Risks in Childbirth: Shoulder Dystocia and Umbilical Cord Compression
I was saddened to read about the tragic loss of Kara Keough’s six-day-old baby boy. Kara is a star of the Real Housewives of Orange County and recently made a public announcement about the loss of her newborn baby and the circumstances surrounding this. Whilst I cannot claim to watch the show, I found it heartbreaking to read Kara’s story. In her announcement, Kara explained that during labour her baby had shoulder dystocia and in the process of her baby being delivered, the umbilical cord became compressed. This led to her baby suffering a brain injury, leading to his tragic death six days later.
It is not clear whether what happened in Kara’s case was preventable and I have no intention of speculating on that, but as a Child Brain Injury solicitor, I wondered whether this tragedy was avoidable. We have recovered compensation for children in similar circumstances, who have suffered brain injury following shoulder dystocia and umbilical cord compression during labour and birth.
Although this happened in America where the healthcare and legal system is different to ours, issues of childbirth and risks to babies and mothers are universal.
I know that reading about this sort of thing in the news can cause fear and concern amongst expectant mothers and their loved ones. As such, I wanted to empower pregnant women by increasing their knowledge about shoulder dystocia and umbilical cord compression. My blog will therefore focus on providing more information about:
- the conditions of shoulder dystocia and umbilical cord compression,
- how these conditions can arise and how often they arise,
- how the conditions can be managed or treated,
- what might happen to a mother and their baby if these conditions occur
My blog will hopefully provide some clarity and reassurance about how infrequently these conditions arise and that, with the right care, they can be treated successfully; but, in the awful and rare circumstances in which a baby suffers an injury, which could have been prevented, how we at Bolt Burdon Kemp can help.
What is shoulder dystocia?
Shoulder dystocia is a birth injury that happens when one or both of a baby’s shoulders are stuck during labour, usually behind the mother’s pubic bone. Although in most cases, shoulder dystocia is managed well and the baby is born without any complications, it can be very dangerous as it can cause delays in the delivery of the baby.
Where there are delays in the birth, this can lead to the baby being deprived of oxygen. In the worst instances, if a baby is deprived of oxygen for too long, this can lead to brain damage or death.
How common is shoulder dystocia?
Shoulder dystocia occurs in approximately 1 in 150 vaginal births. It is usually difficult to predict, however, there are some factors that may increase the risk, such as if the mother has previously had a baby with shoulder dystocia. If this has occurred previously, a planned caesarean section may be offered if the previous delivery was difficult.
Expectant mothers with diabetes or gestational diabetes are at risk of having a larger baby, which can also increase the risk of shoulder dystocia. However, the Royal College of Obstetricians and Gynaecologists reassures in its guidance that the majority of large babies are born safely and indeed shoulder dystocia can happen for smaller babies too.
Given that shoulder dystocia is difficult to predict, in most cases it also cannot be prevented. Therefore what is absolutely vital for the mother and baby is that they receive the right care following the diagnosis of shoulder dystocia.
How is shoulder dystocia treated?
Shoulder dystocia is a medical emergency and the condition needs to be managed as quickly as possible, and in the correct manner, in order to avoid injury to the mother or baby. The baby’s shoulder(s) need(s) to be released quickly so that the baby’s body can be born and they can start breathing air into their lungs. Midwives and obstetricians should be aware of the risk of shoulder dystocia in every birth.
When shoulder dystocia occurs, the following steps will usually be taken:
- the mother will be asked to stop pushing;
- she will be repositioned to give her baby more room inside the vagina. The McRoberts manoeuvre will be carried out, which is where the mother lies on her back with her legs pushed outwards and up towards her chest;
- the doctors or midwives will press on the mother’s abdomen just above the pubic bone to try to release the baby’s shoulder(s);
- an episiotomy will also be considered
If these steps do not result in the baby’s shoulder(s) being released, either the obstetrician or midwife will manually try to release the baby’s shoulder(s) with their hand. In addition or alternatively, the mother may be helped onto all fours, which can also help to release the baby’s shoulder(s).
In home births such as Kara Keough’s, if these measures do not result in the baby’s shoulder being released, the midwife should call an ambulance to transfer the mother to hospital. In these circumstances an emergency caesarean section may be required.
If the baby is born before the ambulance arrives, the midwife may still suggest taking mother and baby to hospital to be checked over. After birth, the baby should be examined by a paediatrician and the mother should be counselled on what happened.
What are the risks of shoulder dystocia?
For mothers, shoulder dystocia can lead to vaginal tears (which can extend to the back passage) and heavier bleeding than normal after birth, requiring additional treatment or a blood transfusion.
For babies the risks can be more severe, as I have already mentioned. About 1 in 10 babies who have shoulder dystocia will have some stretching of the nerves in the neck called brachial plexus injury, which may cause loss of or reduced movement in their arm. The most common type of this injury is Erb’s Palsy. Babies can also suffer fractures to their arm or shoulder as a result of shoulder dystocia. This happens when excessive force is used to try to deliver them when they become stuck during birth. Babies can recover from brachial plexus injuries and the fractures sustained during birth, however there are occasions where these can lead to long term difficulties.
The most severe risk of shoulder dystocia to babies is that they can suffer a brain injury, which can lead to life changing injuries or even death. This occurs when the baby’s delivery is delayed and they are deprived of oxygen.
What is umbilical cord compression?
As my colleague, Mala Patel, explains in her blog which can be accessed here, umbilical cord compression is where, “a baby’s umbilical cord becomes flattened by pressure, resulting occasionally in heightened and extremely dangerous health risks for the unborn baby”. This can happen in the womb or during delivery of the baby.
During pregnancy, very mild compressions will happen as a result of their movement within the womb and these are often harmless. However, prolonged umbilical cord compression can pose danger to an unborn baby as it is another way in which a baby can be deprived of oxygen, thereby leading to brain damage or death. Whilst in the womb, the umbilical cord is the baby’s lifeline as it delivers oxygen to the baby. If the flow of oxygen through the cord is disrupted, this can lead to asphyxiation for the baby.
When a baby has both shoulder dystocia and umbilical cord compression
Umbilical cord compression is a known complication associated with shoulder dystocia. When shoulder dystocia occurs, the umbilical cord can become trapped, for example between the baby’s arm and the mother’s pelvic bone. This is a very serious problem in a situation that is already considered an emergency. In these circumstances, the baby must be delivered immediately, usually via emergency caesarean section.
Another situation in which umbilical cord compression can occur is when the cord becomes prolapsed. Although this condition is rare it is often fatal as it can completely cut off the baby’s oxygen supply. As such, an immediate delivery would also be required, usually through caesarean section. Fortunately, cord prolapse is a very rare occurrence reported in less than half of a percent of all deliveries.
Shoulder dystocia, whilst it can lead to very severe and harmful consequences for a baby and their mother, is in most cases managed and treated well. Even in cases where injuries occur, such as a brachial plexus injury or fracture, these usually heal well and a baby will not have any long term difficulties. However, in some very sad cases, shoulder dystocia can lead to delays in the delivery of the baby resulting in them being deprived of oxygen. Deprivation of oxygen can also result from umbilical cord compression which is a known associated risk of shoulder dystocia. If a baby is deprived of oxygen for too long this can result in brain damage or death.
In some cases, these events are not preventable. However in cases where the conditions of shoulder dystocia and/or umbilical cord compression are not diagnosed when they should be and/or not managed in the right way once diagnosed, and this results in any harm to the baby or mother, they may be entitled to claim compensation for their injuries.
Tragically in Kara’s case, her baby suffered both shoulder dystocia and umbilical cord compression during childbirth, which proved to be fatal.
How we can help
In the Child Brain Injury team we act exclusively for children who have suffered brain injuries in accidents or through clinical negligence. Our team has considerable experience of acting for children who have been injured at birth including in circumstances involving shoulder dystocia and umbilical cord compression. When the worst happens and children suffer brain injuries, they often have complex therapy, education, accommodation, equipment and care needs for life. We are committed to fighting for the compensation our clients need to ensure their needs are met for life so that they can flourish post injury.