Birth injury series - Erb’s palsy or brachial plexus injuries

Brachial plexus or nerve injuries can arise when the baby becomes trapped in the mother’s pelvis during labour and delivery.  Injuries of this kind mainly occur when the shoulder becomes trapped which is called “shoulder dystocia”.  Injuries can sometimes be permanent and can result in restricted hand grasp and movement in the affected arm and shoulder, restricting many aspects of day to day life.

When a shoulder dystocia arises careful obstetric management is needed to deliver the baby safely and with the minimum amount of force in order to avoid permanent injuries to the brachial plexus nerves which run from the spine to the neck and shoulder.  These nerves also control the muscles of the arm down to the hand.

Fortunately when a shoulder dystocia occurs and cases are dealt with appropriately the baby is able to recover quickly.  A small number of babies will however suffer long term and permanent disabilities and this can sometimes result from negligent management of the situation.

Injuries of this kind can, but not always, be avoided and it is important that the medical staff recognise that the complication has arisen and follow appropriate clinical guidelines to ensure as safe a delivery as possible.

Doctors should:

• Advise mothers in advance of the potential risk of a shoulder dystocia.  Babies can be identified as being particularly large during the antenatal period, or the mother’s pelvis may be identified as being small.  Both circumstances can give rise to an increased risk of shoulder dystocia occurring during labour.  If identified early a mother can be advised of the safest options for delivery.
• Recognise that diabetic mothers are also at an increased risk of having a large baby. They should be advised on the impact their condition may have on the size and growth of their developing baby.
• Recognise that babies in breech position (bottom first) may be at an increased risk.

Most importantly, once the condition is identified any attempts made to move the baby to free the trapped arm/shoulder need to be carried out in a careful and controlled way, following recognised procedures.

If these careful steps are not followed, or excessive force is used, the hospital care may be substandard and there may be grounds for bringing a claim for compensation.

More information

For more information, please visit our pages on Cerebral Palsy Birth Injury and Obstetrics and Gynaecology Negligence Claims. You may also be interested in reading some of our other blogs on this topic, including; 

• Home birth v hospital birth – which is safer? The debate continues and 
• Identifying problems before a baby is born: Antenatal diagnosis of fetal anomaly

Kingsley Napley is experienced in acting in clinical negligence claims relating birth injuries. If you would like advice, please contact the Clinical Negligence and Personal Injury team on 020 7814 1200 or by emailing us at clinnegenquiries@kingsleynapley.co.uk.

This article first appeared in At Home Magazine.