Erb's Palsy is an injury that effects the movement of a baby's shoulder, arm, wrist, and hand. It occurs in 0.5%-1% of all births.
Typically, Erb's Palsy results when too much force is applied to the baby's head while trying to pull out a baby whose shoulder is stuck in the birth canal. The baby may be too large to fit easily through the birth canal. When the baby's shoulder gets stuck in the birth canal, it is called "shoulder dystocia."
Pulling on the baby's head when the baby is stuck, stretches and injures the nerves in neck on the side of the stuck shoulder, that provide movement to the arm, hand, wrist, and fingers. This collection of nerve fibers is called the "brachial plexus," or "Erb's Point" (hence the name Erb's Palsy, or Brachial Plexus Palsy).
When it was first identified in the 1800's, Erb's Palsy was originally called "Obstetrical Palsy," because its relationship to traumatic birth was clear. However, doctors did not like having an injury named for their treatment, and so the name was changed to Erb's Palsy (or Brachial Plexus Palsy), so the connection between the injury and obstetrics was obscured.
Erb's Palsy may result in varying degrees of weakness or paralysis of the shoulder, arm, wrist or hand, depending on the severity. Which part of the arm is involved depends on which nerves in this big network, or plexus, of nerves is injured. A baby with Erb's Palsy typically holds his arm limp, down by his side with forearm turned inward and wrist bent. The baby can't lift the arm up and doesn't bring it up even when s/he is startled. A baby with a very bad injury may also have a droopy eyelid on the side that was injured, in addition to an injury to his arm and hand.
Often, the newborn's inability to use the effected arm is recognized immediately or shortly after birth. Sometimes it is detected in the newborn nursery. Following a difficult delivery in particular, the possibility of a nerve injury should always be considered and ruled out. The baby's pediatrician can order a pediatric neurology consultation, a MRI of the shoulder, and/or electrical studies (called EMG's, or nerve conduction or nerve velocity studies), to identify and locate the point(s) of injury to the nerves.
There are several well-known risk factors that increase the likelihood of difficult deliveries and Erb's Palsy:
Yes, Most Erb's Palsies can be prevented! How?
Because the risks factors for shoulder dystocia and Erb's Palsy are well known, many techniques and methods have been developed to prevent it.
The risks of shoulder dystocia and Erb's Palsy can be greatly reduced by having good health care during pregnancy, such as:
1. The blood sugar levels of mothers with diabetes (type I or type II), or gestational diabetes (diabetes only when pregnant) require vigilant monitoring. They also require good dietary instruction, and tight control of blood sugars through diet, or medication administration, or both, throughout the pregnancy. We know that high blood sugars "overnourish" the baby and make it gain weight faster than normal, and larger babies are more likely to get stuck in the birth canal.
2. If there are risk factors for Erb's Palsy, consider an elective cesarean delivery rather than vaginal delivery. Babies born by cesarean section do not get Erb's Palsy! But this decision should not be made lightly either, since it cesarean section is major surgery and also involves significant risks.
3. Good advance planning by your obstetrician can lead to an earlier delivery in the event your baby is thought to be too big for an easy, safe delivery. A large baby can be delivered a few days or weeks early, before s/he becomes too large for delivery vaginally. (A large baby is called "macrosomic"). This is a situation where an ounce of prevention is worth several pounds of cure.
4. Parents should be informed and involved in anticipatory decision-making, not last minute crises during delivery.
5. In the event that a baby's shoulder becomes wedged behind the mother's pubic bone (shoulder dystocia), there are several well-known techniques and maneuvers to dislodge the stuck shoulder safely. A team of nurses and doctors with current knowledge and skill in the techniques for these deliveries are less likely to deliver an injured baby.
A Wood's Maneuver (also called the Corkscrew Maneuver), (pictured below) may be used to rotate the baby in the birth canal, to free up the stuck shoulder.
A McRobert's Maneuver (also pictured below) raises the mother's legs and knees, in order to increase the size of the birth canal and allow the baby to pass through. Below is an illustration of maneuvers that nurses and physicians should employ to dislodge the baby when it has gotten stuck.
6. "Shoulder Dystocia Drills" should be performed on a routine basis at the hospital or birthing facility where you deliver. These are essentially "dress rehearsals" for the delivery team, so that if a shoulder dystocia happens, everybody in the Delivery Room knows exactly what their function is, and everybody can spring into action at once. As always, practice makes perfect! Research demonstrates that rehearsals or drills by the labor team reduce the risk of injuries to the fetus when a true emergency occurs.
The McRobert's Maneuver raises the mother's thighs and knees to increase the diameter of the birth canal. At the same time, a nurse or other attendant pushes down to dislodge the stuck shoulder.
About 75% - 80% of Erb's Palsies are mild, and resolve by themselves over time, typically within a year. A disability that lasts over a year after birth is usually considered to be permanent.
Early recognition and intervention is the key to cure. If detected shortly after birth, prompt splinting and physical therapy can help. Delays in diagnosis and intervention decrease the likelihood of a good outcome, and may be malpractice separate from the traumatic birth.
In severe cases, there are some sophisticated neurosurgical and orthopedic surgical procedures that can sometimes repair or graft the injured nerves.
Because early recognition and intervention is the key to cure, delays in recognition or intevention may limit the opportunities for the best outcome. Delay diagnosis or intervention may be a malpractice event, even if the Erb's Palsy itself was not the result of malpractice.
Most of the time, Erb's Palsy is the result of poor care. The immediate cause of the injury is excessive force during the delivery, but there may be malpractice in failing to anticipate a difficult delivery, failing to monitor and control the mother's blood sugar levels, hyperstimulating the labor with drugs, failing to consider or offer a cesarean section, failing to recognize that a very big baby was coming, failing to properly perform the maneuvers above when shoulder dystocia is encountered, failing to recognize a pelvis that may be too small or odd-shaped to allow an uncomplicated birth, failing to conduct routine "shoulder dystocia drills" to train to handle the problem when it occurs, failing to promptly diagnose and intercede after the baby is born, or many other causes.
The only way to assess whether there is a case or not, is to do a careful review and analysis of the mother's and baby's pre-natal, delivery, and newborn records.
Hiring just any attorney is easy. Hiring the best attorney for your case is a bit more difficult.
Erb's Palsy litigation is a sophisticated sub-speciality of medical malpractice law, which is itself a difficult specialty. You should retain an attorney who has handled several such cases and has a proven record of good results. You don't want a beginner learning the ropes of Erb's Palsy litigation using your case for their learning experience.
We have been prosecuting Erb's Palsy and Birth Trauma cases for over 40 years, with a proven track record of great results.
The Law Offices of Mark R. Bower is the only firm in New York to ever win summary judgment for the patient in an Erb's Palsy case, meaning liability was established just on the legal papers, without the need of a trial, resulting in a prompt settlement. ("Roser v. Benedictine").
Together with co-counsel, we also won a national landmark precedent that precluded the defense from using the usual "natural forces of labor defense" that attempts to blame Mother Nature, or the mother's anatomy or contractions, for the Erb's Palsy. ("Muhummad vs. Fitzpatrick"). This terrific precedent was affirmed on appeal, and quickly followed by courts in two more of our Erb's Palsy cases in NY, driving favorable settlements, and has generated great interest nation-wide in the malpractice bar.
Mark R. Bower has attained national prominence, lecturing on "precluding the natural forces of labor defense" for the American Association of Justice and the Academy of Trial Lawyers of the State of New York.
We welcome your inquiry about your possible case on a free, no-obligation consultation. You have nothing to lose by reaching out to us. All cases are handled on a contingency fee basis, meaning no fee unless we get a recovery for you. The fee will be a percentage of the recovery, which is set by state rules.
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