Determining if A Birth Injury Could Have Been Avoided
One of the issues that should be explored in any case arising out of a delivery in which the baby's brachial plexus has been injured is whether a Caesarian Section should have been performed instead of a vaginal delivery. While some cases of shoulder dystocia are not predictable, many are. The most important risk factors for shoulder dystocia are those which are included in the mnemonic phrase "A DOPE": [Increased maternal] Age, diabetes, obesity, postdatism, and excessive weight gain. Each of these risk factors increases the likelihood that the baby will be macrosomic, that is, very large. Such babies are most likely the ones whose shoulder or shoulders will become entrapped in the maternal pelvis. In addition to the risk factors in A DOPE, there are other risk factors which may be important in an individual case, such as a history of a prior shoulder dystocia delivery or a prior prolonged labor.
Therefore, when assessing the propriety of the obstetrical care in a shoulder dystocia/brachial plexus injury case, one should always carefully evaluate the adequacy of the pre-partum care. Specifically, one should determine whether there were risk factors present which made a Caesarian safer than a vaginal delivery. If such risk factors were present, then a vaginal delivery complicated by a shoulder dystocia is predictable and the obstetrician is responsible for his failure to avoid the predictable consequences of that emergency.