Can Shoulder Injuries (Known as Brachial Plexus Injuries or Erb’s Palsy) Sustained During Delivery be Prevented?

Erb’s Palsy is a relatively common birth injury that affects the nerves of the shoulder. When an infant’s neck is stretched or gets stuck in the birth canal, a brachial plexus injury can result. This bundle of nerves controls the movement of the shoulder and upper arm and can lead to paralysis, numbness, and limited mobility of the affected area.

The medical community has debated possible ways to reduce the incidence of shoulder injuries during delivery. Damage to the nerves that provide movement to the shoulder can have a great effect on a child’s life, both in the first few crucial months of development and beyond. Without timely surgery, the damage sustained in a birth injury may become permanent.

Possible Damages Related to Brachial Plexus Injury

Shoulder injuries in delivery can range from the nerve “stretching” or a total avulsion, or disconnection from the spinal cord. More severe forms of the injury require surgery, which can be costly. A child with a brachial plexus injury may incur high medical bills from procedures and physical therapy. Collectively, these are “economic damages.”

Remediating a brachial plexus injury may not only be expensive, but it could also take a psychological toll on the child as he or she ages. In the case of permanent injury, a child may develop psychological trauma as he or she begins to understand the extent of his or her disability. Children may also miss crucial windows of muscle development and experience gross or fine motor delays, even with therapy or surgery. These damages represent a collection of intangible harms referred to as “general damages.” A provider can be responsible for the economic and general damages that result from Erb’s Palsy, if those damages arose from his or her negligence.

How to Reduce the Chance of a Brachial Plexus Injury

Both providers and mothers can take steps to reduce the risk of Erb’s Palsy during pregnancy and delivery. First, understanding the risk factors for the condition can help improve outcomes for both mother and baby. For example, babies who are large for their gestational age are more likely to get stuck in the birth canal during delivery. Mothers can help control their own weight gain (and that of the fetus) by eating a well-balanced diet and exercising regularly throughout pregnancy. Providers, in turn, have a responsibility to provide coaching about healthy weight gain and must monitor women with gestational diabetes closely.

Another possible risk factor for shoulder injuries during delivery is the breech position. As a mother progresses throughout the third trimester, a provider should monitor her baby’s positioning in the womb. Though many feet first babies turn on their own before delivery, a provider can try a procedure called an external cephalic version (ECV).

If a child has these risk factors as a due date nears, it may be appropriate for the health care provider to schedule a delivery via cesarean section. This can help protect both mother and baby from the prospect of a traumatic birth and subsequent injury.

Even in normal, healthy pregnancies, a possibility of a brachial plexus injury may occur. A health care provider must be aware that this condition can present without warning and take the appropriate steps to intervene. Possible medical interventions include performing rotational maneuvers or performing a cesarean section.

In many instances, health care providers can prevent brachial plexus injuries during delivery. By identifying risk factors present in both mother and baby and responding appropriately, a provider can help protect the health of the baby and prevent any physical or psychological issues that may result from a brachial plexus injury.