The authors presented the birth course, in a primiparous woman with complicated, refractory, high shoulder dystocia, of a macrosomic term-born malformed child (4400/54) with complete occipital meningoencephalomyelocele and microcephaly. After head delivery, high shoulder dystocia occurred that could not be resolved with neither the McRoberts or Resnik maneuver nor with the Woods and Barnum maneuvers, despite recurred tries. Only on third attempt with the Barnum maneuver was the posterior arm released with hand traction, followed by the whole body of the macrosomic baby. The child was transferred to the Neurosurgery department where operative correction was performed, and after the intervention the child died because of respiratory insufficiency. Due to the strict parental decision on pregnancy continuation and prohibition of any obstetric interventions during delivery, unborn child and parturient, as well as the obstetric team, were put into high professional, forensic and ethical risk.