child then has two years from their 18th birthday to initiate a claim in their own name.

Until then, parents or guardians can act as the child’s next friend and pursue a claim on their behalf at any time. However, pursuing the claim early is strongly advisable:

• Medical records and evidence are easier to obtain and assess
• Expert reports can help plan early interventions
• Financial resources secured through compensation can fund urgent therapies or supports

Even though parents may feel they have plenty of time, it is wise to engage a specialist solicitor without delay. Early legal advice allows the case to be properly investigated while the events are fresh in memory, and crucial documents such as maternity and delivery records are more readily available.

At Crimmins Howard Solicitors, we handle shoulder dystocia claims with care and sensitivity, helping families understand the legal process while protecting their child’s right to a secure future.