Shoulder Dystocia Delivery: The Records That Prove What Actually Happened in That Delivery Room

By Rasansky | McKenzie Law

Shoulder dystocia is a serious birth complication that occurs when a baby’s shoulder becomes trapped during delivery, potentially causing severe injuries to both mother and child. Medical records, delivery notes, fetal monitoring strips, and staff documentation can reveal what actions were taken in the delivery room, how quickly providers responded, and whether proper medical protocols were followed.

Shoulder Dystocia: An Emergency That Requires Precise, Documented Management

Shoulder dystocia occurs when, after the baby’s head is delivered, one or both shoulders become impacted behind the maternal pubic symphysis, preventing completion of the delivery. It is an obstetric emergency, typically unpredictable at the moment it occurs, that requires the delivery team to execute a specific sequence of evidence-based maneuvers designed to dislodge the impacted shoulder without applying excessive traction or lateral flexion to the fetal head and neck. When those maneuvers are performed incorrectly, applied with excessive force, or delayed by a team that is unprepared or disorganized, the result can be brachial plexus injury (Erb’s palsy, Klumpke’s palsy), clavicle or humerus fracture, hypoxic-ischemic injury from prolonged delivery, or, in catastrophic cases, stillbirth.

Why These Cases Are Documentation-Dependent

Unlike many medical events, shoulder dystocia unfolds in seconds to minutes, often too quickly for families to observe or process in real time. Parents typically do not know how many maneuvers were performed, which ones were used, in what sequence, how long the head-to-body delivery interval lasted, or whether the traction applied to the head was within the standard of care. All of that information lives in the medical record, and the quality and accuracy of that record is often the central dispute in shoulder dystocia litigation.

The Records Your Family Must Request Immediately

If your baby was born with brachial plexus injury, unexplained arm weakness, or Horner syndrome after a difficult delivery, the following records must be requested and preserved without delay:

• The complete labor and delivery chart, including all nursing notes and flow sheets from the time of pushing through delivery and the immediate neonatal period
• The delivery note is typically a physician-authored narrative that describes the sequence of events and maneuvers. Note the time of dictation: delivery notes dictated hours after the event may be reconstructed rather than contemporaneous.
• The EFM strip from the entire labor, which may help establish how long the baby was in distress during the delivery interval
• Nursing notes from the delivery, which may include additional details about the sequence of events, staff who were called, and time stamps that differ from the physician’s account
• The neonatal physical exam record, which should document the nature, laterality, and severity of the brachial plexus injury
• Imaging studies, chest X-ray (to evaluate for clavicle fracture), MRI of the cervical spine and brachial plexus when indicated
• Anesthesia records, which may contain independent time stamps and observations
• Any incident report, risk management file, or quality review generated by the facility after the delivery

The Standard of Care: What Evidence-Based Maneuver Management Requires

The American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin on shoulder dystocia identifies the recommended management sequence. The McRoberts maneuver (hyperflexion of the maternal thighs) with suprapubic pressure should be the first response. If that fails, additional maneuvers, including the Rubin II/Woods screw, delivery of the posterior arm, all-fours position, or, in rare cases, more advanced techniques, should follow in a systematic, organized sequence. Key legal issues in shoulder dystocia cases include whether the head-to-body delivery interval was documented. Was inappropriate fundal pressure applied? Was excessive traction or lateral neck flexion documented or witnessed? Was the posterior arm delivery attempted? Was the delivery team trained and drilled on shoulder dystocia management?

Preserving the Record Before It Changes

In shoulder dystocia litigation, one recurring issue is the timing and accuracy of documentation. Delivery notes dictated after the event may minimize the degree of difficulty, omit certain maneuvers, or selectively describe the team’s response. If your baby has a brachial plexus injury after a difficult delivery, it is critical to send a written litigation hold notice to the hospital immediately, requesting preservation of the complete medical record, including all electronically stored information, dictation timestamps, and any audit trail showing when notes were entered or modified. Any discrepancy between the contemporaneous nursing notes and the later-dictated physician narrative can become powerful evidence.

📞 FREE CASE REVIEW: If your baby was diagnosed with Erb’s palsy, brachial plexus injury, or another birth injury after a shoulder dystocia delivery, the medical record is the key to understanding what happened. The birth injury attorneys at Rasansky | McKenzie Law handle these cases and know exactly what to look

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