After the baby's head is delivered, the baby's shoulders are
perpendicular to the floor. If the baby's shoulders are too wide
or the mother's pelvis is too narrow, shoulder dystocia can
result. The brachial plexus injury results from the doctor
pulling down on the head to try and disimpact or free the stuck
shoulder. While doctors may use gentle traction on the baby's
head during a normal delivery, traction or pulling on the head
must be avoided when a shoulder dystocia is encountered.
Unfortunately the delivering doctor often rushes the delivery
and tries to pull the baby out of the birth canal by pulling on
the baby's head causing this injury. Doctors and nurses should
be trained
in handling this obstetrical complication in a calm and cool
manner.
There are multiple accepted
maneuvers used to free the baby's shoulder
when it is stuck. These include pushing the mother's legs to her
chest and having the nurse apply pressure on an angle by the
mother's pubic bone. The nurses or delivery room personnel
should never apply pressure on a woman's upper abdomen. This can
get the baby's shoulder more stuck and stretch the brachial
plexus nerves.
This inappropriate maneuver is
called fundal pressure.
There are some women who should not be allowed to have a vaginal
delivery because of concerns of birth trauma. Prenatal factors,
which should be considered by the doctor, include diabetes in
pregnancy, an expected large baby, a small pelvis, excessive
maternal weight gain, obstetric history, maternal obesity, and
the gestational age. There are a number of factors which can
arise during the labor which should lead an obstetrician to
consider performing a cesarean section because of the risk of a
traumatic delivery. These include a long labor, the need for
forceps or a vacuum extractor, and a prolonged descent of the
baby down the birth canal. |
If your baby had an arm that was limp after delivery and has not
recovered on its own, there is medical treatment and attention
which can improve the long-term outcome of brachial plexus
injuries. It is essential that physical and occupational therapy
begin and a referral to a pediatric neurologist be carried out.
Neurosurgeons and plastic surgeons work together in performing
surgery to clean and reattach nerve fibers to the injured and
effected brachial plexus nerves. The surgery must be conducted
at a very young age while there is potential for nerve
regeneration. Subsequent surgeries may include muscle and tendon
transfers at various age intervals. Ultimately the child may
regain some function in their shoulder, arm, elbow, wrist or
fingers as the result of these procedures. At Texas Children's
Hospital there is the Brachial Plexus Clinic which is dedicated
to helping children with brachial plexus injuries.
Permanent brachial plexus injuries are very significant to the
impaired child. They may effect the child's ability to perform
basic life functions. The arm may appear shorter and withered;
there may be pain and discomfort associated with using and
stretching it. Ultimately when the child becomes an adult, he or
she may have difficulty finding a job which only requires the
use of one hand and arm as sixty percent of American jobs
require the use of two arms.
As many parents of children with a brachial plexus injury know,
these injuries are severe and permanent. Their impact on the
child's future is significant. |
