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Shoulder Dystocia / Erbs Palsy

By rights, the birth of a child should be a joyous time for the entire family. The physical process of bringing a child into the world, however, can be a particularly vulnerable and dangerous time for both the mother and the child. It is ultimately the responsibility of both the physician and his staff to accurately diagnose and promptly treat any complications that might arise throughout the process. Injuries during the birthing process is one of the leading causes of cerebral palsy which, if negligently handled, can have devastating consequences for the life of your child and unforeseen costs for your entire family. Should this happen to you, it is important that you consult with an experienced Pennsylvania cerebral palsy attorney in order to safeguard your rights during this very vulnerable time.

Shoulder Dystocia

A common injury that occurs at birth and can lead to cerebral palsy is shoulder dystocia, which occurs after delivery of the fetal head, when the baby's shoulder becomes stuck behind the mother's pubic bone. When this happens, the remainder of the baby does not follow the head easily out of the vagina and the nerves in the shoulder get stretched, compressed, or torn if the doctor pulls too hard on the baby. Often this results in injury to the brachial plexus (a bundle of nerves running from the spine, through the neck, the armpit region and into the arm) during the delivery. In very extreme cases and sometimes as a result of gross negligence, paralysis may occur due to this injury, leaving the child with no muscle control or feeling in their arms or hands. While it can be particularly painful for a family to deal with the outcome of this injury to the child, it is absolutely crucial to consult one of the Philadelphia cerebral palsy lawyers at Silverman & Fodera at this time. Your right to pursue legal relief must be firmly safeguarded in order to protect the interests of you and your family at this delicate time.


Erbs Palsy

Another type of birth injury that is often associated with shoulder dystocia is Erb's Palsy , a kind of cerebral palsy which results from damage induced by excessive lateral traction placed on the baby's head. In a head-first vaginal delivery, excessive lateral traction to the head might occur when the baby's head is pulled sideways in an attempt to dislodge the trapped shoulder. 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. There are treatments that can greatly assist the child in improving from Erb's Palsy, restoring at least partial use of the affected arm or hand. While a limited recovery is possible, it is advisable to enlist the services of an experienced Philadelphia cerebral palsy attorney at this time. The recovery process will be long and complicated and will require a strong legal advocate on your behalf in order to properly seek legal restitution on your behalf.


Treatment Options

Physical therapists will need to work with the affected child to help increase range of movement. Daily exercise to keep the muscle and joints limber and moving may also help. If the child does not exercise the muscles in the arms and hands, the muscles will remain weak and may not grow normally. Electrical stimulation of muscles may also be considered in order to prevent atrophy. Early treatment for these injuries is crucial for optimal recovery. Most parents will also need to do a daily range of motion exercises with the child for several years. Surgery is also an option for children who do not improve from the above treatments.


Predicting and Resolving the Birth Emergency in the Delivery Room

Both Erb's Palsy and shoulder dystocia can be prevented before the actual delivery by recognizing its common risk factors. These 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 a small pelvis. If there is a high risk of shoulder dystocia, a C-section should be performed.


Unfortunately, there are some instances of shoulder dystocia that cannot be anticipated. However, more often, shoulder dystocia can be anticipated, prevented or handled without resulting injury. Injury to the baby can be prevented if appropriate steps are taken once the shoulder dystocia occurs.

It is extremely important that the physician and his staff be adequately trained in the case of such an emergency. There are several proven methods of overcoming the described difficulties which can provide relief to the distress of both the child and the mother. If dystocia occurs, it is extremely important that no lateral traction be applied to the baby's head. The child can be successfully delivered without applying lateral traction to the head by performing the McRobert's maneuver. During this procedure, the mother's legs are held back in a flexed position. At the same time, suprapubic pressure is applied to the mother's lower abdomen. Under no circumstances should pressure be applied to the upper abdomen (i.e. fundal pressure) 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 other 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 through the proper use of these proven methods when shoulder dystocia occurs.


This informational piece was prepared by the Pennsylvania cerebral palsy lawyers at the law firm of Silverman & Fodera. If you would like more information on this topic, call us at (800) 220-LAW1, or use the "Do I Have A Case?" link found here on this web site.