CHILD CASES: Shoulder Dystocia & Brachial
Plexus Injuries
Automobile
| Birth Injury | Shoulder
Dystocia | Product
Liability
Premises Liability | Day
Care Center
The
birth of a child is an awe-inspiring event. So often Mother Nature
and skilled doctors work together to provide a smooth entry for
the baby into the world. However, it is well-known that many births
have complications, and unfortunately sometimes those complications
lead to injuries. Some are preventable, some are not.
One of the most common birth injuries is known as Erb's Palsy. This
condition is the result of Brachial Plexus injuries and Shoulder
Dystocia during delivery. Simply put, shoulder dystocia is when
the nerves in the shoulder get stretched, compressed, or torn when
the doctor pulls too hard on the baby (usually because the baby's
shoulder has been stuck behind the mother's Pubis Symphysis bone).
What causes Shoulder Dystocia, Erb's Palsy, and
Brachial Plexus injuries?
What are the risk factors for Brachial Plexus
injuries?
How do I know if negligence is a possible
cause of my child's injuries?
What are our legal rights if our child has a shoulder
dystocia or brachial plexus injury?
What are the treatment options for Erb's Palsy
or Brachial Plexus injuries?
What causes Shoulder Dystocia, Erb's Palsy,
and Brachial Plexus injuries?
Many instances of shoulder dystocia can be anticipated and prevented
if the warning signs are heeded. There are some instances of shoulder
dystocia that cannot be anticipated. However, injury to the infant
can still be prevented if the appropriate steps are taken once the
shoulder dystocia occurs.
All the means necessary to successfully deliver the child can be
done without applying lateral traction to the head. An example of
a safe intervention during a shoulder dystocia is to perform McRobert’s
maneuver.
During
this procedure, the patient’s legs are held back in a flexed position.
At the same time, pressure is applied to the mother’s lower abdomen,
which is called suprapubic pressure.
Under
no circumstances should pressure be applied to the upper abdomen.
This is called fundal pressure and may cause serious injury to both
the mother and the baby.
If
the McRobert’s maneuver is not successful then there are a number
of methods that the doctor can perform to safely rotate the baby
and free its shoulders.
Almost
all deliveries can be successfully resolved with no injury to the
baby with the proper use of these proven methods where shoulder
dystocia occurs.
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What are the risk factors for Brachial Plexus injuries?
- gestational
diabetes
- obesity
in the mother
- excessive
weight gain during pregnancy
- macrosomia
(a baby weighing more than 4000 grams or approximately 9 lbs.)
- a
previous large baby
- a
post-term pregnancy
- a
small pelvis.
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How do I know if negligence is a possible cause of my child's injuries?
Birth injury as the result of negligence often occurs in the following
circumstances
- Not
recognizing or properly responding to fetal distress,
- Allowing
the pregnancy to go beyond 41 weeks without proper testing, or
42 weeks in any event,
- Failing
to act on changes in the mother's condition during pregnancy,
- Causing
or failing to respond to the umbilical cord being entrapped or
compressed,
- Misuse
of a vacuum extractor or forceps,
- Misuse
of the labor-stimulating drug Pitocin (Oxytocin),
- Delay
in ordering or performing a C-section,
- Poor
resuscitation and newborn care after birth.
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What are our legal rights if our child has a shoulder dystocia or brachial plexus injury?
The
process of childbirth is extremely complicated and requires a high
level of care on the part of doctors. Childbirth is extremely unpredictable,
in fact, 80% of childbirths have some form of complication. All of
these potential complications mean that doctors must make sudden split-second
decisions to react to problems during childbirth. Unfortunately, too
often a doctor or nurse may make the wrong decision under pressure
and that error could cause Erb's Palsy (Brachial Plexus).
Modern
medical technology and techniques make Erb's Palsy largely preventable.
There are several things doctors can do to decrease the risk of
an Erb's Palsy childbirth:
Estimate
the baby's weight before delivery (higher-weight babies are more
at risk and parents should be informed of this risk).
If
there is a high risk of Erb's Palsy, perform a caesarean section,
which removes the risk of the shoulder getting caught.
If
the doctor sees that the baby is not properly aligned, the doctor
should use appropriate techniques to prevent the shoulder from getting
caught. There are numerous techniques doctors know to prevent the
shoulder from getting caught. For example, if the shoulder or the
baby is gently shifted, the risk of the shoulder getting caught
can be greatly reduced. Or, the doctor could press down on the mother's
belly to push the baby's shoulder into the correct position.
This
is not to say that all Erb's Palsy cases are the result of negligence.
Often there is little or nothing a doctor can do. Nevertheless,
parents should consider the possibility that a doctor may not have
done all that is possible to prevent Erb's Palsy and at least request
some form of inquiry.
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What are the treatment options for Erb's Palsy
or Brachial Plexus injuries?
It
is essential that treatment for a Brachial Plexus injury be obtained
as soon as possible from experienced medical professionals who specialize
in treating Brachial Plexus injuries. Early treatment for Brachial
Plexus injuries most likely will include occupational and/or physical
therapy to help maximize use of the affected arm while preventing
contractures (tightening of the muscles and joints).
It
is important to note that even with ongoing therapy treatment and
surgical intervention, complete recovery from a Brachial Plexus
injury may not occur.
What
can be expected with treatment?
Most mild cases of Brachial Plexus injuries recover in 3 to 4 months.
The more severe cases improve slowly over 18 to 21 months. By 2
years of age, any recovery that will occur should have occurred,
and no further improvement is expected. Treatment consists of Physical
Therapy and Surgery.
Therapy
for Brachial Plexus Injuries
An occupational or physical therapist will work with your child.
The therapist will also help you (the parent) learn to do the exercises.
Most parents need to do the range of motion exercises at home with
their children two to three times a day for several years.
We
recommend daily exercises that help to keep the muscles and joints
moving normally. They are called range of motion exercises.
-
Provide tactile stimulation to provide sensory awareness
-
Use exercise to develop strength.
-
Most exercises inclus tasks to increase flexibility, strength and
feeling.
If
your child is not able to use muscles in the arm and hand, these
muscles will stay weak. The arm may not grow normally, and your
child may feel tightness in some muscles and joints. A joint that
stays in the same position all the time can actually "freeze". Exercises
keep the muscles and joints flexible. When the nerves start working
better, the muscles and joints will be ready to work.
Surgery
for Brachial Plexus Injuries
Surgery may help children who do not recover by the age of 5 months.
Nerve surgery is most effective when it is done between the ages
of 5 and 12 months and becomes less effective after 1 year. Nevertheless,
surgical correction for permanent disability or deformity can be
performed in the school-aged child where necessary.
For
some children, neurosurgery is not recommended or is not successful.
In these instances, other procedures can be done to transfer muscles
and tendons. This surgery is done by a plastic surgeon when the
child is older.
Paying
for medical care
The costs for treatment and surgery could overwhelm most families.
Families must be able to dedicate long hours to doctor's visits
and treatment. Financial support may be available to families in
the form of legal compensation.
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