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Can shoulder injuries (known as brachial plexus injuries or Erb’s Palsy) sustained during delivery be prevented?

Great debate has ensued in the medical community concerning what can be done to reduce the incidence of shoulder injuries sustained by babies during the delivery process.  Collectively referred to as: shoulder dystocia, Erb’s Palsy or brachial plexus injuries, this type of birth injury is sustained when the child’s shoulder gets stuck behind the mother’s pubic bone during vaginal delivery and the delicate nerves in the child’s neck—or more acutely—brachial plexus— is damaged.

Recognizing the damages related to arm injuries

Depending on the degree of damage to the brachial plexus, a child can have substantially varied outcome ranging from slight nerve damage to an arm—that can regenerate over time, to severe nerve detachment where the child suffers permanent loss of use of the arm.  Understandably, children with shoulder dystocias may also suffer psychological trauma as they develop and begin to recognize the severity of their handicap and may benefit from counseling.

Another important aspect of Erb’s Palsy cases is the fact that children with arm injuries frequently suffer diminished earning capacity over the course of their lives as the injury precludes them from entering professions that require dual use of arms.  In a litigation context, a vocational counselor can assist in determining how the disability can impact future employment.

Reducing chance of shoulder dystocia during pregnancy

In order to reduce the incidence of brachial plexus injuries during delivery, doctors need to carefully monitor fetuses who may be at risk for developing the condition during development.  By identifying women/fetuses whom may be at an increased risk of shoulder dystocia at an early stage, the pregnancies can be closely monitored as they progress.  In addition to watching the mother’s weight and medical history (including diabetes and any type anatomical anomalies), obstetricians will pay special attention to babies that may be larger than average weight.

By identifying factors that could accompany an episode of shoulder dystocia, doctors may take the following intervening measures during the pregnancy:

  • Take steps to reduce weight gain of mother
  • Control blood sugar levels in diabetic / borderline diabetic women
  • Induce labor prior to due date when babies become heavier
  • Schedule cesarean sections in anticipation of labor and delivery

Minimizing chance of shoulder dystocia during labor and delivery

Even in completely normal pregnancies with healthy mother’s and fetus, shoulder dystocia may present itself.  Depending on the positioning of the child and condition of the mother, the obstetrician or midwife needs to be mindful that this situation can occur without advance warning.   When identified during labor, the physician should make arrangements for a cesarean or be prepared to perform a series of rotational maneuvers to change the positioning of the child.

When performing maneuvers to free the child’s shoulder, pressure should be placed on the mother’s pelvis as opposed to the head of the child— which places tremendous stress on the brachial plexus and increases the risk of serious injury to the child.

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