Brachial plexus injury
Occasionally during the birth of a baby the shoulders will be caught behind the pelvis of the mother as the baby moves down the birth canal. This is creates a medical emergency called dystocia. When this happen a doctor will need to intervene and try to dislodge the shoulders and may use forceps. During attempts to maneuver the shoulders loose the brachial plexus nerves of the child can be damaged by the use of forceps that are used to pull the head and dislodge the shoulders.
Brachial plexus injury is the medical term used for injury to the brachial plexus nerves in the shoulder. The brachial plexus is also called the Erb’s Point. Most brachial injuries are minor and heal spontaneously in 3 to 4 months. The injury can cause scar tissue to form along the nerves in other cases. This scar tissue can interrupt the signals to the muscles in the area. In major injuries the brachial nerves can be so damaged that they are torn from the spine or they may rupture along the spine. In extreme birth injuries to the brachial plexus, the child may be paralyzed in the arm and shoulder. However, surgical intervention can be performed to prevent a permanent paralysis if done quickly.
Some children born with a Brachial Plexus injury may end up having Erb’s pasly, Klupke’s palsy or Brachial palsy. Sometimes a Brachial Plexus injury can occur even if dystocia does not occur naturally during birth. If labor inducing drugs are used to speed up labor the fetus may descend unnaturally down the birth canal and become stuck behind the pelvis. A breech birth usually requires the use of forceps and puts the fetus at risk for injury. Inducing labor increases the chances of dystocia. If the mother has had a previous delivery where dystocia occurred the fetus is at a higher risk for it during subsequent deliveries.
Very large or macrososmic fetuses are at a greater risk for brachial plexus injuries as well. A macrososmic fetus is one that weighs more than 9 pounds 15 oz. In fact, the majority of Brachial Plexus injuries occur with the birth of large fetuses. A prolonged labor can necessitate the use of forceps and vacuum extractors which can injure the fetus. If such tools are used for more than 20 minutes the risk for dystocia increases. Also, a woman who has gestational diabetes may be at risk for delivery a fetus with a Brachial Plexus injury because the fetus can be quite large.
Most brachial plexus injuries are preventable. If such an injury occurs it can result in varying degrees of weakness the arm and the part that directly correlates to the nerves in the upper, middle or lower trunk. When such and injury occurs the forearms turn inward and wrists can be bent. The arm will be limp and the baby will not be able to lift their arm. Another symptom may be a droopy eyelid on the side of the injury. This is called Horner’s Syndrome.
Pregnant women should take care with their diet so that the fetus does not gain weight faster than normal. A woman who has gestational diabetes needs to pay particular attention to blood sugar levels because these pregnancies put a fetus in the higher risk category. If a dystocia is predicted it is possible to prevent a Brachial plexus injury by doing a cesarean section delivery to lower the risk. Other prenatal factors that put the fetus at risk for such an injury include the presence of a small pelvis in the mother, fetal malposition at delivery, such as in breech deliveries, and prolonged labor. Your health care provider can discuss such complications with you prior to delivery. If a cesarean section is indicated it will be discussed with you by your medical doctor.
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