The brachial plexus nerves consist of five nerve roots starting in the upper spine and control movement of the arms. These nerves can be damaged to during delivery, if the doctor uses poor technique or applies excessive force during the birthing process.

During natural child birth, brachial plexus injuries can result from stretching of these nerves, particularly if the baby is large and is unable to pass though the mother's pelvis with out manipulation. In some instances the baby's shoulder gets trapped behind the pelvic bone. At this point a C-section should be considered. If the doctor tries to complete a natural delivery this can stretch the neck and damage the nerves in the brachial plexus.

Brachial Plexus Injuries:

Stretch: The nerves get compressed when the baby's shoulder gets trapped in the pelvic bone. Sometimes stretch injuries can heal themselves within a couple years and the baby regains full functionality. However if scar tissue presses down on the nerves surgery may be required
Rupture: Tearing of the nerves which requires surgery.
Avulsion: This occurs when the nerves are pulled away from the spine. The affected limb can be completely limp. This is the most severe type of plexus injury and surgery with muscle transfer may be needed to regain function.

Erb's Palsy and Klumpke's Palsy

Erb's Palsy and Klumpke's Palsy are forms of brachial plexus injury. These refer to nerve damage in different parts of the plexus.

Erb's Palsy refers damage to the fifth and sixth cervical roots, which start in the back of the neck. Klumpke's Palsy involves damage to the nerve roots in the lower plexus. Both Klumpke's Palsy and Erb's Palsy can result in paralysis or weakness due to the stretching of nerves during labor. Full range of movement in hands and wrists is limited in children with Klumpke's Palsy. Range of motion of the shoulder and arm is limited in children with Erb's Palsy.

Birth injury can occur when the baby is too large to pass through the pelvis during natural delivery.

The doctor will have to try to maneuver the baby if the shoulder becomes stuck (known as shoulder dystocia), therefore, a doctor should consider a caesarean birth instead if there is risk of the baby being too large.

When Natural Delivery May Not be an Option:

1. Fundal height measurement: This is the distance from the top of the uterus to the pelvic bone. During pregnancy your fundal height will grow and the doctor can compare it to expected norms. A measurement that is lower or higher then expected should be evaluated to determine the cause. A higher measurement could mean that the fetus is large and further evaluation should conducted to determine if a C-section is justified.
2. Gestational diabetes: Pregnant women who have never had diabetes before but who have high blood sugar levels during pregnancy.
3. Above normal weight gain during pregnancy: The amount of weight gain that is recommended during pregnancy is dependant the mother's initial weight or body mass index. If weight gain exceeds the norm for a given body type then there is a chance the baby will be large when born.
4. Maternal history: If the mother has previously delivered a large baby, then it is likely that her subsequent babies will be large as well.

If there is a reason to suspect the baby is large the doctor should confirm measurements with an ultrasound. Failure to recognize the signs of large baby can lead to an improper delivery method, which could result in an injury to the baby or mother that was otherwise avoidable.

There are several delivery techniques a doctor can use for a large baby:

• Caesarean section.
• Suprapubic pressure- attempt to manually dislodge shoulder from behind the pubis
• McRoberts maneuver- flexing the mother's legs onto her stomach so that the knees are close to the chest.
• Wood's corkscrew maneuver- rotation of the shoulder in a corkscrew fashion.

Related practice areas: Medical Malpractice, Birth Injury & Cerebral Palsy