What is shoulder dystocia, erbs palsy, klumpke's palsy, and brachial plexus palsy?
Shoulder dystocia occurs when the baby gets stuck behind the mom's pelvic bone while passing through the birth canal. Failure to recognize this can result in significant injury to the baby. Sometimes, an obstetrician will try and pull on the baby's head to get the baby out quickly. This can have devastating effects on the baby.
Applying excessive lateral traction to the baby's head when the baby's shoulder is stuck in the birth canal can cause a baby's nerve to stretch or tear and become severely injured. This injury is called "Erbs palsy," "Klumpke's palsy," or "Brachial Plexus palsy." This nerve injury causes significant disability to the baby's arm and has long-term implications. Most children with this injury are unable to use their arm, and hand.
Here are some maneuvers doctors use to try and get the stuck shoulder out from behind the mother's pelvis:
1. A "woods maneuver," also known as a "corkscrew" maneuver. This rotates the baby to move the stuck shoulder away from the obstruction.
2. If the "Woods" maneuver doesn't work, then they can try a "Rubin" maneuver. This rotates the baby in the opposite direction.
3. At the same time, the doctor should be doing a "McRobert's" maneuver. This is where the pregnant woman's legs are pulled back as far as possible, with her knees up by her chest. This creates more curvature of the spine and more room for the baby to pass through the birth canal.
4. If those maneuvers don't work, an obstetrician can try to deliver the posterior arm to release the shoulder from the mom's pelvis.
5. Another maneuver is applying suprapubic pressure. This is pressure placed on the mother's belly, below where the baby is, in the area of the pubic bone. It is NEVER acceptable to apply fundal pressure, which is pressure placed at the top of the mother's belly to try and force the baby down the birth canal.
6. An episiotomy (an intentional cut made by the obstetrician) is often done to allow and prevent a tear of the skin and muscles as the baby passes through the birth canal.
7. As one of the last efforts, the obstetrican can fracture the baby's clavicle bone, which will collapse the bone, and (hopefully) shrink the size of the shoulders so the baby can pass through the pelvis.
8. As a final, drastic, last ditch maneuver, a procedure known as a "Zavanelli" maneuver can be done. This is also known as a "cephalic replacement" where the baby's head is pushed back into the vagina and an emergency cesarean section is performed. This is rarely done, but is nevertheless a tool in the obstetrician's arsenal to get the baby out when all else fails.
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