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Legal: Forceps delivery results in Erb's Palsy

Labor for delivery of first child was long and complicated by a transverse arrest.

An Ohio woman was admitted to the hospital for delivery of her first child after an uneventful pregnancy. The labor was long and complicated by a transverse arrest. The obstetrician applied forceps for rotation and delivered the head. A shoulder dystocia was recognized and maneuvers were performed to accomplish delivery. The infant was diagnosed with an Erb's palsy and has partial paralysis of her right shoulder.

In the lawsuit that followed, the patient claimed that the obstetrician attempted a difficult rotational forceps delivery that was inappropriate and caused the stretching injury to the brachial plexus. She also claimed he used excessive lateral traction after delivery of the head.

The physician argued that the injury was caused by the natural forces of labor that lodged the shoulder. A $640,000 verdict for the child was returned.

The number of malpractice cases involving shoulder dystocia and associated brachial plexus injury is on the rise, perhaps coinciding with the decrease in the numbers of VBAC deliveries and their subsequent lawsuits when damage occurs. Some of these cases are successfully defended, but many are not. And while some of the cases do involve substandard care in management of the dystocia, most do not. What the majority of these cases where payment is made for malpractice claims do have in common is the lack of adequate documentation.1 Complete and consistent documentation in the chart when any extra maneuver is used to deliver the shoulders could help decrease the payouts and/or settlements in brachial plexus injury cases. Whether it is a check-list based approach for required information accurately recording the events surrounding delivery, and/or mandatory dictation of delivery notes, the documentation must include both what actions were and were not employed. Examples would be that no further traction was used once the dystocia was recognized until a maneuver to dislodge the shoulder was accomplished, or stating that no shoulder dystocia occurred as part of every delivery note. While these suggestions may not be considered requirements to meet the standard of care, they may well prevent a malpractice case or aid the defense of one.

1. Clark SL, Belfort MA, Dildy GA, et al. Reducing obstetric litigation through alterations in practice patterns. Obstet Gynecol. 2008;112:1279-1283.

Department editor DAWN COLLINS, JD, is an attorney specializing in medical malpractice in Long Beach, CA. She welcomes feedback on this column via e-mail to dawncfree@gmail.com