As a solicitor specialising in medical negligence litigation, I was interested in watching “This is Going to Hurt”, the BBC drama based on the bestselling memoir of Adam Kay, in his role as a junior doctor in obstetrics and gynaecology. This was particularly pertinent to me given the significant number of cases relating to pregnancy, childbirth, and neonatal care that we, as a specialist firm handle.
The drama is obviously from the perspective of the medical staff and highlights the difficulties they face daily including difficult patients, long hours, lack of resources, and the hierarchical and often strained relations between NHS staff. Whilst it is humorous, and poignant and undoubtedly aspects have been exaggerated for dramatic effect, it is based on the diaries of a real junior doctor. It also depicts some serious, frightening, life-and-death situations within the healthcare setting.
Episode 7 deals with shoulder dystocia. This typically occurs when there is a vaginal birth of a larger than average baby. In a normal delivery, the baby’s head is delivered first and is then swiftly followed by the rest of the baby’s body. In shoulder dystocia, the shoulders become stuck after the baby’s head has delivered. It is an obstetric emergency as the baby’s chest and the umbilical cord are compressed and the baby’s access to oxygen is restricted. If it is not well managed, then it can lead to the baby suffering an injury to the brachial plexus (a network of nerves in the neck). Worse still it can result in brain damage and even death. Shoulder dystocia is a rare occurrence and permanent brachial plexus injury - Erb’s Palsy - is even rarer with statistics suggesting it affects 0.43 per 1000 live births.
Erb’s Palsy varies in terms of its severity. At the extreme end of the scale, there is an almost complete paralysis of the arm. At the milder end, there is a reduction in the range of movement, sensation, and strength in the arm. Surgery and physiotherapy can help but will never return the limb to full function.
Shoulder dystocia is a very frightening experience for patients and healthcare professionals alike. However, it is complication for which all obstetric and midwifery staff should be trained and competent to deal with. There have been National Guidelines in place for the management of shoulder dystocia for many years. Evidence suggests that this is a largely avoidable injury.
At Tozers, we have a specialist team of lawyers, and have, for over 25 years been seeking compensation for children who suffer injuries as a result of the mismanagement of shoulder dystocia. We are the leading firm in the Country in this area having successfully conducted hundreds of such claims. We have a close affiliation with the Erb’s Palsy Group who support those with the condition. The condition can be devastating, not only for the individual who has a lifelong physical (and often psychological) difficulty but also for their parents. This is often, particularly the case for mothers who have been through the trauma of birth and often carry immense guilt and an unfounded sense of responsibility for their child’s injury.
Whilst one might question the accuracy of the depiction of shoulder dystocia in this BBC drama, it can only be a positive in that it shines a light on this relatively unknown obstetric complication and hopefully raises awareness of brachial plexus palsy, Erb’s Palsy.
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