Brachial plexus injuries and Erb’s palsy are birth injuries related to shoulder dystocia. Shoulder dystocia is a delivery complication that occurs when the baby’s shoulders get stuck on the mother’s pelvic bone during the birthing process. Typically, the baby’s shoulder is stuck behind a symphysis pubis bone in the mother’s pelvis. When this occurs, medical professionals can apply too much force by excessively pulling on the baby; too much downward lateral traction is often applied to the baby’s head and neck. If the baby’s neck is stretched too far during delivery, the nerves in the neck and shoulder can pull away from the spinal column and can be stretched or torn. Stretching of these nerves, which are called brachial plexus nerves, can severely damage them or even cause the nerves to be completely torn from the spinal cord. This nerve damage often results in a condition called Erb’s palsy, which is a severe weakening or paralysis of the arm. The weakening or paralysis affects the movement of the upper arm and rotation of the lower arm. When paralysis occurs, the arm hangs limply at the side, with no movement. When there is just weakness, the arm also hangs abnormally at the side, but the baby may have some limited use.
Signs of Erb’s Palsy
- Loss of sensation in the arm
- Paralysis and atrophy (breakdown) of the shoulder and arm muscles
- The arm is rotated toward the body and the forearm is extended and turned downward
- The arm cannot be raised from the side and power to bend the elbow is lost, so the forearm cannot turn upward
- The affected arm may flop when the baby is rolled from side to side.
- There is no Moro reflex. This is a reflex that causes the baby to react when startled by a sudden, loud noise by stretching out the arms and flexing the legs
- The baby cannot grip or has trouble gripping with the hand on the affected side.
Types of Erb’s Palsy Nerve Injuries
Generally, brachial plexus injuries and Erb’s palsy injuries are categorized into the four following types of injuries:
- Neurapraxia: Neurapraxia shocks the nerve but does not tear it. This injury usually heals within three months.
- Neuroma: Neuroma injuries are those involving damage to the nerve fibers resulting in scar tissue that presses on a surrounding healthy nerve. Some recovery may be possible.
- Tear (or rupture) of the nerve: A tear or rupture will require medical assistance. Most likely, physicians will splice a donor nerve graft. Such grafts vary in results, and they may leave some scarring, take a long time to heal, and are not helpful to older infants.
- Avulsion: An avulsion is the most serious type of nerve injury. It occurs when the nerve is completely torn from the spinal cord and cannot be repaired.
Management of Shoulder Dystocia: Preventing Brachial Plexus Injuries and Erb’s Palsy
Medical professionals can use a number of procedures and maneuvers to help prevent shoulder dystocia, brachial plexus injuries, and Erb’s palsy. These tactics aim to prevent the baby’s anterior shoulder bone from colliding with the mother’s pubic bone.
- McRobert’s maneuver: Physicians and nurses will try to reposition the mother by pushing her knees back to her chest.
- Suprapubic pressure: Medical personnel apply suprapubic pressure by pushing on the lower central portion of the abdomen.
- Rotational maneuvers: The physician inserts a hand into the birth canal in an attempt to rotate the baby.
- Delivery assistance devices: Sometimes risky delivery instruments, such as forceps and vacuum extractors, are used to prevent shoulder dystocia. However, these techniques can be very dangerous and time-consuming.
- C-section delivery: Umbilical cord complications that decrease the flow of oxygen-rich blood to the baby may occur when shoulder dystocia is present, and this often means that the baby must be delivered via emergency C-section. In addition to oxygen deprivation (hypoxia), researchers have found a high risk of intracranial hemorrhage (brain bleeding) when shoulder dystocia is present. Both hypoxia and intracranial hemorrhage can cause brain damage.
It is imperative that physicians do not apply excessive traction to the baby when the shoulder is stuck. Although shoulder dystocia is an emergency and the baby must be delivered immediately, a skilled and experienced physician can use careful maneuvers to deliver the baby without inflicting injury. Medical textbooks and research emphatically emphasize that an unskilled physician must call for help when shoulder dystocia is present. There should always be skilled and experienced physicians present in a labor and delivery facility, and a high-risk pregnancy should not be handled by an inexperienced physician. Experience and skill mean that physicians not only know how to manage complex deliveries, but that they also are able to quickly and skillfully deliver a baby by emergency C-section within a matter of minutes, which often is the safest way to deliver a baby when a shoulder dystocia situation occurs.
Physicians must closely monitor a woman throughout her pregnancy. Pelvic size and fetal size must both be assessed. Macrosomia (an unusually large baby) is the greatest risk factor for shoulder dystocia, and when this condition is present, a planned C-section may be the best option. If a baby weighs more than 5,000 grams, a planned C-section is usually required. It is very important for the physician to discuss the risks and alternatives of various delivery methods with the mother.
Treating Brachial Plexus Injuries and Erb’s Palsy
Some brachial plexus injuries heal on their own. If the injuries do not heal on their own, surgery may help repair the damage, but the operation must be performed before the baby is six months old and the damage becomes permanent. It therefore is imperative for physicians to diagnose Erb’s palsy (sometimes called brachial plexus palsy) right away.
Legal Help for Shoulder Dystocia, Brachial Plexus Injuries, and Erb’s Palsy
Brachial plexus injuries and Erb’s palsy are frequently the result of medical error. Mistakes that can cause brachial plexus injuries and Erb’s palsy include the misuse of forceps or a vacuum extractor, applying too much traction or pressure to the baby’s head and neck during delivery, or simply failing to identify and treat risk factors present in the mother. All of these errors constitute medical malpractice and entitle your child to compensation for his or her injuries.
At Reiter & Walsh ABC Law Centers, our birth trauma attorneys have extensive experience handling birth injury cases involving shoulder dystocia, hypoxic-ischemic encephalopathy (HIE), brachial plexus injuries, and Erb’s palsy. Please contact us today for a free case review. Our award-winning birth injury lawyers are available 24/7 to speak with you.
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