A Primer on Erb's Palsy for the Lay Person
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.