How to Prove Medical Negligence in a Shoulder Dystocia Case

August 25, 2025

Proving medical negligence in a shoulder dystocia case requires demonstrating four key elements:

A doctor-patient relationship existed;
The medical provider breached the accepted standard of care;
This breach directly caused your child’s injury;
And the injury resulted in damages.

The central challenge is that the occurrence of shoulder dystocia itself is not automatically considered negligence; the focus is on the medical team’s response.

Evidence of negligence is sometimes found by analyzing whether the delivery team recognized certain risk factors beforehand, used appropriate maneuvers during the delivery, and avoided actions known to cause harm, like applying excessive force.

A successful claim secures the financial resources necessary for your child’s lifelong care, including medical treatments, therapies, and adaptive equipment. For a clear, no-obligation conversation about what happened, call the team at Wapner Newman at (215) 569-0900.

What is Shoulder Dystocia? The Difference Between a Complication and Negligence

Defining the Medical Event

Shoulder dystocia is a birth complication where, after the baby’s head is delivered, one of the shoulders becomes stuck behind the mother’s pubic bone. This is a medical emergency because it can delay the baby’s delivery, potentially compressing the umbilical cord and depriving the baby of oxygen.

An Unfortunate Event vs. An Improper Response

Shoulder dystocia can happen in deliveries with no identifiable risk factors. As we mentioned in the introduction, its presence alone does not mean a doctor was careless. The basis for a medical negligence claim is not the event itself, but the actions taken in response to it.

The law evaluates whether the doctor or midwife acted with the skill and care that a reasonably competent peer would have under the same circumstances. Shoulder dystocia accounts for a significant portion of all obstetric malpractice litigation in the U.S., highlighting how frequently the response—not the event—is the issue.

The Four Elements of a Medical Negligence Claim

Pillar 1: A Duty of Care

This is the simplest part to establish. When a hospital and its medical staff agree to care for you during your pregnancy and delivery, they take on a professional duty to provide competent care. This establishes the doctor-patient relationship, which is the foundation of any medical malpractice claim.

Pillar 2: A Breach of the Standard of Care

This is the core of your case. It means proving that the healthcare provider’s actions—or lack of action—fell below the accepted medical standards for managing a shoulder dystocia delivery. We will explore exactly what this looks like in the next section.

Pillar 3: Causation

You must show a direct link between the provider’s breach of care and your child’s specific injury. For example, proving that the use of excessive traction on the baby’s head is what caused a brachial plexus injury. This connection must be clear and demonstrable, perhaps through expert medical testimony that explains how the substandard care led directly to the harm suffered.

Pillar 4: Damages

This refers to the actual harm your child and family have suffered. This includes not only physical injury but also the financial and emotional costs that follow, such as medical bills, the need for future care, and pain and suffering.

How Do You Show the “Standard of Care” Was Breached? Uncovering the Evidence

Before Delivery: The Failure to Anticipate and Plan

While not always predictable, certain risk factors make shoulder dystocia more likely. A key part of proving negligence is showing that your medical team failed to identify and act on these signs.

Common Risk Factors:

Macrosomia: A baby estimated to be significantly larger than average.
Maternal Diabetes: Can contribute to a larger birth weight.
A Previous Delivery with Shoulder Dystocia: Increases the risk in subsequent pregnancies.

The Breach

Negligence may occur if the provider noted these risks but failed to have a conversation with you about them, including discussing the option of a planned Cesarean section. According to the American College of Obstetricians and Gynecologists (ACOG), a C-section should be considered for women with diabetes carrying a fetus estimated at 4,500 grams or more, or for non-diabetic women with a fetus estimated at 5,000 grams or more. This failure to provide you with enough information to make an informed choice can be a form of negligence.

During Delivery: Actions Taken in Those Critical Moments

This is where most shoulder dystocia claims are focused. The analysis compares the maneuvers used by the delivery team against established, safe protocols.

Actions That May Constitute Negligence:

Applying Excessive Force: Pulling too hard on the baby’s head and neck is a primary cause of brachial plexus injuries like Erb’s palsy. This is an almost universally condemned practice.
Applying Fundal Pressure: This involves a nurse or other provider pushing on the top of the mother’s uterus. This pressure can worsen the impaction of the baby’s shoulder and is against established medical guidelines.
Improper Use of Delivery Tools: Negligent use of a vacuum extractor or forceps can cause severe nerve damage and brain injuries.
Delay in Action: Failing to recognize the dystocia promptly or wasting time with ineffective maneuvers can lead to oxygen deprivation and brain injury. Medical teams are expected to act quickly and systematically once shoulder dystocia is identified.

After Delivery: What the Medical Records Reveal

The story of the delivery is often told in the hospital’s own records. Our role is to obtain and meticulously review these documents for signs of a substandard response.

The Paper Trail Includes:

Delivery Notes: We look for descriptions of the maneuvers used, the amount of time that passed, and which personnel were present.
Fetal Heart Rate Strips: These can show when the baby began to experience distress, which helps create a timeline to judge the medical team’s response time.
Your Child’s Medical Records: Post-birth records detailing the nature and severity of the injury (e.g., Apgar scores, notes on arm movement) are compared against the delivery notes to build the case for causation.

Comparative Negligence in Shoulder Dystocia Claims

Medical malpractice cases in Pennsylvania and New Jersey, including those involving shoulder dystocia, are subject to modified comparative negligence under 42 Pa. C.S. § 7102 and N.J.S.A. § 2A:15-5.1 respectively. This legal doctrine limits or bars recovery based on the plaintiff’s share of fault. In a birth injury case, this could potentially arise if the defense claims that maternal health factors contributed to the outcome.

What Is Modified Comparative Negligence?

A plaintiff may still recover damages as long as they are not more than 50% at fault. However, any compensation is reduced in proportion to their share of the fault. If a mother were found 30% responsible for the injury, the damages awarded would be reduced by 30%.

How It Applies in Shoulder Dystocia Cases

Defense teams—especially those representing hospitals or OB/GYNs—may attempt to argue that factors beyond the physician’s control contributed to the injury. These arguments may include:

Excessive maternal weight gain during pregnancy.
Poor control of gestational diabetes.
Failure to comply with prenatal care or medical advice.
Pushing before full dilation or other alleged labor management issues.

However, these tactics sometimes fail when evaluated against the medical standard of care. ACOG guidelines make clear that shoulder dystocia is not always predictable and that a provider’s duty is to respond appropriately once it occurs, regardless of risk factors.

Legal Counterpoint: The Duty Is Not Conditional

Even if risk factors are present, they do not excuse a physician’s negligent response during delivery. According to relevant state laws and medical malpractice precedents:

The standard of care must be met regardless of patient characteristics.
Failure to inform the patient of risks or offer a C-section, when medically indicated, is itself a breach of duty.

Case Preparation: Anticipating Comparative Negligence Arguments

A skilled attorney will work to proactively defeat any comparative negligence claims by:

Documenting that all maternal risk factors were disclosed to providers.
Demonstrating that decisions during labor rested solely with the medical team.
Retaining expert witnesses (more on these below) to testify that the injury was caused by inappropriate delivery techniques, not maternal conduct.

The Role of the Medical Expert Witness: Translating Medicine into Law

To prove your case, we work with independent medical professionals—highly qualified obstetricians and neonatologists—who act as expert witnesses.

Their job is to:

Review all medical records related to your pregnancy and delivery.
Provide a professional opinion on whether the care you and your child received met the accepted standard.
Testify on how the breach of that standard directly led to your child’s injury.

Both Pennsylvania law and New Jersey law require a “certificate of merit” before proceeding with a malpractice case. This is a document, signed by a independent medical expert with no financial stake in the outcome, confirming that there is a reasonable basis to believe that the care provided was negligent. We handle this entire process for you.

What Compensation Can Provide for Your Child’s Future?

A medical malpractice claim seeks to secure the financial resources to give your child the best quality of life possible.

While past settlements do not guarantee future results, they illustrate what may be necessary. Settlements for shoulder dystocia injuries range from hundreds of thousands to over a million dollars, depending on the severity of the injury and the projected costs of future care.

What Compensation Covers

Economic Costs: This is the “emergency financial first aid” for your family. It includes all current and future medical expenses, such as surgeries, physical and occupational therapy, adaptive equipment for your home, and any loss of future earning capacity for your child.
Non-Economic Costs: This acknowledges the profound, non-financial impact of the injury. It provides compensation for your child’s physical pain, emotional suffering, and loss of enjoyment of life.

Frequently Asked Questions About Shoulder Dystocia Claims

How long do I have to file a shoulder dystocia lawsuit?

In Pennsylvania, the statute of limitations for medical malpractice is generally two years from the date the injury occurred or was discovered. For minors, a claim must usually be filed by the child’s 20th birthday.

In New Jersey, the standard statute of limitations is also two years. However, for minors, the claim must be filed by the minor’s 13th birthday. These rules have exceptions, so it’s best to speak with a lawyer as soon as possible.

How much does it cost to hire Wapner Newman for a birth injury case?

We handle birth injury cases on a contingency fee basis. In simple terms, this means you pay no fees unless and until we win your case and recover compensation for you. The initial consultation and case evaluation are always free.

My baby’s arm seems to be getting better. Should I still look into a claim?

Even if an injury like Erb’s palsy appears to be healing, it is wise to get a legal opinion. Some injuries have long-term consequences that are not immediately apparent, such as muscle weakness, lack of coordination, or pain that flares up later in life. Securing compensation can create a safety net for any future needs.

What if I don’t know exactly what the doctor did wrong?

You are not expected to. It is the job of your legal team and the medical experts they retain to analyze the records and determine precisely what happened in the delivery room. All you need to start is the feeling that something went wrong. If you are concerned about the care you received, speaking with a member of our team will help bring clarity.

Can I file a claim if the hospital offered me a small settlement?

You should never accept a settlement offer from a hospital or its insurance company without speaking to a lawyer first. Early offers are often a fraction of what is needed to cover a lifetime of care.

Securing Your Child’s Tomorrow, Today

Let us help you get the answers you and your family deserves. Call the team at Wapner Newman for a confidential, no-cost discussion about your options.

Contact Wapner Newman today at (215) 569-0900.