Erb's Palsy - Importance of Therapy and Treatment

Erb's Palsy is a condition that often affects very young children. The condition falls under a category of injuries known as Brachial Plexus Injuries. These are a network of nerves that service the shoulders, arms and hands. Erb's Palsy occurs when these nerves are damaged in some way - usually they are pulled or torn when the shoulder is injured. The reason why this condition affects children so often is because this damage often occurs during childbirth. Studies show that about 2 in every 1,000 babies have this condition.

The severity of this condition varies according to the damage. In some cases, the nerve gets completely cut off from the spinal cord - this is the worst kind of brachial plexus injury. The good news is that in a number of cases, particularly among children, the damage heals on its own. Infants who sustain this injury at birth often take about 4 months to heal completely. If the injury is more severe then physical therapy, and in some cases, surgery is recommended.

It's important to note that nerve surgery should occur within the first three months of the child's life. Surgery performed after the baby's first year will not be effective. It's also important to do physical therapy with your child, starting when they are about three weeks old. These should be done at least twice a day - your doctor will give you a range of exercises to do.

Remember that children who are affected by Erb's Palsy may continue to experience weakness in the affected arm. This is why physical therapy and continued treatment at the right time is so important.

Home Births vs Hospital Births: Who's at Risk?

Should you have your baby at home or in a hospital?

That is a very personal question and how that question is answered is in part dependent on whom you are asking. If you are asking the American Medical Association or the American College of Obstetricians and Gynecologists then the answer is a hospital. It is the feeling of both organizations that home births are not safe and should be discouraged in the United States.

In fact the American Medical Association went as far as to endorse a resolution highlighting the risks of at home births after former talk show host Ricki Lake made a documentary movie advocating home births. According to Ricki Lake, the documentary “The Business of Being Born” was intended to inform women about their choices regarding childbirth and to give women access to all of the facts when making their decision.

The resolution adopted by the American College of Obstetricians and Gynecologists and endorsed by the American Medical Association declares hospitals to be the safest place for women to have babies. It goes on to warn women about the potential dangers of shoulder dystocia and other complications.

The story reported in the June 18, 2008 NY Daily News does not consider whether certified midwives would be able to safely birth babies who suffer from the unpredictable condition of shoulder dystocia. However, reader comments on this story seem to focus on that very point.

Several women discuss their experiences of having a baby who experiences shoulder dystocia.

Some discuss their hospital experiences and others discuss their home birth experiences. If you would like to read the story and accompanying comments, please click here.

Please leave a comment and tell us what you think: Are home births inherently unsafe because of unpredictable complications such as shoulder dystocia or do they provide a viable and important alternative for women?

Erb's Palsy: Can a New Tool Predict Complications?

Regional Women’s Health Management is one of the largest providers of obstetrical and gynecological care for New Jersey women. The group treats over 200,000 women annually and delivers approximately 5,000 babies.

In May 2008 Regional Women’s Health Management entered into an agreement with LMS Medical Systems to provide a new and innovative tool to help predict shoulder dystocia and prevents its potentially horrible effects. Shoulder dystocia occurs when the baby’s shoulder gets stuck during birth. The potential effects include nerve damage, Erb’s palsy, brain damage and even death.

The new tool developed by LMS Medical Systems is called the CALM Shoulder Screen. CALM Shoulder Screen will help doctors manage shoulder dystocia.

Dr. Kay, the Chairman of Regional Women’s Health Management, says that “Shoulder dystocia is one of the scariest crises to occur in obstetrics…We believe the CALM Shoulder Screen will not only help us to identify the higher risk mothers and take action to avoid a significant number of persistent injuries, but also help us to properly identify those lower risk mothers who have a chance of delivering without unnecessary intervention."
While it is too early to tell if Dr. Kay’s predictions will turn out to be true, it is safe to say that this will be a major breakthrough in medical care if they do. It is important to both minimize the cases when shoulder dystocia occurs and to minimize medical interventions. The CALM Shoulder Screen is designed to do both of those things.

Childbirth is a very uncertain undertaking and mothers who develop complications are very dependent on their medical providers to help them through childbirth safely. Any tool that can help doctors anticipate the medical emergency that is shoulder dystocia is a welcome development that could benefit many mothers and newborns every year in New Jersey and around the country.

Complications of Labor: Shoulder Dystocia

Shoulder dystocia is a complication of labor that is not only dangerous to the baby but also to the mother. It is a hard condition to predict and while there are conditions that make it more likely to occur there is not an accurate way to diagnose it prior to delivery.

What are the risks to the mother?
There are several risks to the mother. Some merely add to the already painful experience of childbirth and others are more serious and may require further medical interventions in order or prevent serious injury or death for the mother. The risks include:
· Rupture or significant tearing to the mother’s uterus;
· Hemorrhaging after delivering the baby;
· Bruises or tears;
· Tearing;
· Damage to the bladder.

There is a lot of discussion, research, and attention paid to the complications of shoulder dystocia on newborns. Doctors should have the responsibility to inform parents-to be about the risks of shoulder dystocia to both newborns and mothers.

If you are a pregnant mother and your doctor tells you that your baby is large, you suffer from diabetes, or you are obese or very small then do not hesitate to ask your doctor what his or her professional opinion is about the likelihood of shoulder dystocia.

Also, ask about how your doctor will handle shoulder dystocia if it presents during delivery. Will you be given an episiotomy? Will the doctor use a vacuum or forceps? Or, will the doctor opt for an emergency C– Section?

For more information about the potential risks to the mother, as well as the baby, please visit the University of Michigan’s Health System web page on shoulder dystocia.