Brain injury and shoulder dystocia: a fresh approach from the HSIB?

As a clinical negligence lawyer with a special interest in Erb’s palsy, I was encouraged by a recent report from the Health Safety Investigation Branch ( HSIB ). This examined the prevalence of birth injury and brain damage in larger than average babies, whose shoulders get stuck during birth (shoulder dystocia).

In most cases of shoulder dystocia, the uppermost shoulder gets stuck behind the mother’s pelvic bone. This happens following the birth of the baby’s head, and is diagnosed at that point. This is a clinical emergency, which can result in a range of injuries, including permanent damage to the brachial plexus ( Erb's palsy ) and brain damage, if the situation is not managed effectively and promptly. The longer the child is stuck, the greater the chances of a brain injury occurring. If the head to body delivery interval goes beyond five minutes, the chances of a brain injury occurring rise sharply.

The report noted that greater emphasis should be put upon the identification of larger than average babies in pregnancy, and their subsequent management. Generally, it is possible to assess whether a child is likely to be significantly larger than average and hence at risk of shoulder dystocia in the third trimester (the last three months) of pregnancy by measuring the baby using ultrasound.

Encouragingly, this recommendation has been put to the Royal College of Obstetricians and Gynaecologists, and a response to this is awaited. I look forward to the RCOG’s response and hope that this will lead to improved and safer outcomes for larger babies in the future.