Erb's palsy
What is ERB's Palsy
ERB's Palsy is a condition that can be caused by shoulder dystocia.
Initial symptoms of Erb’s Palsy will likely be a limp or paralyzed arm or lack of muscle control in the arm or hand. Children with Erb's Palsy generally cannot lift their arm above their head and will have difficulty gripping with the affected hand.
Can Shoulder Dystocia & ERB's Palsy Be Prevented?
There are some instances of Shoulder Dystocia that cannot be anticipated. However, more often than not, Shoulder Dystocia can be anticipated, prevented or handled without resulting injury. Shoulder Dystocia and resulting Erb’s Palsy can be prevented before the actual delivery by recognizing common risk factors. They are: gestational diabetes, maternal obesity, excessive weight gain during pregnancy, macrosomia (a baby weighing approximately 9 lbs. or more), a previous large baby, a post-term pregnancy and/or having a small pelvis. If there is a high risk of Shoulder Dystocia, a C-section should be recommended. Injury to the baby can be prevented in the presence of Shoulder Dystocia if it is promptly recognized and appropriate steps are promptly and appropriately carried out.
Erb’s Palsy results in a head first vaginal delivery when excessive lateral traction is placed to the baby’s head. In other words, when the baby’s head is pulled sideways by the obstetrician in an attempt to dislodge the trapped shoulder. Once the dystocia occurs, no lateral traction should be applied to the baby’s head. The child can be successfully delivered without applying lateral traction to the head by performing a variety of maneuvers. The foremost recommended maneuver is the McRobert’s maneuver. During this procedure, the mother’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 (i.e. fundal pressure) in the presence of Shoulder Dystocia, as it 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 without injury to the baby with the proper use of these proven methods where shoulder dystocia occurs.
How is ERB's Palsy Treated?
The goals for a child with Erb’s Palsy are for them to have at least partial use of the affected arm or hand. There are treatments that can greatly assist the child in improving from Erb’s Palsy. Mild cases of Brachial Plexus injuries can recover in as little as a few months with physical therapy. An occupational or physical therapist may work with your child. The therapist will also help you (the parent) learn to do the exercises. For optimal results parents will need to do the range of motion exercises at home with their children two to three times a day. The more severe cases at a much slower rate, sometimes over years. More severe cases may require invasive treatment. Surgery may help children who do not recover with therapy alone. Electrical stimulation of muscles may also prevent atrophy. Early treatment for these injuries is crucial for optimal recovery. Botox injections and surgery on the affected nerves are also options for children who do not improve from the above less invasive treatments.
What are Our Legal Rights?
The process of childbirth is extremely complicated and requires a high level of care on the part of doctors and other Labor & Delivery healthcare providers. Childbirth can unpredictable and often times complications can arise. Obstetricians are trained recognize these complications and make quick but prudent decisions to react to problems during childbirth. Unfortunately, the doctors or nurses may make the wrong decision under pressure in the presence of Shoulder Dystocia and that error could cause Erb's Palsy (Brachial Plexus injury).
However, not all Erb's Palsy cases are the result of negligence. Sometimes there is little or nothing a doctor can do to prevent a Brachial Plexus injury. 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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