Find out what you can do to avoid Erb's Palsy during the delivery of your baby in Kingston, New York.
Erb's Palsy is the loss of movement or weakness of the arm when a collection of nerves (known as the brachial plexus) around the shoulder are injured at birth. Most babies recover within six months, but some suffer permanent, partial or total loss of function of the arm.
The most common cause of Erb's Palsy is dystocia, an abnormal or difficult delivery.Shoulder dystocia is difficulty delivering the baby's shoulder after the head has already emerged. The injury usually happens when too much force is applied to the baby's head (known as lateral traction) while trying to pull a baby stuck in the birth canal. Pulling on the baby's head stretches and injures the nerves in the stuck shoulder.
There are a number of risk factors that make shoulder dystocia predictable. First on the list of risk factors is a mother who had a prior delivery complicated by shoulder dystocia. If the mother had difficulty delivering a baby, it is likely that she will have difficulty on the second go around.
The second risk factor is a large baby (known as a "macrosomic" baby). When ultrasounds reveal a baby that is "large for gestational age" (LGA), a "big baby" can be expected and the bigger the baby the more difficult it will be to deliver.
The third risk factor for shoulder dystocia is gestational diabetes, which is a type of diabetes that only develops during pregnancy. Mothers diagnosed with gestational diabetes are more likely to have "big babies" and thus, have more difficulty delivering their baby. The diagnosis of gestational diabetes increases the likelihood that the mother will encounter shoulder dystocia.
Another risk factor for shoulder dystocia is a mother who has her labor induced or sped up with drugs, such as Cervadil or Pitocin. These drugs increase the force of uterine contractions and if the baby's shoulder gets stuck on the mother's symphysis pubis (pubic bone located in the front of the pelvis), there will be greater force applied to the baby's shoulder.
A big risk factor is an abnormally shaped pelvis. If the mother's pelvis is unusually shaped, such as a shortened pelvic inlet, it will be more likely that the baby will get stuck in the birth canal. To assess the dimension and size of the pelvis, the obstetrician or nurse midwife should perform a test known as clinical pelvimetry, which assesses the shape of the pelvis during the mother's prenatal care.
If the mother has any of the risk factors for shoulder dystocia, she must be informed of the risks and the possibility of shoulder dystocia and Erb's Palsy. Mothers should be informed of the risks that can lead to a difficult delivery with shoulder dystocia and consider their options, such as an earlier induction of labor or a planned delivery by cesarean section if risk factors are present.
The biggest mistake that obstetricians and nurse midwives make is that they do not keep the mother informed of the risk factors for shoulder dystocia and delivery options. If the mother is informed of the risks of shoulder dystocia and Erb's Palsy and knowingly accepts the risks by undergoing a vaginal delivery, then the obstetrician or nurse midwife is doing their job. However, the doctor or nurse midwife must make sure that the mother is fully informed of her risks and the potential for serious injury, particularly when risk factors for shoulder dystocia exist. This is where most doctors/nurse midwives get into trouble.
If you have any of the risk factors for shoulder dystocia, make sure you sit down with your obstetrician/nurse midwife to explore your delivery options. It might be the best conversation you can have for your baby's future.