Welcome, I’m Gerry Oginski, a medical malpractice
and personal injury trial lawyer practicing law here in the state of New York. Today’s
topic is birth injuries, and something called should dystocia, which results in nerve injury
know as an Erb’s palsy, or Klumpke’s palsy, or brachial plexus palsy. Why is this important
to know? Nerve injuries can occur during the time the baby is passing through the mother’s
birth canal and the baby may be too big or the mother’s pelvis may be too small.
In some instances you get what’s know as a shoulder dystocia, means that the shoulder
gets stuck passing through the birth canal, gets stuck under the pelvic bone. What causes
injury is oftentimes a doctor who is trying to deliver the baby, may not recognize that
the baby is stuck, and may try and exert forces on the baby’s head that cause a stretching
or tearing of a group of nerves that run from the neck down into the shoulder. Often when
a baby is born with a limp arm, the question is why is the baby’s arm limp? Is it a temporary
condition or is it a permanent condition? Time will tell as to whether it’s a permanent
condition, but important, and you must answer this question, “Was your delivery a difficult
one?” Were there instruments used to assist the baby in coming out? Did they use forceps?
Did they use a vacuum? Did they have to do maneuvers to try and get the baby out? Was
there a sense of urgency in the delivery room? Did they have to do an emergency c-section?
Did they call in the most senior doctors to come in and assist to find out what the problem
is? Often the first sign of danger is when the doctor performing the delivery will call
for help, and that it is the correct thing to do when it is recognized that there is
a shoulder dystocia. You try and get the most experienced doctor into the room to try and
help. There are a number of things the doctors can
do to try and relieve the stuck shoulder from the mother’s pelvic bone. One of the things
that is commonly done is using a procedure or maneuver known as McRoberts, and that’s
by pushing the legs back, all the way you can, with the knees going up to the chest.
Somebody on both sides of the mother is holding the legs, and what this does is allows greater
room and greater curvature of the pelvic spine to allow the baby to try and get out. Another
common method that’s used to try and help the baby out is using what’s called super
pubic pressure where a nurse or another doctor is applying pressure above the pubic bone,
but below the baby, toward the lower part of the abdomen, to try and get that shoulder
unstuck and let it pass through the birth canal. It is never acceptable to have a nurse
or doctor apply pressure above the baby, at the top of the abdomen. That’s called fundal
pressure, that is never acceptable medical care in order to try and relieve the baby
from being stuck and injuring the shoulder and the nerves running from the neck downward.
What else do they do? Doctors have among their arsenal of procedures, something called a
Wood’s maneuver, or corkscrew maneuver, to try and turn the baby to try and get the should
out from under the pelvic bone. They do that without putting any pressure on the baby’s
head. What is that doesn’t work? There’s another maneuver that they call a Reuben maneuver
that is just the opposite of corkscrew to try and get it out the other way. What else
is there? Another way is delivering something called
the posterior arm. It’s reaching in, grabbing the arm, and trying to get the baby out that
way. Also, another maneuver that’s available is for the doctor to cut what’s know as an
episiotomy, which is cutting the skin between the vagina and anus to allow greater room,
so that the baby can pass through. Often an episiotomy is cut in order to prevent unnatural
tearing of the skin which can go down into the soft tissues and into the muscle. They
intentionally cut it to allow greater room and so that it’s a lot easier to sew up afterwards,
so there’s no permanent long term damage from that.
As a final maneuver, if the baby is still not coming out, the doctor can intentionally
break the clavicle, the shoulder bone, in order to shrink the shoulders, to decompress
it, to allow the baby to come out. There’s one final drastic maneuver that is known to
occur, or can occur, and that’s something called a zavanelli maneuver. It is rarely,
rarely done, and that involves pushing the baby’s head back into the vagina, pushing
the baby up into the birth canal, and then rushing the mother and baby into the operating
room and doing an emergency c-section. That is so rare, most doctors have never even seen
it in their career. These are just some of the things that can
occur to attempt to relieve the stuck shoulder when doing a delivery. Oftentimes, these difficult
deliveries occur when the baby is too large or the mother’s pelvis is too small and it
goes unrecognized, or when they pull and perform excessive traction on the baby’s head in order
to get the baby out in a quick and prompt manner. While getting out the baby safely
is of paramount importance, it is also important to remember that these maneuvers that I’ve
just described are done without having to put the doctors hands on the baby’s head.
Typically, and historically, most of the injuries that have occurred to a stuck shoulder, have
resulted from excessive pulling and excessive traction causing a tearing or stretching of
these particular nerves. The Erb’s palsy results in a limp arm, it
results in an atrophied arm where the muscles are not used and it shrinks down in size,
and it’s devastating for a baby to go through life, as the grow older, to have an arm that’s
simply non-functional and not usable. Over the course of the child’s early development,
you will see whether or not the child is making improvement, and your pediatrician may recommend
that your child be examined by a pediatric neurologist to see whether or not your child
is progressing and whether or not the injury that they have suffered to their arm and hand,
is long term and permanent. These are just some of the things that go on in evaluating
a potential case involving difficult deliveries known as shoulder dystocia cases, resulting
in Erb’s palsy, Klumpke’s palsy, and brachial plexus palsy.
Thank you for joining me. I’m Gerry Oginski, have a great day.