Shoulder Dystocia Edith D. Gurewitsch, MD a,b, * , Robert H. Allen, PhD b a Department of Gynecology/Obstetrics, Division of Maternal Fetal Medicine, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 600 North Wolfe Street – Phipps 217, Baltimore, MD 21287, USA b Department of Biomedical Engineering, The Johns Hopkins University, 3400 North Charles Street, Clark Hall 118-C, Baltimore, MD 21218, USA Brachial plexus injury following shoulder dystocia is the third most com- mon cause for litigation within obstetrics [1], accounting for nearly 11% of lawsuits filed in that discipline [2,3]. Among malpractice cases involving birth injury, brachial plexus palsy (which can also occur in non-cephalic, non– shoulder dystocia deliveries [4]) ranks second only to peripartum hypoxic ischemic encephalopathy [5], which itself is another potential untoward outcome of shoulder dystocia (although far less common) that may also prompt legal action by parents on behalf of their minor child. Rarely, allega- tions of malpractice leading to permanent sequelae from maternal injuries in- curred during shoulder dystocia can also find their way into a courtroom [6]. A harrowing experience for clinician and patient alike, shoulder dystocia deliveries that are complicated by injury are fraught with myriad emotional responses on both sides, including bewilderment, denial, anger, and guilt. Each party can emerge from the event with more questions than answers, leading to dissatisfying clinician–patient encounters. The patient’s growing suspicion of clinician neglect or misconduct is met with the clinician’s defen- siveness and counteraccusations of patient noncompliance. Fueling this con- flagration are the difficulties in prognosticating about expected recovery in the immediate aftermath of the delivery and that clinical follow-up most of- ten will not be occurring with the original health care team, especially not with the obstetric provider. Much has been written about the need for honest, cautious, sympathetic, consistent, and ongoing communication between clinician and patient * Corresponding author. Department of Gynecology/Obstetrics, Division of Maternal Fetal Medicine, The Johns Hopkins Hospital, 600 North Wolfe Street – Phipps 217, Baltimore, Maryland 21287. E-mail address: egurewi@jhmi.edu (E.D. Gurewitsch). 0095-5108/07/$ - see front matter Ó 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.clp.2007.04.001 perinatology.theclinics.com Clin Perinatol 34 (2007) 365–385