There are times when what was supposed to be a happy delivery ends up being a frustration derived from medical malpractice. Approximately 2 out of every 1,000 babies suffer a Obstetric Brachial Palsy (PBO), a brachial plexus damage that occurs during childbirth and that causes the baby to have a “rag arm”.
Shoulder dystocia is the cause
The PBO It is usually the result of a poorly resolved shoulder dystocia. During the expulsion the head manages to get out but the shoulders remain embedded in the pelvic cavity.
The risk of presenting shoulder dystocia increases the larger the baby is, the incidence is 10% when newborns weigh between 4,000 and 4,500 g and 22% when they weigh more than 4,500 g.
This risk is also greater when the baby comes from buttocks (a risk 5 times higher) and when the mother has gestational diabetes and her baby weighs more than 4,000 g (37% of these babies will suffer from shoulder dystocia compared to 10% commented if the mother does not suffer from this disease).
If, at the moment when there is shoulder dystocia, the action is wrong and the healthcare staff simply decides to pull the baby's head, it is very likely that the aforementioned injury of the brachial plexus will occur (which are the nerves that go from the medulla to the arm).
What symptoms can cause a PBO
Having a nerve injury produces a arm paralysis, tone reflexes are lost and muscles tend to atrophy.
The sensory capacity of the limb and the proprioceptive also disappear (the child does not feel that the arm is his own).
If there is lesion of the sympathetic nerves, loss of sweating occurs, the skin becomes thin and lustrous and the arm adopts the room temperature (imagine how cold an arm can be at 24 ° C).
In many cases the limb can recover
Luckily many PBO they can recover, although it is not something that is solved spontaneously. The parents of these children enter a totally different world from the imagined one in which they must practice full-time physiotherapists at home, go to hundreds of medical visits, see how your baby of a few months goes through a surgical intervention and a long etcetera with the purpose of rehabilitating arm functions as much as possible.
Many times you are late
The diagnosis is often late and recovery is difficult and even impossible. The reason? Because from the Hospital they don't give it the importance it deserves, because the bureaucracy makes the baby be visited when it's too late, because many parents go home without knowing that their child has a PBO, because many are wrongly diagnosed with a clavicle fracture, ...
Physiotherapy should start as soon as possible. and it is important to know that some will not improve if they are not surgically operated.
That is why a correct diagnosis and rapid referral to a specialized team that gets to work with rehabilitation, physiotherapy, parent training and relevant tests to assess the suitability of a surgical intervention is vital.
How could it be avoided?
At the moment when a shoulder dystocia occurs, the delivery remains at a time of standby in which professionals should try to act without haste, but with right hands.
At the moment when the nerves are lost because the child, whose head has already come out, does not progress, he tends to perform maneuvers such as Kristeller's, which consists of pressing the bottom of the uterus from the outside (many midwives get on the upper part of the belly to “squeeze” out), which is prohibited in several countries and advised against by WHO or pull the head hard producing this type of injury (or others with a worse prognosis).
The recommended in case of shoulder dystocia is to perform the maneuver of McRoberts, which consists of a hyperflexion of the woman's legs over the abdomen and releases the sacrum so that the diameter of the pelvic area increases. With this maneuver, most cases are resolved.
You can help yourself with the suprapubic pressure maneuver, in which pressure is exerted on the mother's abdomen to make the baby's shoulder go down a little and head back to the birth canal.
These maneuvers are not without risks and there are others that are even more aggressive that can cause fractures of the clavicle and / or humerus.
One may think that the remedy is worse than the disease, however, fractures heal without sequelae, unlike the PBO, whose evolution is more uncertain.
Observing the McRoberts maneuver, it is reaffirmed that the ideal position to give birth is standing, since it allows the coccyx to move backwards up to 2 cm and the woman squatting in the expulsive (which would be the McRoberts maneuver, but being foot).
Parent support
For recent parents with babies suffering from a PBO There are resources on the Internet that can help you speed up processes and understand what pathology is and what to expect. The most representative website in this regard is Adayo - PBO (Association of Help and Guidance - Obstetric Brachial Palsy).
