Most babies are delivered in a head down position, known as vertex. In order for the baby to be expelled from the birth canal by his/her mom’s contractive forces, the shoulders must pass through the dilated cervix and vagina. In some vertex births, one of the baby’s shoulders becomes stuck behind mom’s pubic bone, an obstetrical emergency known as “shoulder dystocia.” In the case of shoulder dystocia, the baby’s head is actually born, but the rest of the body cannot follow because of the stuck shoulder. This is truly an emergency situation; the stuck baby cannot get proper oxygenation, and if the situation goes on too long, the baby can become brain damaged, or even die.
When the obstetrician is confronted with shoulder dystocia, it is vital that she or he not panic, but rather allow her training to take over. Obstetricians are trained during their residency on how to attempt a series of steps and maneuvers that are designed to allow the shoulder to be quickly freed and the baby delivered without any damage to sensitive nerve structures that allow the baby’s arm to function. These maneuvers include the use of a generous episiotomy; putting mom’s legs in the “frog-leg” position to open up the birth canal; putting pressure over the suprapubic area; and rotating the stuck shoulder out from under the pubic bone.
If the obstetrician panics and fails to call for help or fails to correctly undertake the customary maneuvers, the baby’s head may be pulled too hard or pulled in the wrong direction. The use of excessive force, or what the doctors call traction, can damage fragile nerves in a bundle called the brachial plexus. This damage can lead to permanent brachial plexus injury and lifelong disability in the use of an arm and hand.
Most often a problem will be seen immediately at birth, because the baby will be unable to move the affected arm fully, or not at all. If there is an apparent brachial plexus injury, it is common for a child neurologist or orthopedist to be called in to assess the situation. In some cases, the injury will not become apparent until the bay is home. In these situations, mom should immediately bring the problem to the attention of the baby”s pediatrician, because the sooner physical therapy is started, the better.
If the nerves in the brachial plexus are only stretched by the excessive force, there is a chance that over the first year or two of life, the child will improve or even fully recover. However, if the force was severe enough to tear the nerve, or worse, tear the nerve off the spinal cord, the overwhelming likelihood is that the resulting Erb”s Palsy will be permanent, leading to loss of function, muscle atrophy, cosmetic deformity and psychological stress.
The birth injury lawyers at Simonson Goodman Platzer PC believe that permanent brachial plexus injury is almost always the result of malpractice. If you believe that your child might be a victim of New Jersey birth malpractice, contact us to schedule a free consultation, and take advantage of our no-fee guarantee.
To speak to an experienced medical malpractice attorney, call 1.800.405.7783.