Giving birth is an incredible, life-changing experience. However, it does come with risks, both for the mother and the baby. Even with advanced medical care, injuries can and do occur during the birthing process. Knowing the most common types of birth injuries can help parents be aware of warning signs to watch out for in their newborn.
The most common birth injury is trauma to the brachial plexus nerves. This is known as Erb’s palsy or brachial plexus injury. It occurs in 1-3 of every 1,000 births in the United States. Understanding what causes this injury and how it is treated can help prepare parents in case their child experiences brachial plexus injury.
What Is Brachial Plexus Injury?
The brachial plexus is a network of nerves that runs from the spine through the neck and shoulder into the arm. These nerves control movement and sensation in the arm, hand, and fingers.
Brachial plexus injuries happen when these nerves are damaged, usually during the delivery process. There are a few ways this can occur:
- The baby’s shoulders become caught in the mother’s pelvis, stretching the nerves
- The baby is pulled out too forcefully, overextending the neck and damaging the nerves
- There is excessive downward traction on the baby’s head during delivery
When the brachial plexus nerves are injured, signals from the brain can no longer reach the muscles in the arm and hand. This results in weakness, loss of movement, and lack of sensation.
Types of Brachial Plexus Injuries
Not all brachial plexus injuries are the same. There are four main types:
- Neurapraxia: Stretching of the nerves. This is the mildest form and usually resolves quickly.
- Neuroma: Scar tissue forms on the damaged nerves.
- Rupture: The nerves are partially or completely torn. This is very severe.
- Avulsion: The nerve roots completely detach from the spinal cord. This causes permanent damage.
Signs of Brachial Plexus Injury
How can you tell if a newborn has suffered a brachial plexus injury during delivery? There are some clear signs to look out for:
- Lack of movement in the arm and hand on the affected side
- The arm on the injured side hangs limply at the baby’s side
- Weak or absent grasp reflex in the hand
- Fingers are curled inward towards the palm
- Decreased sensation or numbness in the arm/hand
Sometimes only part of the arm is affected, like the hand or wrist. The severity depends on how many nerves are damaged and to what degree.
What Are the Risk Factors?
Certain situations make a newborn more prone to brachial plexus injuries during delivery:
- Baby’s size: A large baby over 8-9 pounds puts more strain on the shoulders during delivery.
- Baby’s positioning: If the baby’s arm is raised up beside their head, it can overextend the neck and shoulders.
- Prolonged labor: Long labors tire out the mother’s pelvic muscles, making it harder to maneuver the baby through the birth canal.
- Delivery method: Vacuum or forceps births can apply excessive traction to the baby’s head.
- Cephalo-pelvic disproportion: When the baby’s head is too large to fit through the mother’s pelvic opening.
However, brachial plexus injury can happen even without any of these risk factors present.
What is the Treatment for Brachial Plexus Injuries?
The good news is that the majority of brachial plexus nerve injuries do heal on their own within a few months. About 90% of cases resolve spontaneously. However, the recovery timeline depends on the severity:
- Mild neurapraxia may heal within weeks
- Neuromas can take 2-3 months to improve
- Ruptures may not fully resolve for 3-6 months
- Avulsions are usually permanent
Here are some common treatments that may help speed recovery:
Occupational Therapy
occupational therapy focuses on stretching and exercises to prevent muscle atrophy and regain mobility in the arm/hand. Therapists analyze movements and adapt daily activities to encourage use of the affected limb.
Physical Therapy
Once pain and swelling have diminished, physical therapists work to rebuild strength and coordination. They may use soft tissue mobilization, kinesiology taping, and electrical stimulation to retrain nerves and muscles.
Nerve Surgery
If nerves are ruptured or avulsed, surgery may be done around 3-6 months. This allows time for spontaneous healing. Surgeries include nerve grafts, nerve transfers, and tendon transfers. These help bridge gaps between severed nerves.
Botox
Botox injections can relax overly tight muscles to help restore normal movement. This is temporary but allows a window for stretching and therapy.
Splinting
Splints hold the arm in a proper position to prevent contractures. This also protects recovering nerves and muscles.
What is the Prognosis for Brachial Plexus Injuries?
With early treatment, most babies fully recover normal arm and hand function within 6-18 months after birth trauma. However, the prognosis depends on the severity of the original nerve damage:
- Mild stretching (neurapraxia): Excellent prognosis, full recovery expected
- Scarring (neuroma): Very good prognosis, near full recovery
- Ruptures: Good prognosis, but some residual weakness possible
- Avulsions: Poor prognosis, unlikely to regain full movement
In the most severe plexus injury cases, some weakness, sensory changes, muscle imbalance, or loss of dexterity may persist long-term. Ongoing physical therapy is beneficial to maximize function.
Preventing Brachial Plexus Injury
While not every brachial plexus injury can be avoided, experts recommend:
- Using proper birthing techniques to deliver baby’s head and neck slowly. Avoid pulling hard on head/neck.
- Waiting for contractions to help guide baby out naturally, rather than forcing delivery.
- Having mother change positions frequently to encourage proper positioning of baby.
- Monitoring baby’s size prenatally and planning c-section if very large.
- Avoiding vacuum/forceps delivery unless medically urgent.
Proper management of labor and delivery helps minimize excessive stretching or traction that can damage delicate nerves.
Emotional Support for Parents
Seeing your newborn struggle to move their arm and hand is extremely distressing for parents. Many feel guilty, blaming themselves or their provider. It is important to know that brachial plexus injuries are not preventable in many cases. Parents should focus on getting treatment rather than assigning blame.
Having a good emotional support system is also vital. Processing fears and anxieties with a counselor, other parents who’ve experienced BP injuries, online support groups, or your faith community can help immensely. Celebrate each milestone your baby reaches in their recovery.
Frequently Asked Questions
Are brachial plexus injuries caused by anything the mother did during pregnancy?
No, there is nothing the mother did to cause or could have done to prevent their baby’s brachial plexus injury in most cases. The nerves are usually damaged during the physical process of delivery.
Will my baby have permanent damage?
The outlook is very good for most infants, with full nerve recovery happening within a few months. Only severe nerve avulsions are unlikely to heal completely. Early therapy maximizes results.
How can I help my baby regain movement?
Follow all occupational and physical therapy recommendations. Do stretching exercises, massage, and gentle range of motion activities. Encourage use of the affected arm during daily tasks like feeding, dressing, and playing once approved.
Are there long-term complications?
Most children regain normal arm function. Mild residual weakness, numbness, or imbalance is possible. Some may need therapy for a few years or surgery to correct deformities. Lifelong impacts are rare if nerve injuries are mild.
Will my baby be in pain?
Brachial plexus injuries can be painful at first. Discomfort usually resolves within a few weeks as nerves heal. Pain medication can provide relief under a doctor’s care. Tell therapists if your baby experiences pain during therapy sessions.
Key Takeaways
- Brachial plexus injury during delivery is the #1 birth-related nerve injury.
- It involves damage to the nerves running from spine to arm/hand.
- Signs include a limp arm and lack of movement/sensation.
- Recovery takes weeks to months based on severity.
- Physical/occupational therapy helps optimize outcomes.
- Most infants fully regain normal arm function.
Conclusion
While brachial plexus injuries can be worrisome for new parents, stay positive knowing that most babies make a complete recovery within months. Seek treatment right away for the best results. Modern therapies allow even severely affected infants to regain nearly normal arm and hand function. With patience, care, and support, your little one can thrive despite this challenging start to life.