Erb's Palsy
What is it?
Erb's Palsy is also known as brachial plexus paralysis. It is a condition in which one, several, or all of the 5 main nerves to the arm affected have sustained an injury. The paralysis can be partial or complete, and is directly linked to the degree of damage to each of the affected nerves. Once it has been detected, surgery may well be required, although success may be limited.
Erb's Palsy is usually caused by shoulder dystocia during labour. Shoulder dystocia happens in approximately 0.6 - 1.4% of vaginal births, and is an obstetric emergency. Shoulder dystocia occurs when the baby's foremost shoulder impacts against the mother's symphysis pubis (pubic bone), during the final stage of labour. As the head is emerging, the shoulder essentially becomes wedged in the birth canal, and various release manoeuvres are recommended, with usage determined by the perceived severity of the dystocia. If traction on the affected arm occurs, or if the baby's head is pulled away from the collar bone, a brachial plexus (i.e., nerve) injury can occur. This can be temporary or permanent.
There are several known maternal risk factors for the condition, namely, diabetes, obesity, high parity and a prior birth in which shoulder dystocia occurred; any very large foetus ("macrosomia") will also be at risk of the condition. There are independent risk factors associated with labour, and these include a prolonged first and/or second stage of labour, and instrumental delivery (i.e., forceps or ventouse - the latter is a kind of suction device, which looks something like a sink plunger with flexible tubing).
Some clinicians plan early induction of labour, or schedule caesarean birth in order to prevent the risk of shoulder dystocia. It is relatively unusual for caesarean section to be considered to avoid this risk, and in point of fact, brachial plexus injuries have been known to occur during caesarean procedures.
Management techniques for shoulder dystocia can result in maternal bruising and lacerations. As will readily be seen from the explanation given above, foetal injuries can be far more severe, including as they do hypoxia (lack of oxygen), fractured clavicle (collar bone) and extensive, permanent nerve injury.
How do we investigate the claim?
In order to win an Erb's palsy claim, we need to prove that contemporaneous clinical guidelines were not followed (breach of duty), and that if they had been, then on the balance of probabilities the condition would not have developed (causation). It follows from this that we need to find out what was most likely to have caused the condition, and whether the relevant guidelines were followed.
These claims can raise a host of questions about the management of labour, but it would be usual to consider whether the birth could or should have been expedited more quickly, whether too much pressure was applied in any release manoeuvre attempted, whether the birthing process was monitored appropriately and (by extension) whether levels of staff communication were adequate for the task in hand. We will most likely need to assess not only the management of the birth itself, but also the antenatal care, and in particular the identification of warning signs. If, for example, ultrasound images of the foetus in the womb reveal that it could or should have been known that the child was likely to be unusually big, we would need to investigate the significance of this. Usually, the input of several clinical practitioners will be needed, probably including a midwife or an obstetrician and a neurologist.
Contact
Angelina Rigby Head of Clinical Negligence
Steve Duddell Partner
Nye Moloney Trainee Legal Executive
Mary Smith Paralegal
Jane Beresford-Huey Assistant
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