Shoulder Dystocia and Brain Injury Claims in NY

When expectant parents prepare for childbirth, they trust medical professionals to handle complications safely. Yet when a baby’s shoulder becomes trapped during delivery—a condition called shoulder dystocia—the situation can quickly escalate into a medical emergency. Without prompt, skilled intervention, this birth complication can deprive a newborn of oxygen, potentially causing devastating and permanent brain injuries.

Shoulder dystocia occurs in approximately 0.2% to 3% of vaginal deliveries, but the rate increases significantly with larger babies—affecting 5% to 9% of infants weighing over 8 pounds, 13 ounces [Source: StatPearls, 2025]. While many cases resolve without lasting harm when managed properly, mishandled shoulder dystocia can result in catastrophic outcomes including hypoxic-ischemic encephalopathy (HIE), cerebral palsy, or even death.

If your child suffered a brain injury during birth involving shoulder dystocia, you may have questions about what happened, whether it could have been prevented, and what legal options exist. This comprehensive guide explains the medical science behind shoulder dystocia brain injuries, when medical negligence may be involved, and how New York families can seek compensation for these life-altering injuries.

What Is Shoulder Dystocia?

Shoulder dystocia is an obstetric emergency that occurs when a baby’s anterior shoulder becomes impacted behind the mother’s pubic symphysis, or less commonly, when the posterior shoulder lodges behind the sacral promontory during vaginal delivery [Source: StatPearls, 2025].

This complication typically manifests immediately after the baby’s head is delivered. Instead of the body following naturally, the shoulders remain stuck inside the birth canal. Medical professionals often identify shoulder dystocia by the “turtle sign”—when the baby’s head emerges but then retracts against the perineum, resembling a turtle pulling back into its shell [Source: Cleveland Clinic, 2025].

How Does Shoulder Dystocia Occur During Delivery?

During normal vaginal delivery, the baby’s head emerges first, followed by rotation and delivery of the shoulders—first the anterior (front) shoulder, then the posterior (back) shoulder. In shoulder dystocia, this natural progression halts when:

• The anterior shoulder becomes wedged behind the mother’s pubic bone, unable to pass through the pelvic outlet
• The baby’s size (particularly shoulder width) exceeds the available pelvic space
• Incorrect fetal positioning prevents the shoulders from rotating properly through the birth canal
• Maternal anatomy creates a narrower-than-average pelvic opening

Once the baby’s head delivers but the shoulders remain trapped, the trunk—including the chest, abdomen, and umbilical cord—becomes compressed within the vaginal canal. This compression reduces blood flow through the umbilical cord and prevents the chest from expanding for the baby’s first breaths [Source: StatPearls, 2025].

Risk Factors for Shoulder Dystocia

While shoulder dystocia can occur in any delivery—even in pregnancies without identifiable risk factors—certain conditions significantly increase the likelihood of this complication. Understanding these risk factors is crucial because medical professionals have a duty to identify high-risk pregnancies and take appropriate precautions.

According to medical literature, the incidence of shoulder dystocia increases dramatically with infant birth weight. While only about 1% of babies weighing under 4,000 grams (8 lbs 13 oz) experience shoulder dystocia, this rate jumps to 5-9% for babies between 4,000-4,500 grams, and further increases to 14-23% for infants exceeding 4,500 grams (9 lbs 15 oz) [Source: StatPearls, 2025].

The Diabetes Connection

Maternal diabetes deserves special attention as a significant risk factor. When mothers have diabetes—whether gestational diabetes developing during pregnancy or pre-existing Type 1 or Type 2 diabetes—elevated blood sugar levels can lead to fetal macrosomia (abnormally large baby size).

Importantly, babies born to diabetic mothers tend to have disproportionately larger shoulder and trunk measurements compared to their head size. This asymmetric growth pattern increases the risk that the head may deliver normally but the shoulders become trapped [Source: Cleveland Clinic, 2025].

How Shoulder Dystocia Causes Brain Injury

The connection between shoulder dystocia and brain injury centers on oxygen deprivation. Understanding the physiological mechanism helps explain both the urgency of proper medical management and when negligent delays can cause permanent harm.

The Oxygen Deprivation Mechanism

Once a baby’s head delivers but the shoulders remain trapped, several critical problems occur simultaneously:

1. Umbilical cord compression: The baby’s trunk, including the umbilical cord, becomes compressed within the vaginal canal, reducing or cutting off oxygen-rich blood flow from the placenta to the baby
2. Chest compression: The trapped position prevents the baby’s chest from expanding, making the first breath impossible even though the head is outside the birth canal
3. Continued oxygen demand: The baby’s brain and organs continue requiring oxygen, but both delivery routes (umbilical cord and lungs) are compromised

As oxygen levels drop, brain cells begin dying within minutes. The brain is exceptionally vulnerable to oxygen deprivation because it has high metabolic demands but limited energy reserves.

Types of Brain Injuries Caused by Shoulder Dystocia

When oxygen deprivation occurs during shoulder dystocia, several types of brain injuries may result:

Hypoxic-Ischemic Encephalopathy (HIE)

HIE is the most serious brain injury associated with shoulder dystocia. This condition occurs when the brain experiences both hypoxia (insufficient oxygen) and ischemia (reduced blood flow), triggering a cascade of cellular damage. HIE can result in:

• Developmental delays and intellectual disabilities
• Seizures beginning in the newborn period
• Motor function impairments
• Vision and hearing problems
• Feeding difficulties

The severity of HIE depends on the duration and degree of oxygen deprivation. Mild HIE may resolve with minimal lasting effects, while severe HIE can cause profound, permanent disabilities or death. For detailed information about HIE, see our comprehensive guide on hypoxic-ischemic encephalopathy claims in New York.

Cerebral Palsy

When oxygen deprivation during shoulder dystocia damages the parts of the brain controlling movement and muscle coordination, cerebral palsy may develop. This permanent condition affects muscle tone, posture, and motor skills. Children with cerebral palsy resulting from birth injuries may require lifetime therapy, assistive devices, and medical care.

Learn more about pursuing cerebral palsy medical malpractice claims in New York if your child’s condition resulted from negligent management of shoulder dystocia or other birth complications.

Permanent Neurological Damage

Even when brain injury doesn’t result in a specific diagnosis like HIE or cerebral palsy, oxygen deprivation can cause various neurological problems including:

• Learning disabilities
• Attention deficit disorders
• Speech and language delays
• Memory problems
• Behavioral challenges

These injuries may not become fully apparent until months or years after birth as developmental milestones are missed. For more information about identifying and pursuing claims for birth injuries causing brain damage, consult with experienced New York birth injury attorneys.

Standard Medical Management of Shoulder Dystocia

Proper management of shoulder dystocia requires trained personnel who can quickly execute a series of emergency maneuvers designed to free the trapped shoulder and deliver the baby safely. Understanding the standard of care helps identify when medical negligence may have occurred.

The HELPERR Protocol

When shoulder dystocia is identified, medical professionals typically follow the HELPERR mnemonic, which outlines a systematic approach to resolving the impaction [Source: Cleveland Clinic, 2025]:

First-Line Maneuvers

McRoberts Maneuver: This first-line intervention involves hyperflexing the mother’s thighs back toward her abdomen. This position increases the pelvic outlet diameter and repositions the pelvic architecture, often allowing the trapped shoulder to pass. Studies show the McRoberts maneuver successfully resolves 40-60% of shoulder dystocia cases [Source: StatPearls, 2025].

Suprapubic Pressure: A healthcare provider applies firm, downward pressure just above the mother’s pubic bone, attempting to push the baby’s trapped shoulder downward and free it from behind the pubic symphysis. This maneuver is often performed simultaneously with McRoberts positioning.

Second-Line Maneuvers

When first-line interventions fail to resolve the shoulder dystocia, providers must quickly move to more advanced techniques:

• Rotational maneuvers (Rubin/Woods screw): The provider inserts a hand into the vagina and manually rotates the baby’s shoulders to a different angle, attempting to free the impaction
• Posterior arm delivery: The provider reaches into the vagina, locates the baby’s posterior arm, and delivers it first, effectively reducing the shoulder diameter that must pass through the pelvis
• Gaskin maneuver: Rolling the mother onto her hands and knees uses gravity and changes in pelvic dimensions to help dislodge the trapped shoulder

Last-Resort Interventions

In extremely rare cases where all standard maneuvers fail and the baby’s life is in immediate danger, physicians may consider:

• Intentional clavicle fracture: Deliberately breaking the baby’s collarbone to reduce shoulder width (the clavicle heals well with minimal intervention)
• Zavanelli maneuver: Pushing the baby’s head back into the birth canal and performing an emergency cesarean section
• Symphysiotomy: Surgically cutting the cartilage of the pubic symphysis to widen the pelvis (rarely performed in modern obstetrics)

These desperate measures carry significant risks but may be justified when all other options have failed and the alternative is fetal death or catastrophic brain injury.

When Shoulder Dystocia Becomes Medical Malpractice

Shoulder dystocia itself is not necessarily evidence of medical malpractice—the condition can occur even with excellent prenatal care and skilled delivery management. However, medical negligence may be involved when healthcare providers fail to meet the accepted standard of care in preventing, recognizing, or managing shoulder dystocia.

Failure to Identify and Manage Risk Factors

Obstetricians have a duty to identify pregnant patients at increased risk for shoulder dystocia and discuss delivery options, including the possibility of cesarean section. Medical negligence may occur when doctors:

• Fail to diagnose gestational diabetes or inadequately manage blood sugar levels
• Ignore fetal macrosomia (estimated fetal weight suggesting a large baby) revealed by ultrasound
• Don’t discuss cesarean delivery with patients who have multiple risk factors
• Allow post-term pregnancies to continue without appropriate monitoring
• Disregard a history of previous shoulder dystocia in earlier pregnancies

While doctors cannot predict every case of shoulder dystocia, they must carefully review each patient’s medical history, monitor fetal size and maternal conditions, and have informed conversations about delivery options when risk factors accumulate [Source: NYC Birth Injury Law, 2025].

Delayed Recognition or Response

Time is critical when shoulder dystocia occurs. Medical negligence may be established when healthcare providers:

• Fail to recognize the “turtle sign” or other indicators that shoulder dystocia has occurred
• Delay calling for assistance when shoulder dystocia is identified
• Waste valuable time with ineffective pulling instead of executing proper maneuvers
• Don’t follow the HELPERR protocol or deviate from accepted management techniques
• Fail to document the timing and sequence of interventions performed

Every minute matters when a baby is deprived of oxygen. Delays in recognizing the emergency or implementing appropriate maneuvers can make the difference between a healthy baby and one who suffers permanent brain damage.

Improper Management Techniques

Using incorrect techniques during shoulder dystocia can worsen the situation and cause additional injuries. Examples of negligent management include:

• Applying fundal pressure (pushing on the top of the uterus), which is contraindicated and can worsen impaction
• Excessive traction on the baby’s head and neck, which can cause brachial plexus injuries and may not resolve the shoulder dystocia
• Forceful pulling that prolongs oxygen deprivation rather than executing proper rotational maneuvers
• Failing to attempt multiple appropriate maneuvers in rapid succession

Medical experts reviewing shoulder dystocia cases examine whether the delivery team used appropriate techniques in the correct sequence and within acceptable timeframes [Source: Block O’Toole & Murphy, 2025].

Inadequate Fetal Monitoring

Babies who were already experiencing oxygen stress before shoulder dystocia occurred have even less tolerance for prolonged delivery complications. Medical negligence may involve:

• Ignoring concerning fetal heart rate patterns during labor
• Failing to respond appropriately to signs of fetal distress
• Not considering cesarean delivery when monitoring suggests the baby is not tolerating labor well
• Allowing labor to continue despite clear indications that vaginal delivery poses excessive risks

For more information about medical malpractice involving oxygen deprivation during birth, see our guide on oxygen deprivation at birth causing brain injury.

Other Injuries Associated with Shoulder Dystocia

While this article focuses on brain injuries, shoulder dystocia can cause several other types of harm to both mother and baby.

Brachial Plexus Injuries (Erb’s Palsy)

The most common injury associated with shoulder dystocia is brachial plexus palsy, particularly Erb’s palsy. The brachial plexus is a network of nerves running from the spinal cord through the neck and into the arm, controlling arm and hand movement.

During shoulder dystocia, excessive traction on the baby’s head and neck can stretch or tear these delicate nerves, resulting in weakness, paralysis, or loss of sensation in the affected arm. Studies report that approximately 50% of brachial plexus injuries are linked to shoulder dystocia [Source: Fuchsberg Law, 2025].

By 18 months, about 82% of babies with brachial plexus injuries achieve complete functional recovery, though over 90% of nerve injuries show improvement within 6-12 months. However, approximately 10% of cases result in permanent neurologic deficits requiring ongoing therapy or surgical intervention [Source: Cleveland Clinic, 2025].

Learn more about pursuing compensation for Erb’s palsy birth injury lawsuits in New York.

Bone Fractures

During attempts to resolve shoulder dystocia, babies may sustain fractures including:

• Clavicle (collarbone) fractures: The most common bone injury, which typically heals well within weeks
• Humerus (upper arm bone) fractures: Less common but also generally heal without permanent complications

While distressing for parents, bone fractures are among the less serious complications of shoulder dystocia and usually heal completely with minimal intervention. In some cases, physicians may intentionally fracture the clavicle as a last-resort maneuver to save the baby’s life when all other techniques have failed.

Maternal Injuries

Shoulder dystocia also poses risks to mothers, including:

• Postpartum hemorrhage: Excessive bleeding after delivery
• Severe perineal tears: Third- and fourth-degree lacerations extending into the rectal area
• Uterine rupture: A rare but life-threatening complication
• Bladder or urethral injuries
• Symphyseal separation: Damage to the cartilage connecting the pubic bones
• Nerve damage from prolonged McRoberts positioning

These maternal complications should be recognized and treated promptly. Failure to address maternal injuries may also constitute medical negligence. For more information, visit our guide on hospital negligence causing harm in New York.

Legal Rights in New York: Shoulder Dystocia Malpractice Claims

When medical negligence during shoulder dystocia causes preventable brain injury, New York law provides families with the right to pursue compensation through medical malpractice lawsuits.

Elements of a Medical Malpractice Claim

To hold healthcare providers liable for injuries arising from shoulder dystocia, your attorney must establish four elements:

1. Duty: The doctor or hospital owed your baby and you a duty to provide care meeting accepted medical standards
2. Breach: The healthcare provider deviated from those standards (for example, by failing to recognize risk factors, delaying appropriate maneuvers, or using improper techniques)
3. Causation: The breach directly caused the birth injury (medical experts must testify that proper care would have prevented or reduced the harm)
4. Damages: The birth injury caused actual, measurable damages such as medical expenses, ongoing care needs, pain and suffering, and lost quality of life

Proving medical malpractice in shoulder dystocia cases typically requires expert testimony from obstetricians, neonatologists, and other specialists who can explain how the standard of care was violated and how proper management would have prevented the brain injury [Source: Rheingold Law, 2025].

Statute of Limitations in New York

New York law imposes strict deadlines for filing medical malpractice lawsuits. Understanding these time limits is crucial to protecting your legal rights.

Standard Deadline for Adults

In New York, medical malpractice claims must generally be filed within 2.5 years (30 months) from the date of the alleged negligent action or omission that caused the injury [Source: Block O’Toole, 2025].

Extended Deadlines for Birth Injury Cases

When a child is harmed by medical malpractice during birth, New York provides additional time to file a lawsuit. The statute of limitations is “tolled” (paused) until the child turns 18 years old, allowing families to file claims up to three years after the child’s eighteenth birthday.

However, there is an important limitation: a lawsuit for medical malpractice that occurred during childhood cannot be started more than 10 years from the date of the negligent act [Source: Block O’Toole, 2025].

Because of these complex timing rules and the importance of preserving evidence and medical records, families should consult with an experienced New York birth injury attorney as soon as they suspect medical negligence may have caused their child’s brain injury.

Compensation Available in Shoulder Dystocia Cases

When medical malpractice during shoulder dystocia causes brain injury, families may be eligible to recover several types of compensation:

Economic Damages

• Past and future medical expenses: Hospital bills, emergency care, ongoing therapy, medications, and specialized equipment
• Rehabilitation costs: Physical therapy, occupational therapy, speech therapy, and other rehabilitative services
• Home modifications: Wheelchair ramps, accessible bathrooms, and other necessary adaptations
• Vehicle modifications: Specialized transportation equipment for children with disabilities
• Educational support: Special education services, tutoring, and educational aids
• Lost earning capacity: Compensation for reduced future earnings if the child’s brain injury limits employment opportunities
• Parental lost wages: Income lost while caring for an injured child

Non-Economic Damages

• Pain and suffering: Physical pain and emotional distress experienced by the child
• Loss of enjoyment of life: Diminished quality of life and inability to participate in activities other children enjoy
• Emotional distress: Psychological trauma to both the child and family members

In cases involving permanent brain injury like severe HIE or cerebral palsy, total compensation can be substantial, often reaching into the millions of dollars to cover lifetime care needs [Source: Fuchsberg Law, 2025].

For comprehensive information about pursuing compensation for brain injuries, see our guide on brain injury medical malpractice claims in New York.

Building a Strong Shoulder Dystocia Malpractice Case

Successfully proving medical negligence in shoulder dystocia cases requires thorough investigation, compelling evidence, and expert medical testimony.

Essential Evidence

Your attorney will gather several types of evidence to build your case:

• Complete medical records: Prenatal care records, labor and delivery notes, fetal monitoring strips, delivery room documentation, and newborn medical records
• Delivery room documentation: Detailed notes about when shoulder dystocia was identified, which maneuvers were attempted, the timing of each intervention, and the head-to-body delivery interval
• Fetal monitoring strips: Electronic fetal heart rate tracings showing the baby’s condition before, during, and after the shoulder dystocia
• Imaging studies: MRIs, CT scans, and other diagnostic tests documenting brain injury
• Witness statements: Testimony from nurses, physicians, and other delivery room personnel
• Hospital policies and protocols: Internal guidelines for managing shoulder dystocia emergencies

The Role of Medical Experts

Medical malpractice cases require testimony from qualified experts who can explain:

• The standard of care: What a reasonably skilled obstetrician would have done in similar circumstances
• How care deviated from standards: Specific actions or omissions that fell below acceptable practice
• Causation: How the negligent care directly caused or contributed to the brain injury
• Alternative outcomes: What would likely have happened if proper care had been provided
• Future care needs: Medical equipment, therapies, and services the child will require throughout life
• Life care planning: Comprehensive cost projections for lifetime medical and supportive care

Experienced birth injury attorneys work with networks of respected medical experts, including maternal-fetal medicine specialists, obstetricians, neonatologists, neurologists, and life care planners who can provide credible, persuasive testimony.

Common Defense Strategies

Healthcare providers and hospitals defending shoulder dystocia cases often raise several arguments:

• “Shoulder dystocia was unpredictable”: Defendants may argue there were no identifiable risk factors and the complication could not have been anticipated
• “All appropriate maneuvers were attempted”: Claiming the delivery team followed proper protocols and the outcome could not have been prevented
• “The brain injury occurred before delivery”: Suggesting the baby was already injured during labor, before shoulder dystocia occurred
• “Timing was within acceptable limits”: Arguing the head-to-body delivery interval was not prolonged enough to cause brain injury
• “The family declined cesarean delivery”: Attempting to shift responsibility to the parents for delivery decisions

Your attorney must be prepared to counter these defenses with evidence demonstrating that earlier intervention, proper risk assessment, or better management could have prevented or minimized your child’s injuries.

Preventing Shoulder Dystocia and Brain Injury

While not all cases of shoulder dystocia can be prevented, appropriate prenatal care and delivery management can significantly reduce risks.

Prenatal Risk Assessment

Effective prevention begins during pregnancy:

• Regular prenatal visits to monitor fetal growth and maternal health
• Screening for gestational diabetes with glucose tolerance testing
• Managing blood sugar levels in diabetic mothers to reduce fetal macrosomia risk
• Ultrasound monitoring to estimate fetal weight in high-risk pregnancies
• Discussing delivery options when multiple risk factors are present
• Considering elective cesarean delivery for very large babies (especially over 5,000 grams) or mothers with diabetes and estimated fetal weight over 4,500 grams

Delivery Room Preparedness

Hospitals and delivery teams should:

• Train all obstetric personnel in shoulder dystocia emergency protocols
• Conduct regular simulation drills to practice coordinated response
• Have protocols readily available in every delivery room
• Maintain equipment needed for emergency interventions
• Ensure rapid access to operating rooms for emergency cesarean delivery if needed
• Document all interventions with precise timing information

When Cesarean Delivery Should Be Considered

While cesarean delivery carries its own risks and should not be performed unnecessarily, it may be the safer option when:

• Estimated fetal weight exceeds 5,000 grams (11 pounds) in non-diabetic mothers
• Estimated fetal weight exceeds 4,500 grams (9 pounds 15 ounces) in diabetic mothers
• The mother has a history of previous shoulder dystocia
• Multiple risk factors are present (diabetes, macrosomia, post-term pregnancy)
• Labor is not progressing normally and fetal distress is developing

Importantly, the decision about delivery method should involve informed discussions between the healthcare provider and the pregnant patient, weighing individual risk factors and patient preferences. For more information about complications from delayed cesarean delivery, see our article on delayed C-section causing brain injury in NY.

Long-Term Outlook for Children with Shoulder Dystocia Brain Injuries

The prognosis for children who suffer brain injuries during shoulder dystocia varies widely depending on the severity and duration of oxygen deprivation.

Mild to Moderate Brain Injury

Children with milder brain injuries may experience:

• Learning disabilities that become apparent during school years
• Attention and concentration difficulties
• Speech and language delays requiring therapy
• Mild motor coordination challenges

With appropriate early intervention, special education support, and therapies, many children with mild to moderate brain injuries can lead relatively independent, productive lives.

Severe Brain Injury (HIE, Cerebral Palsy)

Children with severe oxygen deprivation may face:

• Profound intellectual disabilities
• Significant motor impairments requiring wheelchairs or other mobility aids
• Seizure disorders requiring lifelong medication
• Vision and hearing problems
• Feeding difficulties and nutritional challenges
• Complete dependence on caregivers for daily activities

These children typically require intensive, lifelong medical care, therapies, specialized equipment, and personal assistance, generating substantial ongoing costs.

Importance of Early Intervention

Regardless of severity, early intervention services can significantly improve outcomes:

• Physical therapy to improve motor skills and prevent muscle contractures
• Occupational therapy to develop daily living skills
• Speech therapy to address communication delays
• Developmental services provided through state early intervention programs
• Special education tailored to the child’s individual needs

Compensation from medical malpractice claims can help ensure injured children receive all necessary therapies and services to maximize their potential.

Connect with a Qualified New York Birth Injury Attorney

If your child suffered a brain injury during birth involving shoulder dystocia, you don’t have to navigate the complex medical and legal issues alone. Understanding whether medical negligence played a role requires careful investigation by attorneys who focus on birth injury cases and work with qualified medical experts.

New York birth injury law firms experienced in shoulder dystocia cases can:

• Review your medical records to identify potential deviations from the standard of care
• Consult with medical experts who specialize in obstetrics and neonatal brain injury
• Investigate thoroughly to determine whether earlier intervention or different management could have prevented your child’s injuries
• Calculate comprehensive damages to ensure your child receives compensation for all current and future needs
• Handle all legal complexities while you focus on caring for your child
• Fight for maximum compensation to provide your child with the resources needed for the best possible quality of life

Most birth injury attorneys work on a contingency fee basis, meaning you pay no legal fees unless your case results in compensation. This arrangement ensures that all families—regardless of financial circumstances—can access experienced legal representation.

Time limits apply to medical malpractice claims, even with the extended deadlines for birth injuries. The sooner you consult with an attorney, the better they can preserve evidence, locate witnesses, and protect your legal rights.

Additional Resources

For more information about birth injuries and medical malpractice in New York, explore these related articles:

• HIE Birth Injury Lawyers in New York – Comprehensive information about hypoxic-ischemic encephalopathy claims
• Cerebral Palsy Medical Malpractice Claims in NY – Legal options when cerebral palsy results from negligent care
• Erb’s Palsy Birth Injury Lawsuits in New York – Understanding brachial plexus injury claims
• Oxygen Deprivation at Birth Brain Injury in NY – Medical negligence involving birth asphyxia
• Delayed C-Section Causing Brain Injury in NY – When failure to perform timely cesarean delivery causes harm
• Birth Injuries Causing Brain Damage in New York – Overview of various birth-related brain injuries
• Brain Injury Medical Malpractice Claims in New York – General information about medical negligence claims

This article provides general information about shoulder dystocia and brain injury legal claims in New York. It is not legal advice, and reading it does not create an attorney-client relationship. Every birth injury case is unique and depends on specific facts and circumstances. For advice about your particular situation, consult with a qualified New York birth injury attorney.