Brachial Palsy: A Potentially Severe Birth Injury Explained
The birth of a child is one of the most fulfilling, joyful days of a parent's life. Although many births go smoothly without complications, unfortunately some newborns suffer injuries during the birthing process.
Birth injuries can range from mild to severe, with effects that can last days or cause permanent damage. Babies that are large or premature, mothers with small frames or who experience long, difficult labors, or babies that are born breech (feet first) are considered at risk for birth injuries.
Mild injuries include bruising, hemorrhage and swelling associated with the birthing process and the use of different tools like a vacuum and forceps. Mild injuries only last a matter of days or weeks, and babies are expected to fully recover.
Unfortunately, more severe birth injuries can and do occur. Babies can suffer from facial paralysis and bone fractures due to trauma from the birthing process, especially if the mother's birth canal is narrow and forceps were used to extract the baby. Another, more long-term injury is called brachial palsy, which affects the bundle of nerves that controls the upper arm.
About Brachial Palsy
Brachial palsy is the result of torn or dislodged nerves due to the forceful extraction of a baby during birth. It is associated with the group of nerves at the shoulder joint known as the brachial plexus, which controls the function of the upper arm, although function of the lower arm and hand can also be affected.
Most cases of brachial palsy were caused by doctors or midwives pulling too forcefully on the baby's head in an attempt to extract the baby from the birth canal, typically when a baby is sideways and the position of his or her shoulder prevents smooth passage. Large babies and breech babies are at higher risk of experiencing brachial palsy.
Immediate symptoms of brachial palsy include no movement in the upper or lower arm and hand, the arm being held close to the body at an angle, and lack of grip. Unfortunately, only time can tell if the effects of brachial palsy will pass quickly or be more permanent.
Doctors classify brachial palsy into three tiers: stretch, rupture and avulsion. Stretch is the mildest form, and normal function of the arm usually returns once the swelling goes down and the stretched out nerves return to normal. Rupture occurs when one or more nerves are torn, either partially or completely. The body will attempt to repair the torn nerves on its own, and will be successful in a partial rupture, less so in a complete rupture.
Avulsion is the most severe case of brachial palsy. Avulsion occurs when the entire brachial plexus is torn out of place, causing signals from the brain to not reach the arm. In extreme cases, avulsion can affect the leg on the same side of the body as the affected arm.
Long-term effects from brachial palsy include the inability of the body to repair and create nerves in the injured area, lack of strength and eventual atrophy of the muscles in the affected limb, altered movement due to the non-functioning arm and arthritis, scoliosis, and other bone and joint issues.
Brachial palsy is the unfortunate outcome of forceful extraction techniques during birth. Although incidence of brachial palsy has decreased in recent years due to improved practices and cesarean sections, cases of brachial palsy do still occur. It is important to talk with your obstetrician about the risks inherent in birth and develop a plan that outlines the interventions you are comfortable with should complications arise.