A brachial plexus injury is an injury to a bundle of nerves contained in the neck. These nerves govern the movement of the arm and a brachial plexus injury will result in a neurological impairment in the arm otherwise known as erbs palsy. It has long term implications for child and parents alike as the damage is irreparable and will necessitate further surgical interventions as the child grows up together with long term aids and appliance needs.
This injury can be caused during the delivery of a baby when one of the baby’s shoulders becomes impacted as it passes down the birth canal, typically on the mother’s symphysis pubis, and the baby becomes stuck (shoulder dystocia). This is an extremely traumatic obstetric emergency for mother and clinician alike as the baby must be delivered before it is deprived of oxygen for too long and suffers irreparable brain damage or dies. However the person delivering the baby must also resist the temptation to simply pull hard on the baby’s head in an effort to affect delivery as excessive traction will result in damage to the baby’s brachial plexus nerves.
There are a range of standard and approved manoeuvres which should be followed including suprapubic pressure and the McRobert’s position in order to facilitate delivery of the impacted shoulder. Failure to adopt these procedures may be deemed to be substandard practice in circumstances where a child has been left with erbs palsy as a result of excessive use of traction in delivery.
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