Erb's Palsy & Shoulder Dystocia: 35 Deposition Questions That Separate Maneuver Discipline From Traction Injury

Brachial plexus injury cases turn on one factual question: did the obstetrician apply excessive lateral traction to the fetal head before the shoulder was released? Defense counsel will insist the injury is "caused by the natural forces of labor." Plaintiff counsel has to put enough structure on the record during the OB deposition to make that defense untenable at trial.

This is a 35-question deposition outline organized into five topic groups: (1) the ACOG-defined maneuver order, (2) documentation discipline during the dystocia, (3) traction characterization, (4) team composition and call-out timing, and (5) the exculpatory template defense attorneys instruct every OB to parrot.

Topic 1 — ACOG maneuver order (8 questions)

ACOG Practice Bulletin 178 orders shoulder-dystocia maneuvers in a near-universally recognized sequence: McRoberts, suprapubic pressure, Rubin II, Woods corkscrew, delivery of the posterior arm, and only then Zavanelli or symphysiotomy. Your job is to pin down that the OB knows the order, applied them in sequence, and did not "skip" to a higher-force maneuver.

1. What does ACOG Practice Bulletin 178 recommend as the first maneuver once shoulder dystocia is recognized?
2. What is the second maneuver in the ACOG sequence?
3. At what point in the ACOG sequence does delivery of the posterior arm appear?
4. At what point does Zavanelli appear?
5. Did you perform the maneuvers in the ACOG-recommended order with this delivery?
6. If you skipped a maneuver, which one, and why?
7. How many seconds elapsed between recognition of dystocia and the first McRoberts attempt?
8. How many seconds elapsed between McRoberts and the maneuver that ultimately released the shoulder?

Topic 2 — Documentation discipline (7 questions)

The shoulder-dystocia note is the single most important document in the chart. If it is missing, incomplete, or templated, you have a documentation-violation theory independent of the mechanics.

9. Did you personally dictate a shoulder-dystocia-specific note?
10. Was that note a free-text narrative or an EHR template with check-boxes?
11. Did the note include the head-to-body interval in seconds?
12. Did the note identify which shoulder was anterior?
13. Did the note identify who called for the OR team, and at what time?
14. Did the note identify each maneuver and the order they were performed in?
15. Did the note characterize the traction applied? (Routine? Gentle? Axial? Downward?)

Topic 3 — Traction characterization (7 questions)

Traction is the word every defense expert rehearses. The deposition has to get past the canned language to the physics.

16. When you applied traction, in what direction did you pull?
17. Was the traction axial, lateral, or downward?
18. What force, measured in pounds, do you estimate you applied?
19. Has anyone in the room ever described the traction applied as "excessive"?
20. Did you feel a "pop" or "give" during the traction?
21. At what point during delivery was the Erb's palsy injury sustained?
22. What evidence supports your answer to the prior question?

Topic 4 — Team and call-out timing (7 questions)

23. When you recognized dystocia, how many seconds passed before you announced it aloud?
24. Who else was in the room at that moment?
25. Was a second OB called?
26. Was anesthesia called?
27. Was the NICU team called?
28. Were those calls placed before, during, or after the first maneuver attempt?
29. What does your institution's shoulder-dystocia protocol require with respect to call-outs?

Topic 5 — Rehearsed defense template (6 questions)

Every defense OB is coached to deliver some version of: "Brachial plexus injury can occur even with appropriate care, and is often caused by the natural forces of labor." Your job is to separate that talking point from the factual record.

30. Is there any clinical finding in this chart that would tell you whether the injury was from natural forces or from applied traction?
31. Absent that finding, on what basis do you distinguish the two?
32. Have you ever testified that a brachial-plexus injury in a shoulder-dystocia case was caused by natural forces of labor?
33. How many times?
34. In how many of those cases did the defense verdict reference that testimony?
35. Would you agree that the "natural forces" theory cannot be verified retrospectively from a typical shoulder-dystocia note?

What plaintiff attorneys miss

Most plaintiff depositions in brachial-plexus cases leave the "natural forces" defense intact because they don't ask the six questions in topic 5. Those six are the difference between a defense expert getting to repeat the phrase at trial without rebuttal and having it collapse on cross.

The second miss: documentation lag. The shoulder-dystocia note is typically written 2 to 4 hours after delivery. That means the head-to-body interval, force estimate, and maneuver order are reconstructed from memory under the pressure of charting a bad outcome. That's a Rule 803 business-records admissibility fight your firm should be prepared to have.

Related reading: Birth Injury OB/GYN Deposition Checklist · Fetal Monitor Strip Analysis for Plaintiff Attorneys · 50 Cross-Examination Questions for Medical Experts