Birth Injuries

Posted: February 4, 2017 | Last Updated: February 12, 2017

There is no worse news for new parents than being told that their child has suffered a birth injury.  The only thing worse than learning your child has suffered a birth injury, is knowing that the injury was preventable.

Birth injuries can range from minor injuries to the most catastrophic injuries, including severe brain injuries or even death.  Birth injuries can occur at various times during the birthing process.

It is sometimes difficult to know the full extent of a birth injury until years after the birth and until the child fails to meet to certain developmental milestones.  Sadly, parents often believe that their child’s developmental struggles are genetic when they were actually preventable.  Without significant help, most parents will never know whether their child’s injuries were preventable.

Two of the most common types of birth injuries are Cerebral Palsy and Erb’s Palsy (also known as a brachial plexus injury).

Cerebral Palsy

Cerebral Palsy is brain damage caused by brain injury that occurs while a child’s brain is still developing — before birth, during birth, or immediately after birth.

Common Signs of Cerebral Palsy

The damage to a child’s developing brain can interfere with messages between the brain and the body. Some of the complications of cerebral palsy include:

  • Mental Retardation
  • Speech, Hearing or Sight Impairment
  • Unusual Awareness and Sensation
  • Problems with Walking and Balance
  • Seizures
  • Involuntary Movement
  • Muscle Spasm or Tightness

The majority of children who have cerebral palsy have had it since birth, often due to a lack of oxygen to the brain (called hypoxia) or to the body (called asphyxia), trauma during birth, or premature delivery.

Common Causes of Cerebral Palsy

When a child’s cerebral palsy was preventable, the most common causes include:

  • Failing to diagnose and properly treat infections of the mother during the pregnancy
  • Failing to adequately monitor fetal heart rate before and during labor
  • Failing to identify a prolapsed umbilical cord
  • Poor planning and scheduling of a medically necessary cesarean because a baby is too large for a vaginal delivery
  • Prolonged delays in performing a cesarean (of not performing one at all)
  • Unreasonable errors in using instruments like forceps or a vacuum during delivery.

Types of Cerebral Palsy

Cerebral Palsy is a group of movement disorders caused by neurological damage.  There are four types of Cerebral Palsy:

Spastic Cerebral Palsy:

This type of cerebral palsy causes muscles to be very stiff and permanently narrowed. There are two types of Spastic Cerebral Palsy (1) hemiplegia (only one side of the body is affected) and (2) quadriplegia (when all 4 limbs are affected). Some individuals with Spastic Cerebral Palsy experience uncontrollable tremors or shaking (spasm).

Athetoid or Dyskinetic Cerebral Palsy:

This type of Cerebral Palsy causes slow, uncontrolled, and writhing movements. These abnormal movements can affect the hands, feet, arms, and legs. Muscles in the face and tongue can also be affected.  This can cause excess saliva and difficulty swallowing and speaking.

Ataxic Cerebral Palsy:

This type of cerebral palsy causes poor balance and coordination.  A person with Ataxic Cerebral Palsy is likely to have a gait disturbance and walk with a wide step or move unsteadily.  Ataxic Cerebral Palsy can also cause tremors with voluntary movements, such as reaching for an item or writing one’s name.

Mixed Type Cerebral Palsy:

This type of Cerebral Palsy is a combination of the three primary types of cerebral palsy.  When a child exhibits signs of more than one type of Cerebral Palsy, he or she may be classified as having Mixed Type Cerebral Palsy.  The most common combinations are of Spastic Cerebral Palsy and Athetoid Cerebral Palsy.

It is important to point out that not all cases of cerebral palsy are preventable.  Frequently, doctors, midwives, nurses, and other medical professionals act responsibly when providing prenatal care and delivering a baby; yet, the child still experiences Cerebral Palsy.

Erb’s Palsy (Brachial Plexus Palsy)

Erb’s Palsy is an injury to the brachial plexus during birth.  The brachial plexus is a large system of nerves that travel from the spinal column below the neck to the muscles in the shoulders and arms.  Erb’s palsy is sometimes referred to as brachial plexus palsy because the brachial plexus nerves in the shoulder have been abnormally shifted, damaged, or broken during delivery.

Children born with Erb’s Palsy can suffer partial or total paralysis of the shoulder and arm.  When Erb’s Palsy occurs, it usually results from a difficult birth. Shoulder dystocia is a common cause of Erb’s Palsy. Shoulder dystocia is when one or both of the baby’s shoulders become lodged behind the mother’s pubic bone during birth.

Types of Erb’s Palsy

There are four types of Erb’s Palsy or Brachial Plexus injuries:

  • Avulsion:  Avulsion injury is when the nerve is torn from the spine (this is the most severe)
  • Rupture:  Rupture injury is when the nerve is torn but not away from the spine
  • Neuroma:  Neuroma is when the nerve has tried to heal itself but scar tissue has grown around the injury; and
  • Neuropraxia:  Neuropraxia is when the nerve has been damaged but not torn (this is the most common).

Signs and Symptoms of Erb’s Palsy

Inability to Move Arm or Shoulder:

One of the most common signs of Erb’s Palsy is an infant’s inability to move his or her arm or shoulder after birth.

Arm Bent Toward Body:

Newborns who have suffered an injury to the brachial plexus will often bend their arm toward their body on the injured side.  This is because the body will attempt to rest the injured nerves in the most comfortable position.  In many cases, the injured arm is limp and bent at the elbow towards the body.

Weak Reflexes:

The brachial plexus nerves are responsible for sensation and reflexes in the arm.   When the brachial plexus nerves are damaged, an infant’s arm will not respond as it should. The reflexes in the injured arm may be weak or altogether absent. Reflexes cannot perform properly if the nerves are damaged.

Loss of Feeling:

Infants with Erb’s palsy sometimes have little sensation in the injured arm.  Nerves are responsible for producing sensation.  When the nerves are damaged, sensation is too.  Sometimes the decreased sensation is similar to a foot that is asleep.  In more severe cases, there may be no feeling at all. Infants with Erb’s Palsy may not react to a squeeze, scratch, poke, or any sensation a normal infant might react to.

Pain:

While some infants with Erb’s Palsy may have decreased or no sensation, others may have irregular or intense pain.  When pain occurs, it is usually in the shoulder or arm.  In some instances, the pain is also in the neck.  Usually pain sensations are expressed through high-pitched cries and screams when the baby is moved or touched.

Decreased Grip:

Nerves control the firing of muscles.  When the nerves are injured or destroyed, the ability to flex muscles and grip are inhibited on the injured side.  Injured babies may have a decreased grip or no ability to grip at all.

Waiter’s Tip Posture:

A common physical sign of Erb’s Palsy is a position of the arm and hand called a “waiter’s tip.”  This is a position where the arm hangs loosely and the hand cuffs palm up with the wrist facing the front and the fingertips in the rear, as if someone was expecting a tip in the palm of the hand.

Risk Factors for Erb’s Palsy

Shoulder Dystocia, where the head and shoulder cannot pass through the birth canal, is a leading cause of Erb’s Palsy.  Although a doctor cannot predict when shoulder dystocia will occur, there are red flags that should be taken into consideration.  These red flags include:

  • Pre-birth weight over 8 pounds 14 ounces
  • The mother’s diagnosis of gestational diabetes
  • The mother’s obesity
  • Late pregnancy (gestational age of 40 weeks or more)
  • The mother’s short stature
  • The mother’s gaining more than 35 pounds during pregnancy
  • A long and drawn out first stage of labor
  • Any abnormal presentation of the baby at birth, including breech.

Epidural anesthesia, a local anesthetic that blocks nerve impulses from the lower spine down, is the most common type of pain medication administered during labor.

Approximately 50% of women undergo epidural anesthesia during labor.  While highly effective at reducing pain, epidurals can cause a loss of pushing sensations during labor.  If the baby moves in a difficult or unnatural position, the mother may not feel it. If this happens, a doctor may use forceps or vacuums to help the baby move through the birthing canal.

These tools can cause brachial plexus injuries, as well as cerebral palsy.

Alternative Methods of Delivery

When shoulder dystocia is present, doctors can use different procedures and positions to assist a baby during delivery, such as:

  • Performing a cesarean
  • Repositioning the baby
  • Repositioning the mother
  • Applying pressure to the suprapubic region (the pelvis)
  • Applying traction in a horizontal plane
  • Intentionally breaking the baby’s collar bone
  • Intentionally breaking the mother’s pelvic bone
  • Creating a deep episiotomy (a surgical cut made at the opening of the vagina)
  • Performing the McRobert’s maneuver (pushing the mother’s thighs to her abdomen)

Treatment of Erb’s Palsy

Immediate recognition and treatment of Erb’s Palsy is required.  If left untreated, Erb’s palsy can lead to:

  • Full or partial paralysis in the affected arm
  • Permanent arm weakness and numbness
  • Muscle atrophy (the wasting away of muscles)

Research has shown that brachial plexus surgery to repair Erb’s Palsy is most effective in children between the ages of 5 and 12 months.

Brachial plexus surgery is very complex and requires a pediatric neurosurgeon, an operating microscope, special anesthesia, and monitoring equipment.  Brachial plexus surgery is often completed through multiple smaller surgical procedures in order to avoid creating additional injuries.

Physical therapy is useful in treating brachial plexus injuries.  A physical therapist works with a child suffering from Erb’s Palsy in order to increase strength and range of motion.  Daily exercise may help prevent joints from freezing in place.

How do I Hire You to be my Ohio Birth Injuries Lawyer?

The first thing to do is complete the contact form at the bottom of this page. That way, you can put in details that we can review before we schedule a phone call.

You can also call us at 216-777-8856 if you prefer.

You will likely not speak to us immediately, but will schedule a phone or in-person meeting. Why? Because we’re busy working on the important cases other families have entrusted to us. Just like we would not constantly take phone calls when we’re entrusted to work on your case.

You should also gather all the records and papers you have from the medical providers, go back and look for dates, names, and events that happened, and otherwise prepare to discuss the case. We’ll have a meeting and, if it seems like a case we’d be a good fit for, we’ll move into an investigation phase.

Once we’ve investigated, we’ll candidly tell you what we think about what happened, whether the medical provider is to blame, and what we think about the strength of the case.

Fair warning: we only take on clients whose cases we believe have very strong merits. We’re not lazy—the cases are still very complex, difficult, and expensive—but the risk to your family of being drawn into a difficult process with little chance of a positive outcome is not something we do.

Which means when we do take on a case, our reputation tells the other side this is a serious case we believe in.

If for whatever reason we do not take on the case, and we think there is some merit to the case, we’ll try and help you find a lawyer who might take it on.

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