Shoulder dystocia describes a birth in which the baby’s shoulder gets stuck behind the mother’s pubic bone, thus preventing the baby’s delivery. If the shoulder is not freed in a timely manner or is freed in a negligently manner, serious injury and death will occur. In fact, 20 percent of births involving shoulder dystocia result in the baby suffering serious injury. Examples include birth asphyxia, fractures of the humerus or collarbone, cuts, bruises or damage to the brachial plexus nerves, which can lead to paralysis of the arm and hand.

However, if a baby is determined to be at high risk for shoulder dystocia, preemptive c-sections can be performed to avoid the dangers associated with delivering a baby with shoulder dystocia. CALM is the tool of choice to predict this dangerous condition and give expecting parents some peace of mind about at least one aspect of birth. In making its prediction, the program weighs such factors as maternal history including previous shoulder dystocia and gestational diabetes, gestational age, estimated fetal weight, maternal weight and maternal height.

Though not perfect, CALM is the best tool we have to predict shoulder dystocia and can provide a measure of ease to expecting parents.

To make matters worse for medical malpractice plaintiffs, of those 27-36 percent of courthouse winners, fewer that half receive any money at all. So only 13.5-18 percent of medical malpractice victims who win their case in court receive any money to compensate them for their medical bills and other damages. That I why I will never guarantee that I can recover money to help pay a medical malpractice victim’s medical bills.

Medical malpractice cases are some of the toughest around. That’s why we accept very few of them for representation. They are so expensive to litigate that it is not cost-effective for victims to bring lawsuits in all but the most serious cases. I’ve seen many cases with legitimate, substantial injuries caused by negligence that I decided not to accept because I did not think that I could recover enough money to cover the costs of bringing the case. I always feel badly explaining to people that I’m not saying their injury is trivial or small (it never is to them) but that it is just not catastrophic enough to warrant filing suit in this harsh medical malpractice climate.

Every so often though, we do accept a medical malpractice case. The only strategy in a medical malpractice suit (and most lawsuits for that matter) that affords a victim with any degree of control over the outcome is to settle out of court before trial. If you go to trial, you are submitting your fate to a group of strangers whose only qualification to render judgment on your case is that they hold driver’s licenses.

Whether a malpractice case settles or goes to trial, it is tough road to hoe. Make sure you work with an attorney you trust to handle your case.

If you give birth in America, chances are good your doctor will use a fetal monitoring device during delivery. In fact, doctors use fetal monitoring devices in more than 85 percent of births in this country. They do this despite any evidence the devices are beneficial in any way.

“Honestly, the technology got rolled out before we knew if it worked or not,” said one St. Louis obstetrician.

In use since the early 1970s, fetal monitors have failed to reduce the risk of either cerebral palsy or newborn deaths. In addition, fetal monitors have significantly increased the incidence of both Cesarean surgeries and forceps deliveries.

Cesarean surgeries are much more costly than traditional births and extend the new mother’s recovery time.

Fetal monitoring technology was supposed to reduce the risk of either cerebral palsy or newborn death by giving doctors early warning signs of when a baby was not receiving enough oxygen to its brain during child birth. The thinking was that the early warning would give doctors more time to take corrective action and save the baby from injury or death.

The flaw in that reasoning is that 70 percent of cerebral palsy cases are caused before labor begins. Only 4 percent of cerebral palsy is caused solely from a mistake during childbirth. The remaining 26 percent of cases are caused by a combination of factors that can occur before, during or after childbirth.

In summary, fetal monitoring has the potential to prevent only 4 percent of cerebral palsy children and it has failed to do even that. Physicians’ new understanding of the technology is not expected to result in a lower incidence of cerebral palsy, but hopefully it will result in a lower incidence of unnecessary, costly Cesarean surgeries.

The reason for such hope is that the new guidelines refine what once were two categories of fetal monitor data into three categories. Previously, data was categorized as “reassuring” and “nonreassuring” so doctors would err on the side of caution and often intervene in the “nonreassuring” cases when in fact the babies would have been perfectly healthy without intervention.

Now the categories are “normal,” “nonreassuring” and “abnormal.” The “normal” babies clearly do not require intervention like Cesarean surgery or forceps delivery. The new guidelines go as far as to say that “abnormal” babies do not require immediate intervention but should instead be quickly evaluated for other means of providing the baby with oxygen such as giving the mother oxygen, changing her position, treating her low blood pressure or ceasing the artificial induction of labor.

The “nonreassuring” category now calls for much more thorough evaluation of additional factors before doctors are encouraged to intervene. Previously, where a doctor was apt to intervene in “nonreassuring” cases based solely on the fetal monitoring data, the guidelines now call for doctors to “look at the entire clinical picture, not just the [fetal monitor data].”

The entire clinical picture includes things like the mother’s blood pressure, heart rate and temperature, what medicines she might have been given, the frequency of contractions and how fast labor is progressing.

Immediate delivery is discouraged by the guidelines so hopefully that will save future mothers from the pain and costs of unnecessary Cesarean surgery. Further refinements of the guidelines are expected to be released next year.

The cooling method has been used successfully since the 1950s in to reduce damage to the brain and other organs caused by heart attacks. More recently it has been used on neurological patients, and about two years ago, doctors began treating newborn infants who have suffered brain injuries.

Babies can suffer brain damage during childbirth for any number of reasons but it almost always stems from a lack of oxygen to the brain. Often, the child does not get enough oxygen because the umbilical cord becomes pinched.

Every year, about 2 to 4 of every 1,000 babies suffer oxygen deprivation at birth. However, doctors will not currently treat their brain injuries with hypothermia therapy unless the infants have reached 36 weeks gestation because premature babies are too fragile for the procedure.

The treatment reduces the infant’s body temperature to 92 degrees. After doctors feel the appropriate amount of time has passed, they gradually warm the infant to a normal body temperature over the course of six hours. As of yet, there are no significant, known side effects to infant cooling.

One hospital has used the therapy on eight oxygen deprived babies to date and only one has died. That infant died not from the cooling itself, but because his birth injuries were so severe. Of course, the full measure of the children’s brain injuries cannot be known until they grow out of the newborn phase.

MRIs can reveal some damage, but not the full extent. Some of the babies who have been treated so far have partial brain injury, and some do not.

The treatment works because cooling reduces swelling, slowing the injury and preventing a cascade of events that causes cell death. The technique saved the life of a newborn that had too little oxygen for almost 15 minutes. That is almost three times longer than it takes for brain damage to occur.

In 2005, an 18-year-old who was cooled amazingly maintained normal brain function after he lost his leg in a boating accident and his heart stopped for 45 minutes.