Should Dystocia: Birth Injury Risk Factors

If you are pregnant and your unborn child is estimated to weigh more than 8 pounds, 13 ounces, then you may be concerned about potential birth injuries including shoulder dystocia and Erb’s palsy. While neither condition is able to be predicted prior to your child’s birth, there are number of factors that put you and your baby at risk.

Your risk for those conditions is elevated if you are over the age of 35, obese, significantly past your due date, diabetic or if you have previously given birth to a large baby or one who suffered from shoulder dystocia.

Being at risk does not render you helpless. Depending on how large your baby is estimated to be and the number of risk factors, you may decide to speak with your doctor about delivering the baby via a Cesarean Section (C – Section).

Yet, it is important to know that a C – Section is major surgery and it not without risk. C – Sections carry many of the same risks as other major surgeries including the risk of infection, blood loss and respiratory complications from anesthesia. Other complications include risk of changes in bladder or bowel function that may require further surgeries. C- Sections require longer hospital stays and recovery times than vaginal births and carry a higher risk of maternal death at about 1 in 2,500 as compared to 1 in 10,000 vaginal births.

For more information about the pros and cons of C – Sections please visit the NYU Langone Medical Center website.

When the time comes to make a decision, most women are dependent on the knowledge and expertise of their doctors to help them come to the right decision. It's important that you work with a doctor whom you trust to exercise the right standard of care.

Shoulder Dystocia, Pregnancy, and Diabetes

Shoulder dystocia is one of the most common birth injuries. The degree of severity varies significantly within the .3 -2 births per 1,000 that are affected by this complication. The likelihood of shoulder dystocia increases if you are a mother with diabetes.

It is often said that is not possible to predict shoulder dystocia until the mother is actually delivering the baby. While that is technically true, there are risk factors such as maternal diabetes that increase the chances of shoulder dystocia and there are ways to minimize the risk.

Can Shoulder Dystocia be Prevented?
No, shoulder dystocia cannot be prevented because it cannot be accurately predicted. However, if you have Type I, Type II or Gestational Diabetes then there are things that you can do to lower your risk of delivering a baby that suffers the trauma of shoulder dystocia.

The best way to prevent shoulder dystocia is to keep your baby within an ideal birth weight of approximately 6 pounds to 8 pounds 13 ounces. Of course, this is not always possible and there are many factors that are not within the control of either the mother or her doctor.

Here are some things that you can do to keep your diabetes under control and maximize the odds of having a baby that is less than 8 lbs 13 oz:
· Allow your doctor to perform the recommended tests to determine if you have diabetes;
· Follow the diet prescribed by your doctor, nurse or nutritionist;
· Exercise regularly, as discussed with your doctor;
· Take oral medications or insulin as prescribed by your doctor;
· Test your blood sugar several times a day, as directed by your doctor, to make sure that your blood sugar levels are staying within your targeted range. Whenever you get a reading that is outside of the targeted range, contact your doctor.

It is hard to be diabetic and pregnant. However, it is well worth the effort that it takes to effectively manage your diabetes so that you may be able to prevent your baby from suffering a birth injury.

Erb's Palsy Risk Factors

Prospective parents are often nervous about the impending birth of their child. Labor and delivery is serious business and apprehensive parents often spend a lot of time planning for a healthy baby.

Parents are often worried about possible injuries that can happen at birth. One of the injuries that can occur during birth is Erb’s Palsy. Erb’s Palsy affects the nerves that are required for proper movement of the shoulder, arm and hand. There is no one cause of Erb’s Palsy. However, there are a variety of factors that make it more likely to occur and it is important for prospective parents to speak to their obstetricians about their options for a safe delivery if one or more of the risk factors are thought to be present.

The risk factors for Erb’s Palsy include difficult deliveries, large babies (over 8 lbs 13 oz), a baby in the breech position, prolonged labor and the use of forceps or vacuum suction to help the baby be delivered. It is possible for ultrasound technicians and obstetricians to estimate the size of the baby and ascertain the baby’s position prior to delivery. And, it is often, though not always, the size of the baby and the baby’s position that result in difficult deliveries, prolonged labor and the use of forceps or vacuum suction.

So, if you are a parent-to-be and you have a breech baby or a baby that is estimated to weigh more than 8 lbs 13 oz, discuss your options with your doctor. Discuss whether the risk of Erb’s palsy or other birth injuries is greater than the risks associated with a C-section.

It is important that parents take the initiative and not wait for doctors to begin the conversation. It is your baby and you want to do everything possible to bring your baby into the world safely and with as little trauma and injury as possible.

Erb's Palsy: Definition and Treatment

Erb’s Palsy or Upper Brachial Plexus Palsy is a birth injury that restricts movement and sensation in the arm. It occurs when there is damage during birth to the upper brachial plexus, or the group of nerves that control movement and sensation in the arm. Infants with Erb’s Palsy cannot move their shoulder and keep their arm extended. It is estimated that somewhere between .2 and 2.0 infants suffer from some kind of Brachial Plexus Palsy for every 1,000 births.

How is Erb’s Palsy Diagnosed?
Erb’s Palsy is first diagnosed in the delivery room. Usually the obstetrician or the pediatrician who is in the delivery room will make the initial diagnosis.

There are four types of Erb’s Palsy:
· Avulsion: where the nerves separate from the spine
· Rupture: the nerve is torn but not separated from the spine
· Praxis / Stretch: the nerve is damaged but not torn
· Neuroma: Scar tissue from an injury pressures the nerve but the nerve itself is not damaged.

How is Erb’s Palsy Treated?
Over the course of the next few months, the infant should receive help from a team of professionals. The team should include the child’s usual pediatrician who should help the parent monitor and coordinate the efforts of the rest of the team. The rest of the team should include:
· A neurosurgeon who can determine whether the child is likely to need surgery and who can perform the surgery;
· Both physical and occupational therapists who can assess the arms function, provide treatment to maximize use of the arm and teach parents exercises to do at home
· An orthopedic surgeon, if the child is over one year old and has deformities of the shoulder, arm or hand; and, most importantly,
· The parents who perform exercises regularly at home and who initiate and provide consent for the rest of the treatment.

It is scary to find out that your newborn has Erb’s Palsy. However, it is very important to get treatment as soon as possible so that your child has the best chance of overcoming the condition.

Medical Malpractice: Injury at Birth

When a baby is physically injured during labor or delivery, it is often a bittersweet moment for the parents. The baby is greeted with excitement and joy. Yet, the parents may also be experiencing anger that their child was born with a problem that may not have existed except for the circumstances surrounding the child’s birth.

Sometimes birth injuries are unavoidable but other times they are a result of medical malpractice. Usually proper prenatal care and a qualified team of doctors at a baby’s deliver can minimize the risk of birth injuries. However, when there are known risk factors and the doctors do not take the proper precautions, some babies may be born with injuries that were otherwise preventable.

The risk factors for significant birth injuries include: large babies (usually over 8 lbs 13 oz), premature babies (born before 37 weeks), the size and shape of the mother’s pelvis being inadequate for delivery, shoulder dystocia, prolonged labor or a baby that is not head first when delivered vaginally.

Some birth injuries are cosmetic or temporary in nature and others have life long effects. Injuries to be concerned about are to the brain and spinal cord. Some infants suffer from conditions like Cerebral Palsy and Erbs Palsy. Both can occur from damage to muscles and nerves during the birthing process and both often present lifelong challenges.

Other injuries cause infants (and their parents) pain and discomfort but can be corrected with proper medical care. For example, sometimes babies are born with fractured bones or damages to the facial nerves. In both cases, doctors can often correct the birth injury although surgery may be required and the babies will still experience pain and discomfort that could have been avoided.

Additional information about common birth injuries can be found at the Children’s Hospital of Philadelphia website.