Erb's Palsy

Welcoming a new child into the world should be a joyous occasion for new parents.

However, when the child is born with a birth injury, joy is immediately replaced with concern.

Inevitably, questions arise. Why did this happen? What does the future hold for my baby?

Predictable and  Preventable

Erb's Palsy is a birth injury which is usually preventable. It occurs when the nerves from the cervical spine which go to the arm are stretched or torn during the delivery process.

Unfortunately this nerve damage is often permanent. 

When a doctor has reason to believe that there will be a large baby, Caesarean Section should be considered.

One clue is when the mother suffers from diabetes during the pregnancy. The increased sugar in her blood causes the baby to grow more than usual, resulting in a larger head and broader shoulders. This makes it more difficult for the child to fit through the pelvis, and more likely that one of the shoulders will get caught on the mother's pelvic bone, creating the circumstances for an Erb's Palsy injury.

A sonogram may also indicate a larger than usual baby. If the mother does not progress quickly through the initial stages of labor, this too can indicate a large baby. A larger baby will not move down the birth canal as smoothly or rapidly as a smaller one.

When this occurs, the physician should realize that there is the possibility that the baby is too large for normal vaginal delivery, and steps should be taken to prepare for Caesarean Section. 

By performing a Caesarean Section, the excessively large baby does not have to pass through the narrow birth canal, avoiding trauma from being forced into and through the boney pelvis.

Sometimes during the delivery process, the baby's shoulder gets caught on the pelvic bone without advance warning. Even when this occurs without advance warning, permanent nerve injury is generally preventable. 

The key for the doctor is not to panic. The doctor should not pull on the child's head because this can stretch or tear the nerves in the spine which lead to the impacted shoulder. 

Similarly, the doctor should not try to push the child out by applying pressure to the mother's stomach. This is like trying to force a square peg through a round hole. If you push hard enough, you can fit a square peg through a round hole, but only with significant damage to the corners of the peg.

If you push on a mother's stomach hard enough or pull on the child's head hard enough, you can ultimately deliver the child, but only after causing serious and permanent injury.

Although there are many acceptable maneuvers that can be used to deliver the child without permanent nerve damage to the shoulder and arm, many doctors do not follow them.

Unfortunately, sometimes physicians panic, fail to perform the appropriate maneuvers and end up causing permanent nerve damage by pushing the baby out from above or pulling the baby out from below, despite the fact that the shoulder is impacted on the pelvic bone. When this occurs, the physician is committing medical malpractice.

Permanent Injury

Although many children born with Erb's Palsy injuries recover to a significant degree, many are often left with permanent nerve injury to their shoulder and arm. The arm can be weaker and shorter than the other arm, atrophied, and the shoulder deformed. In some cases the nerve damage is so severe that surgery is necessary.