Erb’s palsy is not the only type of injury that can be caused by shoulder dystocia – this blog explores the relationship between shoulder dystocia and brain injury in babies.
In the setting of birth, shoulder dystocia occurs either when, during delivery the baby’s uppermost shoulder gets stuck on the mother’s pubic bone or, more rarely, the lower shoulder gets stuck on a large triangular bone at the base of the spine. Shoulder dystocia is a medical emergency, which can cause injury to the baby if not managed correctly.
Erb’s Palsy is caused by damage to the nerves which supply the arm, and which are known as the brachial plexus. It is associated with varying degrees of paralysis within the affected arm. In severe cases, babies can also suffer from oxygen deprivation causing brain damage as a result of shoulder dystocia, which I discuss further below.
There are a number of factors which may be known during pregnancy which may increase the risk of shoulder dystocia, including:
Once shoulder dystocia has occurred, there is a limited time to release the stuck shoulder and deliver the baby before serious injuries occur. A delay in delivering the baby’s body will heighten the risk of oxygen starvation. Once the baby’s head has delivered, the umbilical cord can become compressed, meaning that there is limited or no blood exchange between the placenta and the baby. The risk that the oxygen levels will drop increases over time, but the levels can drop very quickly. Consequently, deliveries should occur within five minutes where possible after delivery of the head. The risk of injury to one or more organs – including the brain – increases with the time to full delivery.
Shoulder dystocia is an emergency, and a rapid response is obligatory. That rapid response should also be structured and should follow the relevant Royal College of Obstetricians’ Guidelines, which should usually prevent the baby suffering from such injuries.
Birth asphyxia (damaging lack of oxygen at the time of birth) can be indicated from a range of factors, including:
Shoulder dystocia can lead to Erb’s Palsy, but also to brain injuries ranging from quite subtle learning difficulties, problems with fine co-ordination and behavioural issues, to profound injuries including cerebral palsy, which is why it is vital that shoulder dystocia is managed correctly during delivery. Any suspicions in this regard should not be ignored, because help to a child to develop to the best of their ability is better given earlier rather than later. The more subtle effects of a brain injury at the time of birth may not become apparent for many years. If a child begins to struggle at secondary – as opposed to primary – school, when the educational and social demands upon them increase, this could be related to problems at the time of birth.