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Newborns who suffer brachial plexus injuries during delivery face partial paralysis and months or years of physical therapy. Corrective surgery may also be required, but an attempted repair will not always succeed.

As Virginia medical malpractice attorneys, my colleagues and I have focused on helping families hold negligent OB/GYNs, obstetrics nurses and hospitals accountable for injuring children during the birthing process. Brachial plexus injuries are not rare, but they are often preventable.

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The brachial plexus is a bundle of closely related nerves that run along the muscles of the shoulder and which connect the spinal cord to the arms. Damaging one or more these nerves produces symptoms that range from temporary weakness in the affected arm to permanent paralysis.Wikimedia Commons -- https://commons.wikimedia.org/wiki/File:Brachial_plexus_ca.svg#/media/File:Brachial_plexus_2.svg

Shoulder dystocia — when a newborn’s head emerges from the birth canal but the shoulders get stuck — is the most-common situation in which brachial plexus injuries occur. The nerves stretch, tear or rupture as members of the birthing team work to free the baby’s shoulders.

Risk factors for shoulder dystocia are well-known, as are the proper responses. Doctors and nurses should be prepared to take precautions not to damage a newborn’s brachial plexus when any of the following observations are made prior to labor:

  • The fetus is large
  • The mother has diabetes
  • More than one baby is being delivered
  • The mother is obese
  • The baby is past its due date
  • Labor has been induced
  • An epidural has been administered to the mother

Misusing forceps or a vacuum while dealing with shoulder dystocia can damage the brachial plexus. So can pulling too hard on the baby’s head and neck, which can also tear the spinal cord.

Minimal damage to the brachial plexus usually heals on its own, but the baby may be unable to raise its arm or use a hand for several weeks. Injuries close to spinal cord may be repaired surgically, but a specific type of severe brachial plexus injury called an avulsion cannot be fixed by a surgeon.

An avulsion occurs when one or more of the nerves becomes detached from the spinal cord. The baby can then have trouble breathing in addition to weakness and paralysis in his or her arm and hand.

Specific lifelong disabilities linked to brachial plexus injuries during birth include

  • Erb’s palsy, which requires physical therapy starting as early as 3 weeks of age to strengthen shoulder muscles and the biceps;
  • Horner’s syndrome, which can be addressed by grafting new nerves to the spinal cord and affected muscles but will likely lead to lifelong symptoms like drooping eyelid, facial flushing and pinpoint pupils; and
  • Klumpke’s palsy, which is a rare problem with controlling the muscles of the hand.

Parents whose babies suffering brachial plexus injuries incur additional medical costs and experience additional stress atop that which comes along with caring for any newborn. The child my also face a lifetime of difficulties from being unable to move or fully control an arm or hand.

EJL

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