An injury to the brachial plexus can be a devastating, life-changing injury to a child that occurs during birth. To identify these types of injuries, it's first important to examine what the cause of the birth injury is. The brachial plexus is a nerve network that travels from the spinal column, through the neck, and out through the shoulder and into the arms. It essentially functions as a branch that allows nerve signals to be sent to the wrists, arms, hands, elbows, and shoulders.
Excessive pressures during labor caused by excessive use of Pitocin, a fetal-pelvic misfit or cephalopelvic disproportion, or excessive traction forces during delivery with forceps or vacuum can cause the nerves of the brachial plexus to stretch or tear. If the pressures applied are strong enough to cause a major stretch or tear, a baby can loose feeling in his or her arms, wrists, and hands. Nerve tissues can regenerate, and sometimes this injury will resolve itself. However, if a major tear, or "abruption", occurs, the damage is likely permanent and total paralysis can be the result.
These types of injuries are usually caused by a long labor in which the baby, due to his or her size or the size or shape of the mother's pelvis, has difficulty navigating the birth canal and being delivered. This "stalled" labor is known as labor dystocia. If a baby's shoulder gets trapped in an awkward angle, and becomes stuck on the maternal pelvis, the doctor will often apply excessive forces, which cause the nerves to stretch or tear.
Maternal factors that are related to shoulder dystocia include:
- Excessive weight gain in pregnancy (more than 30 pounds above normal weight gain)
- Small stature
Patients with these risk factors should be assessed prior to birth, and alternatives to natural birth should be discussed.
There are procedures, such as suprapubic pressure (pressure applied to the pelvic floor) that can assist in delivering a baby who is experiencing shoulder dystocia. Doctors and nurses have a duty to manage these types of labors safely to prevent any injury from occurring to mother or baby.