Maternity Negligence Claims & Erbs Palsy
1. About Birth Injury Claims & Erbs Palsy
Our preliminary understanding of Erb’s Palsy (palsy is defined as “paralysis, especially that which is accompanied by involuntary tremors”) is that is is an injury that occurs when the nerves in a baby’s upper arm are damaged and this condition primarily occurs during the delivery of a child where trauma is experienced. The condition can affect up to 5 of the primary nerves that supply the movement and feeling to an arm. Erb’s Palsy is frequently caused by shoulder dystocia during a difficult birth. Infants with this condition usually can’t move the affected shoulder or upper arm, but they may be able to wiggle their fingers – see: Maternity Negligence Claims & Compensation Link. Further information can be obtained by looking on Wikipedia: Erb’s Palsy.
Courtesy of Wikipedia: Erb’s Palsy.
Thorough management of gestation can prevent this condition through dietary advice or electing for a planned caesarean section. The injury usually affects the spinal cord’s ability to send messages to the arm, wrist, hand, or fingers through normal nerve impulses. Babies with Erb’s palsy often look as if their arm in the affected area is paralyzed. Furthermore, Erb’s Palsy refers only to damage to the upper nerves. If nerves on both the upper and lower ends of the brachial plexus are stretched and injured, the result can lead to a more severe condition known as total or Global Brachial Plexus Palsy – see external link Birth Injury Claims.
Global Brachial Plexus Palsy refers to a condition where the nerves in the brachial plexus get damaged and signals cannot travel like usual from the brain to the arm muscles. So some or all of the child’s arm muscles may no longer work. As mentioned previously, when this affects only the shoulder and upper arm, it is called an Erb’s palsy. When it affects all of the muscles of the arm, hand and wrist, this is known as Total Plexus Palsy.
Brachial plexus palsies usually happen because of a stretch injury to the child’s head, neck and shoulder. This can happen during birth, especially when the birth is difficult or complex. Sometimes a child’s shoulder will get stuck against the mother’s pelvis. This can result in a stretch injury as the child is being delivered. The brachial plexus may be injured if a baby’s shoulder gets stuck on the mother’s pelvis during birth:see further maternity negligence & birth injury conditions – brachial plexus palsy.
Erb’s palsy is generally occurs during a difficult labour, and can happen in three different ways:
• One way that the brachial plexus nerves are affected is when the baby is passing through the birth canal at an awkward angle, with the head being turned to one direction while the arm is being pulled in the opposite direction.
• Excessive pulling on the shoulders is also common in cephalic presentation, when the baby is delivered face-first. Both circumstances can involve cephalo-pelvic disproportion (CPD), when the baby is disproportionately bigger than the birth canal.
• Another situation in which that Erb’s palsy can occur is when the baby is delivered through the birth canal in a breech birth (a delivery of a baby which is so positioned in the womb that the buttocks or feet are delivered first). The brachial plexus nerves can be stressed and injured when the baby’s arms are pulled backward over the head as the delivering physician pulls the newborn from the birth canal by the legs. During these situations, the baby is violently stretched. In some cases, shoulder dislocation also occurs, but the forceful stretching always causes nerve damage to the brachial plexus.
Although excessive lateral traction (the treatment technique in which weight or tension is used to move a body part to the side or away from its original location) and stretching the baby’s head and neck during delivery may cause some cases of Erb’s palsy, the chances of developing the condition increase if the infant develops shoulder dystocia. Additional risk factors include:
• The use of forceps and/or vacuum extraction tools during delivery
• Large infant size
• Small maternal size
• Excessive maternal weight gain
• Second stage of labour lasting over an hour
• Infants with high birth weight
How to Know If a Baby Has Erb’s Palsy?
Erb’s palsy is evident when a baby exhibits weakness in the affected arm, favours it, or cannot even move it. The severity of Erb’s palsy symptoms can range from signs of weakness or soreness to total or partial paralysis of the arm.
The most common signs and symptoms to look out for include:
• The affected arm may be limp, held against the side of the body, and bent at the elbow
• A decreased ability to grip with the hand on the affected side
• Partial or full paralysis
• Loss of sensory function in the upper arm of the affected area
• Loss of motor function in the upper arm in the affected area
• Arm numbness
• Impaired circulatory, muscular, and nervous development
In most cases, infants who develop Erb’s palsy should be referred to a treatment centre that provides multidisciplinary specialties. These types of treatment centres are made up of a large team of physicians who specialise in different areas of healthcare, such as neurologists, neurosurgeons, physical therapists, occupational therapists, and orthopaedic surgeons. However, not all infants have the option of going to a multidisciplinary treatment centre. In these instances, the infant should be seen by a paediatric neurologist. Treatment options include the following listed below, but this of course, does not exclude a claim for compensation for a maternity negligence claims for Erb’s Palsy.
If surgery is recommended, it should be done within the first three to six months after birth, unless the baby’s doctor recommends otherwise. Studies suggest that postponing surgery until the baby is older reduces the operation’s chances of success. Microsurgical techniques should be performed at around three months of age. Surgical attempts to restore partial arm function to treat avulsion-type injuries should be performed around six months of age. Another form of surgery that might be performed is exploratory surgery, a type of surgery that involves removing scar tissue from neuromas in order to repair the affected nerve. It also involves grafting with the transplant of a nerve from another part of the body to repair nerve ruptures. Studies suggest that the most improvement usually comes from nerve grafting techniques.
When nerve injuries to the brachial plexus are mild, the best approach is usually physical therapy, which should include gentle massages around the affected arm. Physical therapy also includes the use of such techniques as range of motion exercises to improve arm strength and flexibility, as well as nerve function. In some cases, Botox injections into the affected area and the application of electrical stimulation may help a baby recover. If neurological function doesn’t return by six to eight weeks after therapy and other forms of treatment, the physician may recommend surgery.
It’s important to note, however, that home care is just as important. For instance, a parent will want to gently massage the infant’s arm and practice physical therapy exercises at home along with physical therapy sessions. It is also an imperative that a parent stays involved during the baby’s physical therapy sessions so that they will understand that type of exercises they should practice at home.
8. What is the Long-Term Prognosis (the likely forecast of a medical condition) for Erb’s Palsy?
A prognosis for Erb’s palsy will depend mainly upon the severity of the baby’s injuries. Mild cases of Erb’s palsy may clear up within three to six months with physical therapy. Around 70 to 80% of all Erb’s palsy cases will usually clear up within a year as long as proper and consistent treatment is provided. The younger the infant is when treatment begins, the better the results are. One way to determine a positive prognosis is if the infant begins to grasp objects or make fists with the hand associated with the affected area during treatment sessions.
In some cases, infants may live with lifelong problems due to Erb’s palsy. Although such cases are rare, children with Erb’s palsy may suffer permanent functional loss in the affected arm. Abnormal muscle contractions may also become permanent.
Long-term effects of Erb’s palsy may also cause a child to suffer psychologically, resulting in lack of self-esteem and difficulty with performing daily tasks, which may lead to anger and frustration. In addition, children with limited use of their arm may not be able to participate on sports teams and other activities. This often makes self-esteem issues harder to resolve. If a child is having a difficult time dealing with socialization or has emotional problems as a result of a medical condition, counselling by a child psychologist may be necessary.
Making a Maternity Negligence Claim – Erbs Palsy
We appreciate that is it a difficult for parents to sue the experts but things can go wrong. We are not all perfect. The long term damage to the baby and family can be emotionally and physically demanding. A maternity negligence claim, often called a birth injury claim can be made against the Hospital concerned if it is believed that there is a negligence claim for compensation for the birth injury in this case Erbs Palsy.
Please contact us now if you wish to consider make a birth injury claim for Erb’s Palsy.
Further reading on clinical negligence & maternity compensation claims:
Author Ikram Miah, Law Graduate/Para-Legal