The baby’s head has emerged from the laboring mother but suddenly, its neck retracts against the mother’s perineum, causing the baby’s cheeks to puff like a turtle retracting its neck into its shell. This tell-tale “turtle sign” of delivery complication is obstetricians’ greatest fear and means only one thing: shoulder dystocia. The baby’s anterior shoulder is caught on the mother’s pubic bone, leaving the obstetrician seconds to decide an alternative means of delivery. If the baby is not delivered within a few minutes, it could suffer irreversible brain damage or in some cases, death.

n this emergent circumstance, obstetricians consider multiple maneuvers to free the baby’s anterior shoulder. When shoulder dystocia is first recognized, both the McRoberts maneuver and suprapubic pressure should be simultaneously executed. According to M.D. Henry Lerner, the execution of these two maneuvers will resolve more than half of all shoulder dystocias.

Because the diagonal orientation of the symphysis makes shoulder delivery difficult, the McRoberts’ maneuver tilts the mother’s pelvis to make the symphysis more horizontal. This frees the anterior shoulder.

If the McRoberts maneuver does not resolve the troubled delivery by itself, suprapubic pressure can be concurrently applied. Obstetricians will place their fist above the maternal pubic bone and push the fetal shoulder in one direction to change its position to allow delivery.

The delivery complications as a result of shoulder dystocia can result in a brachial plexus injury. Shoulder dystocia is a frequent catalyst of BPI, but is by no means the only cause. The nerves at risk of injury in a BPI pass from the spinal cord between the bones of the neck and go into the arm. The nerves that run along the neck merge and branch out to form a “plexus” of nerves (American Academy of Orthopedic Surgeons,www.orthoinfof.aaos.org). Brachial plexus nerves control the muscles of the shoulder, arm, elbow, wrist, hand and fingers.

An infant with a brachial plexus injury will demonstrate symptoms including a limp, or paralyzed arm, loss of feeling in the arm and hand, or a lack of muscle control in the arm, hand and wrist. The National Institution of Neurology Disorders and Stroke says the injury can be diagnosed as an avulsion (the most severe case), in which case the nerves are completely separated from the spinal cord, a rupture, meaning the nerve is torn but not at the spinal attachment, neuroma, when the nerve is torn but the healed scar tissue puts pressure on the nerve and prevents sending signals to muscles, and as neuropraxia/stretch: the nerve is damaged but not torn.

Brachial Plexus Injury may also be referred to as Erbs Palsy, which refers to the damage done to nerve higher in the plexus. Global, or total, brachial plexus birth palsy involves higher and lower damaged nerves.

Brachial Plexus injury is one of the most common birthing injuries. 1 or 2 of every 1,000 babies are diagnosed with BPI. Even though BPI is a common injury, it’s recovery rate is extremely high. According to the University of Pittsburg Department of Neurological Surgery, a Collaborative Perinatal Study of 1973 showed that 90-95% of diagnosed infant–usually with neuroma and neuropraxia– have a spontaneous recovery of function, leaving only 5-10% at risk for permanent functional disability. In circumstances of avulsion and rupture when spontaneous return of function does not occur, surgery may be necessary.

A full recovery can take up to two years using parent-child exercises and physical therapy. Doing physical therapy exercises with your child each day will not only ensure good range of motion and prevent joint contracture, but show your daily support of their recovery process and journey to independence. During this difficult time, both you and your infant deserve support and peace of mind.

Chicago Brachial Plexus Support Group
Jennifer Engelhart
3952 West 102nd Street
Chicago, IL 60655
773-445-4652
Chicago_bpi@hotmail.com
http://www.chicagobpi.com/

Chicagoland Area BP Erbs Palsy SG
Penny Dwiel
1638 Chestnut
Des Plaines, Illinois 60018
Open Arms BP Palsy Support Group
Shoba Shekar
1087 Black Wolf Court
Fairview Heights, IL 62208
pshekar@aol.com

Should your child be a victim of Brachial Plexus Injury due to medical malpractice, consider hiring legal representation to assist you during this difficult time. The experienced lawyers at Ronaldson & Kuchler want to help you establish peace of mind that both you and your child are getting the help and justice you deserve.