Shoulder dystocia: What is the legal standard of care?
It’s your job to educate the jury that, even in the best of hands, permanent brachial plexus injuries can occur
IN THIS ARTICLE
Given that the most frequent criticism of obstetricians in the courtroom in brachial plexus injury lawsuits is that they pulled too hard, the best defense consists of careful, complete, and contemporaneous documentation of one’s actions at delivery.
Lawsuits happen
Even when everything is done correctly, there is a very high likelihood that a lawsuit will be filed when there is a permanent brachial plexus injury.
The 2 claims generally made against obstetricians are:
- The obstetrician should have known or predicted that the risk of shoulder dystocia was high, and should have performed a cesarean section or at least offered the mother that choice.
- As the baby has a permanent brachial plexus injury, the obstetrician must have pulled too hard at delivery.
The best defense
The best defense is, as always, to have practiced good medicine and to have documented it. You must be able to demonstrate from your records—years after a delivery that you no longer remember—that you:
- made appropriate prenatal judgments and were aware of risk factors
- informed the mother of such risk factors when they are significant
- provided proper obstetrical care
- documented in the medical record that you knew what you were doing and did it correctly
Some good news is on the horizon. Recent research has produced a mathematical tool that appears to be able to predict 50% to 75% of all women destined to have shoulder dystocia, with a false-positive rate of only 2% to 3%.37 If this model holds up under further investigation, it may become possible to avoid most shoulder dystocia deliveries and, with them, permanent brachial plexus injuries.
Meanwhile, what is an obstetrician to do about shoulder dystocia? As always, give the best care you can. Know the risk factors. When possible, consider alternatives to vaginal delivery and be less aggressive in the management of labor. Know the techniques for resolving shoulder dystocia and have a preestablished plan for what to do.
Document, document, document.You can give the best care in the world, but if you cannot demonstrate on paper years down the road that you did so, our current liability system will make it seem as if you did not.
