Shoulder dystocia is a birthing emergency in which the baby's shoulder get stuck on the mother's pelvic bone. If not handled right it can cause nerve damage called brachial plexus palsy or Erb's palsy. Though doctors cannot predict shoulder dystocia and the danger of brachial plexus palsy, certain factors may suggest that certain births face a higher risk of shoulder dystocia.

An obstetrician can identify those patients at risk by taking a careful history from the mother about prior deliveries and birth weights, by performing ultrasound evaluation on all patients at risk for macrosomia to estimate fetal weight, and by testing for gestational diabetes with a glucose tolerance test.

The way obstetricians can prevent injury to patients at risk for Shoulder Dystocia are to:

• Perform a prophylactic cesarean section for non-diabetic mothers whose fetuses have an EFW over 4500 grams and to perform a prophylactic cesarean section for diabetic mothers whose fetuses have an EFW over 4000 grams, and
• Follow a structured and practiced "plan or drill" for the management of Shoulder Dystocia if it occurs unexpectedly during delivery.

The most important factor in the initial management of Shoulder Dystocia is for the operator to immediately remove his or her hands from the fetal head as soon as the diagnosis is made and to not pull on the fetal head and neck until the baby's shoulder is unstuck and freely able to exit and deliver vaginally. There are approximately sixteen different obstetrical maneuvers that can free the anterior shoulder so the baby can be safely delivered. Proper use of these maneuvers can prevent the traction on the fetal head that injures the brachial plexus and causes Erb's Palsy.

In some cases, the doctor can reposition the mother, or the doctor can use his or her hands to maneuver and change the position of the baby. In particularly dangerous and difficult births, the doctor can break the baby's clavicle bone on purpose, break the mother's pelvic bone or perform an emergency C-section. A doctor can cut a deep episiotomy, perform the McRobert's maneuver, and exert suprapubic pressure. The doctor can also use gentle traction in a horizontal plane to avoid damaging the brachial plexus.

Doctors can negligently cause an Erb's Palsy injury by failing to perform appropriate prenatal testing to identify patients at risk for shoulder dystocia thereby avoiding a vaginal delivery or, when it occurs during birth, by failing to utilize appropriate maneuvers to dislodge the anterior shoulder before continuing the vaginal delivery. It is the excessive traction to the baby's head and neck by the obstetrician that causes the injury to the brachial plexus.