What Happens When Your Baby Gets Stuck During Delivery

When a baby’s shoulders become trapped during delivery, everything in the room changes speed. What happens in the next sixty to ninety seconds is not improvised.

Obstetric teams train for this exact emergency using a specific, ordered sequence of maneuvers, and how closely a delivery team follows that sequence often becomes the central question when a family later asks whether their child’s injury could have been prevented.

This is not a general introduction to what shoulder dystocia is. It is a closer look at how the medical response actually works, what a properly executed response looks like compared to one that falls short, and how that gap connects to a New York medical malpractice claim.

What Happens the Moment Shoulders Become Stuck

Shoulder dystocia is diagnosed in real time, not in advance. It happens when a baby’s head has delivered but the anterior shoulder catches behind the mother’s pubic bone, or less often when the posterior shoulder catches on the sacrum.

The clearest visual cue is the “turtle sign,” where the baby’s head appears to pull back against the mother’s body immediately after delivering. Once that happens, gentle downward traction will not work, and the delivery team must move to a specific set of interventions.

For a full explanation of what shoulder dystocia is, why it happens, and the injuries it can cause, see our overview of shoulder dystocia and its complications.

The HELPERR Protocol Explained Step by Step

Once shoulder dystocia is recognized, obstetric teams are trained to work through a specific sequence taught in emergency obstetric courses, remembered by the mnemonic HELPERR. Every letter represents an action, and the order matters because each step is meant to be attempted for a short, defined window before moving to the next.

Help. The delivering provider calls for additional staff immediately. This typically means another nurse, a second obstetrician, an anesthesiologist, and a member of the neonatal team. Someone in the room should begin timing from the moment the head delivers, because that timestamp becomes medically and legally significant later.

Evaluate for an episiotomy. Shoulder dystocia is a bony obstruction, not a soft tissue one, so an episiotomy does not free the shoulder by itself. Providers consider it only when more room is needed to perform internal maneuvers.

Legs into the McRoberts position. Two people help the mother sharply flex her legs up toward her abdomen. This changes the angle of the pelvis and is typically the first physical maneuver attempted.

Suprapubic pressure. An assistant applies firm, targeted pressure just above the mother’s pubic bone, angled to push the trapped shoulder downward and out from under the bone. This is different from fundal pressure, which is pressure applied to the top of the uterus. Fundal pressure is not part of an appropriate response and can worsen the impaction.

Enter maneuvers for internal rotation. If external maneuvers do not resolve the impaction, the provider reaches inside to manually rotate the baby’s shoulders into a more favorable position, using techniques such as the Woods corkscrew or Rubin maneuver.

Remove the posterior arm. The provider sweeps the baby’s back arm across the chest and delivers it first, which reduces the effective width of the shoulders.

Roll the patient. Repositioning the mother onto her hands and knees, known as the Gaskin maneuver, changes the pelvic dimensions and can free the shoulder when the mother is able to move quickly into that position.

In the rare case where these steps do not resolve the emergency, more invasive interventions exist, including intentionally fracturing the clavicle to narrow the shoulder width or, in extreme cases, the Zavanelli maneuver, where the head is pushed back and an emergency cesarean is performed.

These last-resort steps are uncommon and are typically reserved for situations where the standard sequence has already failed.

What a Properly Executed Response Looks Like

A well-managed shoulder dystocia looks calm and coordinated even though it is fast. The team should call for help immediately rather than attempting to manage the emergency alone.

Maneuvers should be attempted in a logical sequence, each given a brief window before moving to the next rather than repeating a failing technique indefinitely.

Traction on the baby’s head should remain gentle throughout, never forceful, and fundal pressure should not be used.

The mother should be kept informed as events unfold, and the newborn should be examined promptly afterward for signs of nerve injury, fracture, or oxygen deprivation.

How Excessive Traction Causes Nerve and Brain Injuries

The two injuries most closely tied to how the emergency was physically managed are brachial plexus injuries and hypoxic-ischemic encephalopathy. The brachial plexus is the bundle of nerves running from the neck through the shoulder and into the arm, and it can be stretched or torn when excessive downward or lateral force is applied to the baby’s head while the shoulder remains trapped.

This is the mechanism behind a total brachial plexus injury caused by negligent traction, where every nerve root in the bundle is affected rather than just the upper roots involved in a typical Erb’s palsy. Separately, the longer the shoulder remains trapped, the more the umbilical cord is compressed, which reduces oxygen flow to the baby.

When that reduction is severe or prolonged, it can result in hypoxic-ischemic encephalopathy, a brain injury whose severity depends heavily on how quickly the team was able to complete the delivery.

Building a Medical Malpractice Claim After Shoulder Dystocia

A malpractice claim arising from shoulder dystocia usually rests on the full delivery record rather than any single fact. That includes the fetal monitoring strips leading up to delivery, nursing notes documenting the sequence and timing of maneuvers, the pediatric examination immediately after birth, and any imaging or nerve studies performed afterward.

An experienced birth injury attorney works with medical experts to reconstruct the timeline minute by minute and compare it against accepted obstetric protocols like HELPERR.

The goal is not to second-guess an inherently difficult emergency, but to determine whether the specific choices made during it were reasonable given what the team knew at the time.

New York Deadlines for Filing a Claim

New York law gives most medical malpractice claims two and a half years from the date of the negligent act to be filed, under CPLR 214-a.

Because the injured patient in a birth injury case is a newborn, New York also applies an infancy toll under CPLR 208, which pauses the clock while the child is a minor, but that toll is capped at ten years from the date the malpractice occurred, not ten years from the child’s tenth birthday.

In practice, this generally means a claim must be filed well before the child turns ten, and families should not assume they have until any later date.

If you are trying to understand exactly how these deadlines apply to your situation, our full breakdown of New York’s birth injury statute of limitations and infancy tolling rules walks through the calculation in more detail.

Frequently Asked Questions

Does a brachial plexus injury after shoulder dystocia automatically mean the doctor did something wrong

No. Brachial plexus injuries can occur even during a properly performed response, because the maneuvers used to free a trapped shoulder are inherently forceful. Whether the injury points to malpractice depends on the specific timeline documented in the delivery record, including how quickly help was called, which maneuvers were attempted, and whether excessive traction or fundal pressure was used. This determination generally requires review by a qualified medical expert.

What records should I request if I want my child’s delivery reviewed

Ask for the complete labor and delivery record, not just a discharge summary. This should include fetal heart rate monitoring strips from before and during delivery, nursing notes documenting the timing and sequence of any maneuvers used, the delivering physician’s operative or delivery note, and the newborn’s initial examination and any follow-up imaging or nerve studies. Hospitals are required to provide these records to the patient or their legal representative upon request.

How long do I have to file a claim if my child’s injury was not diagnosed right away

New York’s medical malpractice statute of limitations generally runs two and a half years from the date of the negligent act under CPLR 214-a, and the infancy toll under CPLR 208 caps at ten years from that same date rather than from diagnosis or from a birthday. Because some injuries are not identified as a birth injury until later, it is important to have the timeline reviewed as soon as you have concerns, since waiting can affect what options remain available.

What does a medical expert actually do in a shoulder dystocia malpractice case

A medical expert, typically an obstetrician with relevant clinical experience, reviews the delivery record to determine what the accepted standard of care required in that specific situation and whether the documented response met it. The expert’s opinion is generally required to establish that the care fell below that standard and that the departure caused the injury. Without this analysis, a claim based on a bad outcome alone is unlikely to succeed.

Can a family pursue a claim if the hospital says the response followed protocol

Yes, this happens regularly, and a hospital’s internal characterization of events is not the final word. An independent review of the actual documented timeline, not just the hospital’s summary of it, often reveals gaps between what protocol called for and what the record shows actually happened. This is why obtaining and reviewing the complete record independently matters, regardless of what a family has already been told.

Getting the Full Picture After a Difficult Delivery

Shoulder dystocia will always be a fast-moving, high-pressure emergency, and most cases resolve without permanent harm when a delivery team responds the way it was trained to.

But because the response is protocol-driven, it is also reviewable, and the same documentation that guides a newborn’s follow-up care is often what later shows whether that protocol was actually followed.

Understanding how HELPERR is supposed to work gives families a concrete way to evaluate what happened during their own delivery, rather than being left with only a diagnosis and no context for it.

This article is for informational and educational purposes only. It is not a substitute for medical advice from your child’s healthcare providers or legal advice based on your family’s specific circumstances.

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