Erb's Palsy Causes
Occasionally during labor and birth, a baby's shoulder can get stuck on the mother's pelvic bone. This birthing emergency is called Shoulder Dystocia. Accepted medical protocol exists to deal with this birthing emergency. Doctors may use many different procedures to dislodge the baby's shoulder so that the baby can safely pass through the birthing canal. In some cases, the doctor can reposition the mother, or the doctor can use his or her hands to maneuver and change the position of the baby. In particularly dangerous and difficult births, the doctor can break the baby's clavicle bone on purpose, break the mother's pelvic bone or perform an emergency C-section. A doctor can cut a deep episiotomy, perform the McRobert's maneuver, and exert suprapubic pressure. The doctor can also use gentle traction in a horizontal plane to avoid damaging the brachial plexus.
In the event of shoulder dystocia, the doctor can support the head of the baby and apply a small amount of traction during the dislodging maneuvers. When the doctor uses excessive traction on the head while the baby's shoulder remains stuck, the brachial plexus nerves in the baby's neck may suffer injury. Depending on its location, this injury then causes one of the types of brachial plexus palsy. If you and your baby have suffered injury contact us here.
Though doctors cannot predict shoulder dystocia and the danger of brachial plexus palsy, certain factors may suggest that certain births face a higher risk of shoulder dystocia. These risk factors include:
1) Fetal macrosomia, which is a condition in which the pre-birth weight of the baby is over 8 lbs. 14 oz.
2) Maternal diabetes
3) maternal obesity
4) Gestation that lasts beyond 40 weeks
5) Short maternal stature
6) Platypelliod, or contracted or flat pelvis
7) Maternal weight gain of 35 lbs. or more
8) Additionally, a protracted first stage of labor may suggest an increased risk for shoulder dystocia and consequently, increased risk for brachial plexus palsy. In addition breech birth or other abnormal presentation of a fetus, while not a risk for shoulder dystocia, can result in brachial plexus injury.
Because of the loss of sensation from an epidural, a mother may not feel the pushing sensation, and the baby might descend in an awkward position. The use of tools, including forceps or vacuum, to help the baby descend, may increase the risk of shoulder dystocia as well. Studies also suggest an association between an increased risk for shoulder dystocia and the use of labor-inducing drugs.
Despite these risk factors, more women have uneventful birthing experiences than those whose labors are complicated by shoulder dystocia. In addition, shoulder dystocia can occur in the absence of these risk factors as well. A minority of obstetric brachial plexus impairments are not related to shoulder dystocia. Some other reasons for this disability include tumors in the baby's neck or the mother's uterus, viral disease or other abnormalities.
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