There are several types of physical injuries that can occur during birth. Many involve trauma to the skull and face from improper use of birth-assist devices like vacuum extractors or forceps. During c-section delivery, babies can be cut by the scalpel. While these injuries can be serious, they most often resolve just like any other cut or bruise.
Shoulder dystocia is not a birth injury. It is a medical description of an event that occurs during the birth process. A shoulder dystocia occurs when an infant’s head and shoulders get trapped behind the mother’s pelvic bone during delivery. If a shoulder dystocia is not properly recognized and managed by the doctors, both baby and mother can be severely injured. Mother can suffer uterine rupture, and the baby may experience a collarbone fracture, cerebral palsy, a brachial plexus injury, an erb’s palsy, and in some instances, death.
A brachial plexus injury, also called an “Erb’s palsy” is diagnosed when a newborn baby shows weakness or lack of movement in one or both arms. These findings are evidence of damage or injury to the nerves in the brachial plexus; the area near the baby’s neck where certain nerves leaving the spinal cord extend across the top of the baby’s shoulder and down into her arm.
An Erb’s palsy is frequently caused by something called a “shoulder dystocia” during delivery. Shoulder dystocia is the medical term doctors use to describe a baby’s shoulder geting “stuck” or “hung up” on something as she is pushed down the birth canal. Doctors are supposed to recognize this immediately, and take actions to release the baby’s shoulder. If they don’t, the forces of labor and mom’s pushing will move the baby’s body forward, but the shoulder will be stuck in place. This can cause the baby’s arm to be pulled down, away from her head. This pulling can stretch, and sometimes even tear, the nerves in the baby’s shoulder.
Nerves are the wires through which our brain sends signals to the rest of the body. If these wires are damaged or torn, the signals can’t travel through them properly. If a baby suffers a brachial plexus injury during birth, her brain will have less ability to send messages to her arm, wrist, hand, or fingers. That is why babies with an Erb’s palsy have a weak grip in one hand, or look as if their arm is paralyzed and constantly bent at the elbow.
Treatment for an Erb’s palsy usually involves several types of specialty doctors working together. A pediatric neurologist (nerve specialist) will work with a physical therapist and an orthopedic surgeon. Their goal will be to repair the damaged nerves (if possible) and to strengthen the muscles and nerve signals around the injured area. Because babies grow develop so quickly, early treatment is critically important. Early treatment and strict adherence to physical therapy plans, including exercises the doctor will teach you to do for your baby, give the baby’s body the best chance of diminishing the long term effects of his injury.
Babies are incredibly resilient. Thus, early, proper and consistent treatment has been shown to “cure” almost 75% of Erb’s palsy symptoms by the baby’s first birthday. However, there are cases where the injury is severe enough to cause lifelong problems. Although such cases are rare, these children can face the life long challenge of having an arm that does not work properly. Difficulty with performing daily tasks may lead to anger and frustration. Limited use of the arm can make participation in sports and other activities hard or impossible. As you can imagine, this can cause the child to suffer psychologically and emotionally. Counseling by a child psychologist can help with these real and important issues.
Erb’s palsy is a term used by doctors to describe a baby with muscle and nerve dysfunction in one or both arms caused by damage or malformation of the brachial plexus nerves. It is named after Wilhelm Erb, who, in 1874 concluded that associated paralyses of the shoulder, back, and arms are derived from damage to the nerves in the brachial plexus region, rather than isolated nerves further down the arms. It is marked by the nerves of the upper arm being affected, usually after a birth injury. Infants with Erb’s palsy may experience the loss of feeling and weakness in the affected arm and hand. In severe cases, infants may have total paralysis in the affected arm.
Klumpke’s palsy is diagnosed when damage to the lower nerves in the arm affects the arm, wrists, and fingers. It is named after Augusta Déjerine-Klumpke, an American-born French physician known for her work in neuroanatomy. A baby with Klumpke’s palsy will usually have total paralysis in the lower half of the affected arm, and the hand usually takes on a permanent, claw-like shape.
Head injury during birth is far less common than a brachial plexus injury. When it does occur, it is usually associated with the doctor’s use of either a vacuum extractor and/or forceps to assist with delivering the baby. Both of these devices are applied to the baby’s head. Improper use can cause bruising and swelling around the baby’s head and face. This will usually resolve within a few days and have no long term effects.
However, improper use of forceps and/or vacuum devices can also damage the blood vessels in and around the baby’s brain, or the nerves leading from the brain to the rest of the spinal cord. This may cause loss of memory, speech, or movement in the affected area.
Your baby’s pediatrician should be aware that your baby was delivered by vacuum or forceps, and be on close watch for any developmental delays. Your baby should be seen by specialists in neurology and physical medicine at the first sign of decreased physical or mental development.