In a recent Irish High Court settlement, a 14 year old girl was awarded compensation in the sum of €700,000 for shoulder injuries allegedly caused at birth, by the negligence of her obstetrician. This teenager suffers from shoulder dystocia. Dystocia arises in the course of a baby’s delivery and is widely regarded as an obstetrical emergency, because of the risk it presents to the wellbeing of the baby. As occurs in many negligence cases, the damages were paid without admission of liability on the part of the obstetrician.
When a baby suffers from shoulder dystocia, they are at a high risk of developing further conditions such as Erb’s Palsy, brachial plexus, diaphragm paralysis or klumpke’s Palsy. All of these associated injuries may not appear immediately and are caused by an initial tearing of the shoulder nerves. Dystocia can cause this tearing, as it occurs when the baby’s head has crowned but the front part of the baby’s shoulder gets caught and cannot pass through the birth canal. The midwife or obstetrician will then try manipulations to release the baby’s trapped shoulder.
The most common manipulation in these circumstances is called ‘the McRoberts Manoeuvre’. This involves pushing the mother’s legs back towards her abdomen, leading to a widening of the pelvis. If this procedure fails to be effective, pressure is then placed on the abdomen in an attempt to move the shoulder and the baby’s head will be gently guided out.
Thankfully shoulder dystocia is a rare occurrence. However, in cases where manipulation is required to free the baby’s trapped shoulders, there is a significant risk of irreparable nerve damage. This is so because excessive force may be used to push the baby back into the birth canal, in order to be in a better position for delivery. At this point, medical professionals will be concerned with ensuring that the baby does not suffer from asphyxia. Asphyxia occurs when the baby’s body does not receive enough oxygen. This can have fatal consequences such as serious brain damage or even death.
One of the more common risks associated with shoulder dystocia at birth is Erb’s Palsy (Brachial Plexus Birth Palsy). The symptoms of Erb’s Palsy occur after shoulder dystocia is diagnosed and can include a variety of the following;
Weakness or paralysis of the arm,
Limited mobility in terms of rotating the arm,
Inability to sit up properly,
Decreased hand grip.
If you notice any of these symptoms particularly on one side of your baby’s body, this may indicate serious nerve damage to the shoulder. Such damage may be long-term and can take months, if not years to rectify. In extreme cases surgery may even be required.
Those who suffer from Erb’s Palsy will have continuous problems with movement and achieving normal daily physical tasks. It is therefore natural that they will need some form of ongoing treatment. In particular, they may require the attention of specialists, consultants, physiotherapists and even surgeons. The reality of this is extremely costly and is financially crippling for many.
It is important to note that when shoulder dystocia has been diagnosed, it may not be due to human error or mistake. It may be a natural consequence of unavoidable circumstances that would not lead to a successful negligence claim. The recent English case of Croft v Heart of England NHS Foundation Trust given on May 31, 2012 is strong authority for the proposition that in order for negligence to be found there must be excessive traction or force applied to the baby’s head after dystocia is diagnosed.
In this case it was held that there will be no negligence for shoulder dystocia where the following occurs;
After diagnosis for shoulder dystocia, all traction is stopped;
Immediate assistance is called;
Attempts are made to place the patient in the McRoberts Manoeuvre;
Professional / hospital guidelines are followed.
However, if there is strong oral testimony to the effect that there was a significant delay before assistance was called or there was force or fundal pressure applied after diagnosis of shoulder dystocia, this would highlight potential negligence on the part of the medical staff present.
Medical negligence in shoulder dystocia cases can arise in a variety of ways;
Failure to assess the risk factors of an expectant mother,
Failure to intervene and act where natural birth is potentially unsafe for the baby,
Failure to determine the correct weight of the baby prior to birth,
Use of excessive traction to release the baby’s trapped shoulders,
Delay in calling for assistance when problems with natural birth arise;
Failure to follow guidelines when such an emergency occurs;
Failure to diagnose or treat shoulder dystocia after birth.
Although this list is not exhaustive, it does provide an overview of likely types of negligence causing these types of injury in newborns.
When it has been established that shoulder dystocia was caused by negligent care in childbirth, there will be an entitlement to recover damages from the healthcare provider responsible. This compensation, in common with many other types of case will be made up of a number of elements as follows:
Compensation for the pain, trauma, anxiety or suffering caused to the child.
Medical costs which may include the following;
2)Specialist Consultations fees,
3)Surgery and Radiology fees,
4)Aids or devices needed for the loss of mobility to the shoulder,
6)Prescription fees for pain.
Any loss of earnings that might result in later life for the child or loss of earnings for the parents due to ongoing care needs of the child.
Out of pocket expenses such as travel to and from medical treatments and other necessary journeys relating to the injury.
For more information on issues of medical negligence or accident related injury law, call Cian O’Carroll Solicitors – A Medical Negligence & Personal Injury Law Firm on FREEPHONE 1-800 60-70-80 or visit our website at.....
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