While breech presentations can increase the risk for Erb’s palsy, it also occurs in head-first deliveries. Head-first presentation, also known as cephalic presentation, is the “normal” way a baby enters the birth canal.
When the baby presents face-first without tucking its chin or when it faces the mother’s abdomen, it can increase the difficulty and length of delivery as well as the risk of Erb’s palsy and other birth injuries. It may also increase the need for the doctor to employ forceps or a vacuum-assisted extraction device.
Birth Injuries From Excessive Pulling on the Shoulders Can Occur During Head-First Deliveries
In a cephalic presentation, especially when the baby presents face-first, the doctor may pull and tug at the child’s shoulders to try to get the newborn to move down the birth canal. Even in a normal head-first delivery, delivering the shoulders can be a problem. Shoulder dystocia, when both shoulders get stuck in the birth canal, is a leading risk factor for Erb’s palsy.
If the baby is much larger than the birth canal, a Cesarean section (C-section) may have been a better delivery route. Failure to order a C-section when necessary could be grounds for a medical malpractice birth injury lawsuit.
Understanding Erb’s Palsy and Why Brachial Plexus Injuries Occur
Erb’s palsy results from damage to the nerves that supply movement and sensation to the baby’s upper arm.
These injuries often occur because of forceful pulling, putting excessive lateral traction on the baby’s head and neck in an effort to move it down the birth canal. Shoulder dystocia causes a significant increase in risk for this type of injury and Erb’s palsy. Other risk factors for developing this type of nerve injury in a head-first delivery include:
- The use of forceps or a vacuum extraction tool during delivery
- Large infant size, high birth weight
- Mother with gestational diabetes resulting in a large baby
- An especially petite mother
- Excessive maternal weight gain during pregnancy
- Extended and difficult labor, especially the second stage
If the mother and baby face these risk factors, the doctor should recognize them and consider if a C-section is a better option than a vaginal delivery. If delivery is already in progress, there are techniques the doctor can use to properly turn the child or deliver without excessive pulling.
Knowing which birth technique to use and how to use it is paramount. Choosing the wrong option or applying it incorrectly may be grounds for a medical malpractice case if the child develops Erb’s palsy or suffers another birth injury.
Identifying and Treating Erb’s Palsy
If a newborn does suffer a brachial plexus injury during birth, the symptoms are usually apparent immediately. Hospital staff often recognize the symptoms, and many newborns receive a diagnosis in the first hours or days after birth. Signs and symptoms of this type of injury include:
- Paralysis or weakness in one arm
- Weakened grip in the hand of the affected arm
- Lack of sensation in the affected arm
- Holding the arm in a “waiter’s tip” position, with the arm extended and held close to the body, and the wrist flexed
- Absent Moro (startle) reflexes in the affected arm
The most common treatment for a child with Erb’s palsy is a conservative approach that includes close monitoring of their progress and physical therapy to help them maintain and build muscle mass and range of motion. This is effective in the vast majority of children with Erb’s palsy. It rarely causes lasting damage.
Occasionally, surgical repair is necessary. In rare cases, a child could have a lasting disability related to a birth injury and Erb’s palsy.
Erb’s Palsy Lawsuits
Most cases of Erb’s palsy are preventable. The doctor has a duty to monitor both mother and baby and make decisions about the delivery that reduces the risk of birth injuries. If the delivery is already too far progressed when complications arise, the doctor must choose which options are best for helping the baby through the birth canal. This could include:
- Using specific techniques to turn or assist in the delivery of the infant’s shoulders
- Proper use of forceps, vacuum-assisted extraction devices, or other tools
- Other procedures or techniques advised depending on the specific conditions
What this will never include is excessive force or a forceful pull of the infant’s arm or shoulders. If your child has an Erb’s palsy diagnosis, you may have grounds for a birth injury medical malpractice lawsuit. You should discuss the merits of your case and your legal options with a birth injury lawyer near you.