Shoulder dystocia is a delivery emergency where the baby’s shoulders become stuck after the head is delivered. It can happen quickly and requires a coordinated response. For families, the experience can be frightening, and the aftermath can include questions about nerve injury, fractures, and whether the response was timely. This guide explains the basics, risk factors, common injuries, and the records that matter most for Chicago families. It focuses on practical, family-friendly steps today.
What shoulder dystocia is (plain English)
Shoulder dystocia occurs when a baby’s shoulders become impacted during delivery and do not pass easily after the head is delivered. ACOG describes it as an unpredictable and unpreventable obstetric emergency that can place the mother and baby at risk of injury. citeturn0search5
Why shoulder dystocia is hard to predict
Risk factors exist, but ACOG notes that prepregnancy, antepartum, and intrapartum risk factors have extremely poor predictive value for shoulder dystocia. citeturn0search5
The AAFP review lists risk factors such as fetal macrosomia, prior shoulder dystocia, and diabetes, but also notes that prediction models are not accurate. citeturn0search1
That means many cases occur without clear warning signs, which is why the delivery team’s response and documentation are so important.
Common risk factors (what the research shows)
According to the AAFP review, risk factors include:
- Fetal macrosomia (large birth weight) citeturn0search1
- Prior shoulder dystocia citeturn0search1
- Diabetes (preexisting or gestational) citeturn0search1
- Maternal obesity or excessive weight gain citeturn0search1
- Prolonged labor or operative vaginal delivery (forceps/vacuum) citeturn0search1
These factors raise risk, but they do not reliably predict which births will have shoulder dystocia. citeturn0search1turn0search5
Common newborn injuries linked to shoulder dystocia
The most common neonatal injuries include brachial plexus injury and fractures. citeturn0search1
MedlinePlus explains that neonatal brachial plexus palsy (NBPP) happens when the brachial plexus nerves are stretched or damaged, often during a difficult delivery such as shoulder dystocia. citeturn0search0
NINDS notes that symptoms can include a limp or paralyzed arm, lack of muscle control, or loss of sensation in the arm or hand. citeturn0search2
Maternal complications can also occur
The AAFP review notes that shoulder dystocia can cause maternal complications such as postpartum hemorrhage and obstetric lacerations. citeturn0search1
Documenting maternal complications is important because these events help reconstruct the delivery response and overall outcome.
What the delivery record should include
In a shoulder dystocia case, the delivery record should document:
- When the dystocia was recognized
- Which maneuvers were used and in what order
- How long the shoulder dystocia lasted
- Newborn status at delivery and APGAR scores
- Any maternal complications or lacerations
ACOG notes that systematic approaches and simulation training can improve outcomes and documentation. citeturn0search5
Why timing and teamwork matter
Shoulder dystocia requires a coordinated, step-by-step response. The head-to-body delivery interval alone does not predict injury, but the overall response and documentation are critical. citeturn0search1
Families often want to know whether the team acted promptly and whether standard maneuvers were attempted in a safe sequence. The record, not memory, is what matters later.
Chicago-specific context
Chicago labor units are busy, and shoulder dystocia can happen without warning. High-volume settings make documentation especially important. If the delivery occurred at a hospital that transferred the baby to a higher-level NICU, request records from both facilities. Transfer timing and NICU admission notes can help show the newborn’s condition immediately after delivery. If a pediatric specialist evaluated the baby before transfer, ask for that consult note as well.
Evidence checklist for families
- Complete labor and delivery record
- Fetal monitoring strips
- Delivery note documenting dystocia maneuvers
- NICU admission and discharge summaries
- Newborn imaging (if fractures or nerve injury suspected)
- Maternal postpartum records
If you are unsure what to request, ask for the full record, not just summaries. Missing documentation should be followed up in writing.
How to document newborn symptoms at home
Some brachial plexus injuries improve quickly, while others require therapy. MedlinePlus notes that recovery can vary, and some infants improve over time. citeturn0search0
At home, keep notes about:
- Arm movement differences
- Grip strength or finger movement
- Changes in muscle tone
- Therapy visits and progress notes
Consistent documentation helps specialists track improvement and determine next steps.
How to build a clear timeline
Create a one-page timeline with key timestamps: when labor started, when the head delivered, when the dystocia was recognized, and when the body delivered. If the record includes time stamps for maneuvers, include those as well. This timeline helps specialists review the response quickly.
If you have your own notes from the delivery or hospital updates, keep them with the timeline. Personal notes do not replace medical records, but they can help clarify what happened.
Insurance and benefits that may help
Families often need therapy, equipment, or specialist visits before any legal review is complete. Coverage may include private health insurance, Illinois All Kids for eligible children, and Early Intervention services. Early planning can reduce stress and avoid gaps in care.
Keep a folder of therapy notes, prescriptions, and appointments. Organized records make it easier to coordinate approvals and follow-up care.
Early Intervention in Illinois
Illinois offers Early Intervention services for children from birth to age three with delays or conditions that can cause delays. The Illinois Early Intervention Clearinghouse explains eligibility, evaluation, and the Individualized Family Service Plan (IFSP) process. citeturn1search5
Families can request an evaluation through their local Child and Family Connections office, and services should begin after the IFSP is signed. citeturn1search3
Questions to ask your pediatric team
- What diagnosis best explains the arm weakness or limited motion?
- Do we need imaging to rule out fracture?
- What therapy schedule is recommended?
- When should we see a pediatric neurologist or specialist?
What to say (and not say) to insurers
If an insurer contacts you, keep statements factual and avoid guessing about the cause of shoulder dystocia or the severity of injury. It is reasonable to say you are gathering records and want to review the medical file before answering detailed questions.
What happens during the response
Shoulder dystocia is managed with a series of coordinated steps that focus on relieving the shoulder safely. The delivery team may reposition the mother, apply targeted maneuvers, and call for additional staff. The record should show the sequence used and how the newborn responded.
The goal is a safe delivery with minimal traction on the baby’s neck and shoulders. This is why documentation matters: it shows what was done and whether the response was organized and timely.
Newborn evaluation after delivery
After a shoulder dystocia, newborns are often assessed for nerve injury, fractures, and breathing issues. This may include a pediatric exam, imaging, and observation in the NICU. If your baby was transferred, request the transfer note and the first NICU assessment because it documents the newborn’s immediate condition.
If a brachial plexus injury is suspected, early referral to a pediatric specialist can help guide therapy and monitoring. Some infants improve quickly, while others need ongoing therapy.
Maternal recovery and postpartum care
Maternal complications can include tears, bleeding, or a longer recovery. The postpartum record should document any lacerations, hemorrhage management, or follow-up instructions. These details can also help reconstruct the delivery response.
Claim timeline: what to expect
Month 1-2: Newborn evaluation, therapy referrals, and record requests.
Months 3-6: Follow-up with specialists and therapy progress tracking.
Months 6-12: Medical review of records and clearer understanding of long-term needs.
Longer cases: Some nerve injuries require ongoing therapy or surgical evaluation, which can extend the timeline.
Red flags that warrant a closer review
- Missing delivery documentation of maneuvers
- Conflicting notes about the duration of the dystocia
- No pediatric assessment documented immediately after birth
- Unclear explanation of the newborn’s arm weakness
These issues do not prove negligence, but they are common reasons families seek a second review.
How to request records in Illinois
You can request medical records directly from the hospital’s medical records department. Ask specifically for the delivery note, fetal monitoring strips, NICU records, and postpartum records for the mother. Request the full record, not just summaries.
Keep a log of what you requested, when you requested it, and when you received it. If you receive an incomplete record, follow up in writing.
Emotional and family support
Shoulder dystocia can be traumatic for families. It is common to feel anxious, overwhelmed, or uncertain about the future. Consider asking your pediatrician for counseling referrals or parent support resources. Hospital social workers can also help connect you with local services.
At-home care and therapy follow-up
Therapy plans vary, but consistency is important. If your child is in physical or occupational therapy, ask for home exercises and written instructions. Keep notes on how your child responds and bring those notes to follow-up visits.
If your child’s arm movement changes, or if you notice pain, swelling, or reduced use of the arm, contact your pediatrician promptly. Early assessment can prevent small issues from becoming bigger setbacks.
When possible, schedule periodic check-ins with a pediatric specialist who monitors nerve recovery. Even when improvement is happening, structured follow-up helps ensure progress stays on track.
FAQ
Is shoulder dystocia always caused by medical error?
No. ACOG describes it as an unpredictable and unpreventable emergency. citeturn0search5
Can brachial plexus injuries heal on their own?
Some do. MedlinePlus notes that many newborn brachial plexus injuries improve over time, though recovery can vary. citeturn0search0
What if the baby has a fracture?
Clavicle or humerus fractures can occur. Imaging can confirm the injury, and pediatric follow-up is important to monitor healing.
Does a normal ultrasound rule out shoulder dystocia risk?
No. Risk factors are not highly predictive, and shoulder dystocia can occur even when prenatal estimates appear normal. citeturn0search1turn0search5
When to talk to a lawyer
If your child has a shoulder dystocia-related injury and you have questions about the delivery response, a lawyer can help obtain records and connect you with medical experts for review. Early review protects evidence and helps families understand their options.
If you are unsure whether the response to shoulder dystocia was appropriate, a short consultation can help clarify what records matter and what steps to take next.
Disclaimer: This article provides general information, not legal advice. Every case is different, and you should consult a qualified attorney about your specific situation.