Obstetric brachial plexus injury involves a deformity in which the arm is held in adduction and is internally rotated, the forearm being extended and pronated. Whilst some of the minor injuries to the nerves may “heal” in time, a major disruption of the fibres result in permanent injury since nerves themselves cannot regenerate. The majority of brachial plexus injuries – those born vaginally are associated with large babies and in recent years 4.5kgs has been accepted throughout the developed world. Shoulder dystocia occurs when baby’s shoulder or shoulders get stuck inside the mother’s pubic bone during labour which carries risks for both mother and baby. In regards to the mother the commonest injury is massive soft tissue damage to the pelvic floor which may include anal sphincter injury and lifelong impaired incontinence and for the baby, not only obstetric brachial plexus injury, but asphyxial injury may result if rescue is delayed beyond the baby’s normal tolerance which is usually about ten minutes. Difficult births of the shoulders are not peculiar to vaginal delivery as it can occur, in the hands of inexperienced surgeons, during a caesarean section when the incision made in the uterus is insufficient for the easy birth of the shoulders and the doctor is obliged to use traction (pulling), whether applied during caesarean section or during vaginal delivery is of course liable to cause injury to the baby. In vaginal delivery there are two possible adverse outcomes:
- Injury to the brachial plexus
It is because of these injuries that shoulder dystocia is commonly the subject of medical negligence litigation and certainly ones that we have seen over the years.
With the head born and the shoulders obstructed, the baby will suffer hypoxia as the umbilical cord is compressed and baby has no oxygen supply, although the baby’s head is in air it cannot expand the chest and therefore cannot draw oxygen into the lungs. Unless the baby is rescued within a relatively short period (about ten minutes) brain injury is sure to follow and thankfully such circumstances are rare.
Injury to the brachial plexus
More common is injury to the brachial plexus which is a traction (pulling) injury.
It must be pointed out that not every brachial plexus injury is as a result of medical negligence, for example if it becomes apparent that the baby is in severe distress and will soon be asphyxiated, brain damaged or even dead if nothing more is done under those circumstances the doctor is fully entitled to take a deliberate decision to pull hard and risk brachial plexus injury in order to save the life of the baby, but of course on the opposite side this does raise a separate issue of how in the 21st century a baby so big has to be irrevocably stuck could have been permitted a vaginal exit and perhaps negligence can be made out against the hospital in that circumstance and that delivery affected earlier and far safer by caesarean section. The experts involved in successfully establishing a case will be the responsibility of either an obstetrician or a midwife (occasionally both). The case will also need the input of an orthopaedic surgeon with a special interest and experience of brachial plexus injury and there will also be other experts involved to prepare reports on compensation such as a physiotherapist, occupational therapist and a vocational rehabilitation consultant who will assess the injured person’s ability to earn a living as a consequence of the disability they face in not having two fully functioning arms. Successful cases have been made that shoulder dystocia should have been predicted and a lower risk caesarean section performed instead in order to avoid the complication. The courts have held that a woman has a right to information about a material risk in order to make an informed decision about how to give birth. In a decided case a mother was in her first pregnancy and suffered from insulin dependent diabetes, it was agreed that risk of shoulder dystocia occurring during such a vaginal delivery was 10% in the case of diabetic mothers; nevertheless, she was not told of the risk of shoulder dystocia and during vaginal delivery the umbilical cord was obstructed, depriving her baby boy of oxygen and he was born with severe disabilities including brachial plexus injury. It was found that had the mother been advised of the risk of shoulder dystocia and the potential consequences discussed with her and the alternative of a caesarean section she would probably have decided to be delivered of her baby by caesarean section and it was not in dispute then that her baby would not have been born harmed and therefore her case rightfully succeeded.
If you or a loved one have been affected by obstetric brachial plexus injury or related matters, our medical negligence solicitors can help you pursue a claim for compensation. We believe in putting you our client first and we are committed to achieving the best result possible while all the time remaining sensitive to your needs. Please feel free to reach out to us below and will be pleased to discuss your case and offer no obligation advice.