Erb's Palsy and Brachial Plexus Blog

Birth injuries are obviously difficult to go through for both the families and the infant. And even though most Erb’s palsy injuries heal on their own over time, about ten percent of these injuries will need further treatment. Having your child diagnosed in the first two months of their life will help to determine if therapy or surgery is necessary.

Treatment depends on the severity of the injury:

• Avulsion – The nerve is torn from the spine and permanently damages the affected area.
• Stretch/Neuropraxia/Praxis Injury – The nerve is damaged, but has not torn. The nerve will try to heal itself, but function may be limited.
• Neuroma – When the nerve heals itself, a scar may form, which interrupts communication to the injured area.
• Rupture – The brachial plexus has been torn in one or more places, but the nerves have not detached from the spine.

While mild injuries may heal on their own, to fully recover, exercise and therapy may be prescribed. Follow-up appointments will help to ensure that your baby’s recovery is on the right track.

If the injury does not heal within the first four months, or if there is an avulsion or rupture, surgery is the best option. Surgeons will use one of three techniques to repair the nerves:

• Neurolysis – Scar tissue is cleared from the nerve
• Nerve graft – A nerve is transplanted from the leg to reconnect the damaged nerves
• Nerve transfer – An attempt is made to restore function to paralyzed muscles by sewing a nearby functioning nerve to the damaged area

While this might be enough in most cases, a secondary surgery may be required. This is due to other conditions developing when there is less than full recovery after the first surgery. Shortening or imbalance of the muscle or joint problems may occur. There are a number of procedures to correct this including a tendon transfer, joint fusion, and free muscle transfer.

Rehabilitation may still be needed, even after a second surgery.

You want to spend the first year at home with your newborn, and not in a hospital watching your child go through surgery. And all this time you may be wondering why this happened in the first place. Because Erb’s palsy may be preventable, and may in fact be the fault of the hospital, you should seek legal advice. Please contact the experienced Erb’s palsy attorneys at Trief & Olk for a case evaluation.

When a baby’s shoulder cannot pass the mother’s pubic bone, there is a chance for shoulder dystocia. There has not been any one cause of shoulder dystocia found, yet evidence points to this as a preventable condition. The possibility of inadequate contractions, the baby’s abnormal positioning, and more can be helped by medication, such as oxytocin, as well as forceps and cesarean delivery. Active management of labor (first adopted at the National Maternity Hospital in Ireland to prevent prolonged labor) and surgery are two ways in which shoulder dystocia can be avoided.

Active Management of Labor (AMOL) Prolonged labor has been identified as one possible cause of shoulder dystocia. These labors put strain on both the baby and the mother, and increase the chance of an injury to both, as well as longer hospital stays. AMOL follows strict criteria to manage birth and includes:

• Admission of patients who are going through an early labor
• Preparing the cervix for labor (also called effacement) when contractions have begun may be performed by doctors or attending nurses
• Artificially rupturing the fetal membrane (early amniotomy)
• Giving the mother a high dose of oxytocin if cervical dilatation is inadequate. If dilatation is still inadequate after 24 hours, it is considered a prolonged labor

The hope with AMOL is to reduce the incidence, not only of shoulder dystocia, but also cesarean delivery. However, if it seems that the baby may be in danger of dystocia, a cesarean delivery is the next option.

Surgical Care Delivery with surgical forceps or vacuum-assisted delivery may help to avoid dystocia. Your obstetrician will determine if forceps or vacuum-assisted delivery is necessary. Both can be used to help deliver the baby when its head begins to show. This is all contingent on the position o f the baby. If the birth seems like it will not happen spontaneously, and that dystocia is a possibility, the baby will be helped with the use of forceps or vacuum-assisted. Both will help the rotation of the baby to a more normal position for delivery.

Obviously, the mother has very little say in how their child is going to come into the world. However, it is important for expectant families to understand what some of the options are to avoid shoulder dystocia. If you have any questions about this, we encourage you to discuss them with your health care professional. If your child has suffered a birth injury that may have been prevented, please contact Trief & Olk.

While there are several factors that may increase the chance of Erb’s palsy or shoulder dystocia, there isn’t one that may increase the chances more than another. Though there may be a higher chance if the baby is born large or the mother is short or small, even what we might call “average” births can result in birth injuries. Your doctor should discuss all of this information with you before your baby’s birth, but they should also discuss the best birthing position or maneuvers to alleviate the chances of a birth injury. Birth is different for each expectant mother, but some of the best techniques are:

• Gaskin Maneuver – The mother is on her hands and knees. This changes the diameter of the pelvis allowing for an easier birth. This may not be possible if the mother has had an epidural.
• McRobert’s Maneuver – The mother’s legs are flexed toward her shoulders as she lays on her back. This expands the pelvic outlet, and may reduce the chances of shoulder dystocia by half.
• Woods Maneuver – Also known as the corkscrew, the doctor or attending nurse places two fingers behind the shoulders of the baby and pushing in 180 degrees.
• Rubin Maneuver – Two fingers are placed behind the baby (as they are in the Woods Maneuver), but they push in the direction of the baby’s eyes to line up the shoulders.
• Suprapubic Pressure – Pressure is put on the pubic bone and not the top of the uterus. This gives more room and allows the shoulder to move under the pubic bone.
• Zavanelli Maneuver – This is the most dangerous maneuver, but may be necessary if the baby is already breaching. The head is pushed back into the vagina and a cesarean is done.

If you are concerned that your child may be at risk for Erb’s palsy or shoulder dystocia, consult your obstetrician about these maneuvers. If your child has suffered a birth injury, please contact the experienced birth injury lawyers at Trief & Olk.

Giving birth to your child is supposed to be one of the most joyous and memorable occasions in an adult’s life. But for some parents, the birth of their baby is not always a happy occasion filled with excitement and celebration. We have all heard medical malpractice horror stories in which surgeons amputate the wrong limb or even perform an operation on the wrong patient. But perhaps the most egregious of all medical mistakes are the ones that leave an innocent, helpless child with an injury that will affect him or her negatively for the rest of the child's life. Birth injury is an all-too-common occurrence in our nation’s hospitals, and we want you to know that if your baby was injured during birth due to medical malpractice or negligence, there is legal help out there for you.

Parents, siblings, grandparents, and other loved ones of a birth injured child face overwhelming physical, emotional, and financial hardships. Children with birth injuries often require a lifetime of medical supervision and twenty-four hour care. Many parents must quit their jobs to care for injured children, making the financial burden of medical expenses, therapy, and special education even more difficult to meet.

Depending on the type of birth injury your child has suffered, he or she may require surgery, medications, or physical therapy. All of these come at great financial expense. Your child’s best hope is in getting the best, most advanced treatment available. If your child has suffered a preventable birth injury, getting the compensation that you deserve may be your only means of providing the care your child needs and can mean the difference between recovery and permanent disability.

Some of the most common birth injuries are:

• Brachial plexus injuries
• Brain injury
• Untreated jaundice
• Infections
• Spasticity
• Paralysis
• Seizures
• Bruising from forceps
• Skull fractures
• Excessive bleeding
• Bleeding beneath the scalp
• Bleeding inside the skull
• Clavicle fractures
• Spinal cord damage
• Cranial nerve trauma
• Facial paralysis
• Soft tissue injuries
• Skin irritation
• Stillbirth

What makes birth injuries so tragic is that they may be preventable in most cases. Knowing that human error is the cause of your child’s lifelong disabilities is just so hard to accept. The following is a list of some of the preventable contributors to birth injuries:

• Untreated infections and undiagnosed medical problems in the mother
• Administration of improper medications during pregnancy and/or delivery
• Rh incompatibility
• Infections and medical problems in the fetus
• Miscalculation of the size of the fetus
• Failure to monitor fetus and respond to fetal distress
• Failure to perform a timely c-section
• Abnormal presentation, including shoulder dystocia
• Improper use of delivery instruments
• Failure to give oxygen to newborns when needed

If your child suffered a birth injury, you may be entitled to compensation to cover medical expenses, future medical needs of your child, and even pain and suffering. Only experienced birth injury attorneys can advise you at this difficult time. Please contact Trief & Olk today to schedule your initial consultation. We represent birth injury victims throughout New York and New Jersey and will fight to get you the compensation your family deserves.