This site was created to educate you about one specific birth injury: Obstetrical Brachial Plexus Injury (OBPI). It is honest, clear and maybe a little "in-your-face". The slight undertone of anger has not been filtered out because I wanted you to hear this information as it comes - directly from my heart - not stripped clean, "diplomacized" or made politically-correct. As long as I continue to watch my own daughter struggle because of her injury and as long as I get weekly emails and calls from saddened new mothers about their injured newborns, I will continue to hold on to this anger energy. It's this energy that creates informative sites like this... sites that have the courage to tell people the TRUTH.
My dear friend, another mom with an injured child told me that there are now five children in her tiny neighborhood who have brachial plexus injuries. I know that in my own local area we gather an enormous crowd at our group gathering. I also know that when my daughter's specialist comes to town for his clinic, he is booked from morning until night and extra days had to be added to his schedule to see everyone - and that's in a town that already has four other specialists! Another sign that makes me think that this is almost or already at the point of epidemic is the number of new brachial plexus specialists and clinics that seem to pop up all the time. It's scary to think that they are all so busy! So what are we talking about here? Read on...
What is a brachial plexus injury?
The "brachial plexus" is a complicated set of nerves that go from the spinal column in the neck down to the fingertips. Injury to these nerves include a mild or severe "stretch" injury, a partial or full "rupture" [tear] and a partial or full "avulsion" [dislocation from it's origin in the spinal column]. It could involve many nerves and might be a combination of the above. The infant is left with a paralyzed arm (or two) and a lifetime of secondary issues that affect the entire body, daily life and the emotional, social and spiritual being... including that of family and surrounding friends and community as well.
Some brachial plexus injuries are mild and will resolve with full function of the affected arm in a short time. However, a very large population of babies with brachial plexus injuries have a permanent disability. New studies also show that some of the children who were considered to have temporary, mild brachial plexus injuries, are showing up at specialized clinics at later ages, with deformities that may or may not be able to be corrected.
Depending on what source you read, the statistics show that anywhere from 1 to 8 out of 1000 babies born each year will receive a brachial plexus injury. And quite frankly, I have no idea how they arrived at these numbers because no one's counting! That's right - even as of today, hospitals and doctors do not have to report these injuries. But whatever the number is - even 1 out of 1000 is too many - and the only way these numbers can be reduced and this travesty avoided is by educating yourselves on how these injuries can possibly be prevented. So bravo for coming here to learn more!
Shoulder Dystocia
In the pregnancy books, the birth canal is shown very straight forward. I'm sure you've heard about a cord being wrapped around a baby's neck - which certainly is an emergency. But have you have heard about a baby's shoulder being stuck inside? Well, sometimes the baby's shoulder can get stuck underneath the mother's pelvic bone. This birthing emergency is called shoulder dystocia.
There is accepted medical protocol on how to deal with shoulder dystocia. There are many different ways to dislodge the baby's shoulder safely so that the baby can complete his/her journey without injury. One of the easiest (but not often used because of epidurals) ways to dislodge a "stuck shoulder" is to reposition the mother. The mom can be put on all "fours" [Gaskin Maneuver] or other uterine-forward, pelvic opening positions. Another way is to push the mother's knees to her chest [McRoberts Maneuver]. Then there's the Woods Screw Maneuver, where the baby is "un-screwed" out of the birth canal and now there is a Rubins Maneuver as well. If done correctly, there are many maneuvers that can safely dislodge a stuck shoulder. In addition to those already mentioned, the practitioner can break the baby's clavicle bone, break the mother's pelvic bone or push the baby's head back in the birth canal and perform an emergency C-section [Zavanelli Maneuver].
There are some maneuvers that can be detrimental to the infant. When excessive traction on the head is performed while the baby's shoulder is stuck, the brachial plexus nerves in the baby's neck may be injured. If fundal pressure (pushing at the top of the belly) is done while excessive traction is applied, the injuries may be extremely severe. It takes an enormous amount of traction to tear [rupture] a nerve and even more traction to pull it out of the spinal column [avulsion]. I remember reading on one site that it takes 40 to 150 pounds of pressure to injure nerves! (40 pounds for stretch injuries and 150 pounds for avulsions - global brachial plexus injuries) Think of how much pressure that is on a newborn infant's neck! I know moms who have told me that their doctors put one leg on the bed and just pulled with all their might. What were they thinking?
Why does shoulder dystocia occur?
There are numerous reasons. The mother's pelvis may be too small or have a flattened shape (platypelloid). The shoulders themselves may be very large. [I read that mothers that have regular or gestational diabetes grow infants with larger shoulders. And currently, because of society's sugar-laden diet, gestational diabetes is epidemic.] There are some mothers that may have a harder time giving birth - the moms with a smaller frame, shorter body, those who are obese in combination with being short or are not obese but gain over 35 lbs. during the pregnancy. And yet, infants are injured even if none of these factors exist - even with smaller infants, taller moms and those born by C-section!
How does the baby get injured?
The way in which we birth on our back, with the lower half of our body numb... for one, our pelvic outlet might be as much as 30% smaller or more in this position. And then, because we are numbed, we can't be put in any other position, especially not on "all fours" to help a baby come out. Then our practitioners use mechanical interventions such as forceps and vacuum extractors. [Injuries sustained from mechanical interventions can be quite severe: cranial damage, brain damage and even death.] Maneuvers are done incorrectly. The wrong kind of pressure may be applied to the uterus. A 4th degree episiotomy might be cut (now studies show that these are done unnecessarily). Panic ensues, excessive traction is applied. The rest is history... another injured baby and most probably an injured mom, too.
Injured mom?
Hold on to that thought... I'm going to finish up on shoulder dystocia and come back to that later....
Continuing...
With a C-section, they seem to want to cut a smaller and smaller incision so that the mom is less scarred and the baby gets the "feeling" of a vaginal birth. Mechanical interventions are used, babies heads and arms are pulled excessively and injuries occur even with C-sections.
Then there is the combination of professional error (I call this medical negligence), inexperience and not being trained well enough in how to deal with emergencies. There are those practitioners who actually care and take the time with the mothers, follow their labors, watch the progress and can stop an emergency from happening through prevention and the correct and expert application of the maneuvers. Then there are the practitioners who show up at the last minute (almost inconvenienced), rush through things, do the maneuvers poorly and injure one baby after another. The current health, insurance and legal systems don't stop them, although I wonder how they go to sleep at night and why they don't stop themselves !
How can you try to prevent this from happening to your baby?
The utmost important thing you need to do is to educate yourself as much as you can about the birth process, risk factors, about shoulder dystocia and other birthing emergencies as well (because shoulder dystocia is just one of many).
Try to reduce as many risk factors as possible. For example, if you are not yet pregnant, have an x-ray done of your pelvis and have them determine what size and shape your pelvic outlet is. If your pelvis is flat, you may always require a C-section to birth safely. Also, if regular or gestational diabetes runs in your family history, then make sure you get the correct testing done and strictly follow the gestational diabetes diet. These are both easy things to do.
Of course you can't do anything about your height, your age or your frame. You can try to lose as much weight as possible before you get pregnant and you can try not to gain a whole lot during your pregnancy (if you are already obese). You can learn about uterine-forward labor and birthing positions and practice them as much as possible before and during your pregnancy. (see books on the right column).
You can also educate yourself in birthing methods that will help you manage your birth without the use of medication. A couple of possible choices might be the Bradley Method and there is also Hypnobirthing (which just amazes me).
Your partner's role...
Your partner (whether it's a husband, same sex partner, mom, or friend) needs to be educated and take a very assertive role during the pregnancy and the birth - including knowing what things should NOT be done during a birth (like fundal pressure). I highly suggest that your partner come with you to each and every appointment and follow the pregnancy closely - even keep a journal about each visit. This is important because when you are pregnant "everything's almost always ok" in your mind because most women are so happy when they are pregnant. Hopefully, your partner will be able to weed out the information and recognize the red flags if and when they pop up. If you notice red flags in the practice you are going to - find a new practice. One major red flag might just be the tip of the iceburg.
In the labor and delivery room, your partner, again, needs to play an active role in supporting you through the birth, helping you labor and get into uterine-forward positions and more... and to wade through the red tape and beaurocracy that may exist in the hospital you are at. For example, some hospitals don't allow you to walk around if your water has broken. Why? Because you might slip! So your partner can get you a little towel and some slipper socks that have the rubber coating at the bottom so you can stay upright and labor more efficiently. (Staying upright is the best way to keep labor going.) When you arrive, your partner should make sure that all the necessary accommodations you need are available - like a squat bar, lots of pillows, etc. so you don't have to go searching in the midst of things. What I'm trying to say is that your partner needs to be assertive and run interference so that you can do everything possible to stay off your back and out of interventions way. Please read the book "The Birth Partner" by Penny Simkin - all this information is there. (listed on the right)
And if your partner can't play that role in the birth room (which, honestly, some just can't and that's ok), then hire a birth doula (labor support) who understands what shoulder dystocia is and who will support you with uterine-forward, pelvic-opening labor and birth positions but also support you emotionally if a C-section is necessary. You will need to interview your doula extensively. When you meet her you should get an instant feeling of loving sisterhood and if you don't, move on to the next one. Ask the doula what her opinion of C-section is. You will need to have a partner who is NOT anti-C-section just in case an extreme measure is needed to get the baby out.
You should discuss an emergency plan in case severe shoulder dystocia does occur with your birthing practiioner, doula and partner. It needs to be decided how long in the process you will go until a decision is made for a C-section. C-section needs to be a possibility in your mind because it can save your baby and is NOT defined as a failed birth - so you might need to spend some time processing this concept. You have NOT failed at birth if you need a C-section. And you still have every chance to bond with your baby if you have a C-section - none of this will be taken away from you. Just remember that if adoptive parents can fully bond to their adopted children, so will you bond with your baby if you have a C-section. Having a (medically necessary) C-section can save your baby's life!
And the most important piece is to find a practitioner (or group of practitioners), whether it be doctors or midwives (yes, even midwives injure babies), who have excellent track records with these types of emergencies. If your state has this availability, look into their medical malpractice records - go to the courthouse in the counties where they practice and see what's there (you might need to know all their corporate names). Ask them pointed questions about shoulder dystocia and how they would handle it (see the list of questions over to the right). If you have a very specific plan in place, write it down as a "prescription" so that if another doctor attends your birth, the plan will be clear. (The example being the primary OB deciding that a C-section would be the only way for you to birth because of specific factors, and an alternate OB shows up and decides that he won't give you a C-section because "he can handle it" and the result is an injured baby.)
Back to Injured Moms
So... you thought that it's only the babies that get injured? Wrong! You don't hear too much about the moms being injured because the moms are so caught up in the daily life of having an injured newborn. Most of them feel so guilty because they think it's their fault - that they can't and don't take the time to even acknowledge their own injuries and pain.
Physically, many of the moms I have encountered over the last seven years have been ripped to shreds "down there". Many have had torturous 4th degree episiotomies - incisions that go right through the sphincter muscles. Some moms have fissures - holes between the rectum and the vagina, so excrement can empty into the vagina. Moms have urinary tract issues, incontinence and more. Moms have lost their entire sexual appetite because of the pain intercourse causes due to the scar tissue. Moms have lost self esteem and confidence in their sexual selves and don't want their husbands looking, touching or being near them... often out of sheer embarrassment. What about moms that stop going to doctors because they have been so traumatized that they can't even handle going for a PAP smear! (This is very common.) Yes, the trauma that some mothers have gone through is akin to a rape.
Emotionally, the guilt eats them up alive. They somehow feel that the injury is their fault - they didn't birth well enough - when millions of women give birth to babies, why couldn't they get it right? Their husbands may feel the same way and blame them, too - even if it is silent - moms sense the change in attitude. Of course, it doesn't help when doctors write "peer reviewed" (I wonder who their peers are!) articles about how the uterus or the vagina caused the injury so that they can protect their negligent OB buddies from a malpractice case. (I call this the "killer vagina syndrome") Unfortunately, some jurors are stupid enough to actually believe it.
How many divorces occur because of this injury? How many husbands can't handle their wives depression, guilt, anger, lack of sexual desire, and post traumatic stress disorder? How many can't face their wives because they blame them for the injury? How many can't handle all that is necessary in daily life to raise a child who was injured and walk out on their families?
And they think they are only injuring an arm and that it will get better in a couple of weeks? <big sigh> Unbelievable!
Nobody knows what we moms know - nobody experiences it like we moms do. Nobody knows how many tears we shed and how many screams we scream.
Our precious little babies...
they have injured our babies and they have injured us and our families and our lives will never be the same!
Why isn't anybody stopping them!
Someone MUST stop them!
E-mail: franlitz@gmail.com |
