Shoulder Dystocia Claims in South Africa

Shoulder dystocia is a medical emergency that requires a prompt response from healthcare professionals.

If medical negligence surrounding shoulder dystocia results in serious injury to the mother or infant, it can be grounds for a medical malpractice claim. This article explains the medical and legal aspects of shoulder dystocia claims in South Africa.

What is shoulder dystocia?

Shoulder dystocia is the medical term to describe when a baby’s head is born but a shoulder gets stuck behind the mother’s pubic bone. In other words, a baby’s shoulder is not delivered spontaneously.

Urgent medical assistance is required to release the baby’s shoulder. Shoulder dystocia puts both the baby and mother at high risk of permanent birth-related injuries.

Possible complications

While shoulder dystocia can lead to death, more commonly complications occur for mother and child.

When an infant’s shoulder, neck or head is pulled with undue force during the birthing process, the brachial plexus, a cluster of five nerves in the infant’s neck, can stretch, rupture or tear.

The damage can lead to temporary or permanent paralysis of the affected arm known. This can lead to Erb’s palsy or Klumpke’s palsy.

Shoulder dystocia can also cause oxygen starvation to an infant that results in cerebral palsy. This brain injury causes permanent physical and cognitive disabilities.

Other complications include foetal distress, the loss of the infant’s arm or shoulder, and permanent disfigurement.

When shoulder dystocia is incorrectly managed it can cause permanent damage to the mother. Common conditions include tearing and ruptures of the peritoneum, vagina, cervix, rectum and uterus. Permanent nerve damage can lead to lifelong urinary or faecal incontinence.

Shoulder dystocia also puts the mother at risk of infection and haemorrhaging.

When do shoulder dystocia injuries constitute medical negligence?

Medical negligence occurs when a doctor or healthcare professional fails to follow accepted medical standards of care during pregnancy and in treating shoulder dystocia during labour. This act, or failure to act, must have led directly to avoidable injuries in the mother or baby.

When shoulder dystocia exists, certain steps and recommended manoeuvres must be made to resolve it and deliver the baby quickly and safely.

Some women are at greater risk for shoulder dystocia. These women include those with diabetes, gestational diabetes, obesity, multiple pregnancies, large babies, and baby being past due date. Certain actions and omissions that lead to injury and constitute medical negligence include:

• failure to anticipate shoulder dystocia in a woman predisposed to it
• use of excessive force caused by inexperience or the improper use of forceps, vacuum extractors or the healthcare professional’s hands.

Examples of shoulder dystocia claims in South Africa

Here’s a quick sample of a few shoulder dystocia claims that have been successful in court.

Z.L obo A.L vs. MEC for Health in the Eastern Cape

The court found that medical staff at the Frere Hospital in East London failed to consider numerous antenatal risk factors for shoulder dystocia and were negligent during the mother’s labour.

These facts led directly to the woman’s son being born with brachial plexus injuries to his right arm.

N.P vs. MEC for Health in the Eastern Cape

In this claim, the court found that there had been clear mismanagement of pregnancy and labour that led directly to a brachial plexus injury to the left arm and a fracture of the right of the plaintiff’s baby. The baby’s injuries were found to be a direct result of traction exerted during the course of delivery.

The mother, who made the claim on behalf of her child, had many risk factors for shoulder dystocia, including obesity, small stature and a very big baby (4.95 kilos). Given these risk factors, a proper management protocol should have been followed.

Msawenkosi Mene vs. the East Cape Health Department

The court found in favour of the plaintiff, Mene, who has a permanently atrophied right arm as result of his birth in 1994.

His legal team claimed the defendant’s birth at St Lucy’s Hospital, Tsolo, was not assessed and monitored properly. A medical expert told the court the plaintiff’s right shoulder was stuck behind his mother’s pubis. Although his head had passed through the pelvis, it was not possible for his body to do so uninjured.

He was a very big baby, weighing 4.7 to 4.9 kilos, and the failure to monitor and assess the labour resulted in his delivery by vacuum extraction, rather than Caesarean section. The vacuum extraction method caused injury to Mene’s right arm, resulting in Erb’s palsy.

The court ordered the defendant to pay damages proven in court, or as agreed between the parties in an out-of-court settlement.

What to do if you have a shoulder dystocia claim

If you have a shoulder dystocia claim in South Africa, contact an attorney who is an expert in medical negligence and personal injury cases. An attorney knows how to win a shoulder dystocia claim, which is complex and lengthy.

Your legal team will explain who may be sued for compensation. This includes doctors, nurses and medical professionals in clinics and hospitals. You can also sue the provincial health department and or hospital, as well as private hospital groups.

Compensation for shoulder dystocia claims can be made for costs arising from the plaintiff’s injuries due to medical negligence, including:

• past and future medical care, including the costs of treatment and medical supplies
• special education needs
• nursing care
• future loss of earnings.