Seriously, I get so frustrated and DEEPLY saddened by all the convenient distortions of truth surrounding this birth injury. I had to take a few deep breaths while reading this. I need to vent about a few points, but if anyone wants to read the article/quiz, here is the link that Rich found.https://e-edcredits.com/nursingcredits/ ... ?TestID=45
A few things stated by the author/doctor that I feel inclined to comment on....
“It is important to understand that most shoulder dystocia deliveries do not result in Erb’s palsy. Likewise, approximately half of the Erb’s palsies that are seen come from deliveries in which there was no shoulder dystocia. This is a fact that needs to be understood.” (I believe the fact that needs to be understood, is the fact that MANY babies are injured with brachial plexus injuries when there WAS a SD that was conveniently not documented. I also believe many babies are injured from so called "gentle" traction BEFORE a SD is even diagnosed.)
“It is now a truth that only about half of these brachial plexus injuries come from a delivery complicated by shoulder dystocia. The other half comes from deliveries in which NO shoulder dystocia occurred. This fact has now been demonstrated in numerous studies that total more than 2600 Erb’s palsies” (Again, is it really a TRUTH and has this fact been reliably demonstrated?)
“In conjunction with the large numbers seen in the table above, there are two other compelling facts that verify the issue that most brachial plexus injuries are not caused by the delivering healthcare provider. These are cesarean section and the posterior arm.” (MOST bpis are not caused by the healthcare provider. Hmmmmm........
Also, the c-section and posterior argument do come in handy, however, babies can still be yanked on and pulled out of small c-section incisions, in ways that can damage the plexus and yes, it happened to a friend of mine. And as far as the big posterior argument, it personally means little to me. Upward traction and certainly twisting the neck could potentially damage the plexus. We also know that sometimes injuries are conveniently documented as a "posterior" injury in an attempt to avoid litigation, even though the injury was actually to the anterior shoulder. So again, if we are relying on inaccurate records, we do not have the true information.)
"The posterior arm is the second compelling finding that verifies that the delivering healthcare provider does not cause most brachial plexus injuries." (still beg to differ on that one, not to say it isn't possible to have an injury not caused by the healthcare provider, but I am more interested in the rule versus the rare exception)
"The importance of this finding is that none of the maneuvers applied by the delivering healthcare provider will actually further stretch the nerves in a posterior arm injury." (Not even twisting and turning the head in both directions? And excessive upward traction, even during an anterior or bilateral dystocia, could never injure the posterior plexus?)
"The size and shape of the fetal shoulders may, however, affect how well the baby traverses the birth canal once the mother has dilated to complete (which is the second stage of labor)." (the baby would probably traverse much better if given all the space our bodies were designed to give it)
"However, from a simplistic point of view, there are 2 basic risk factors for shoulder dystocia and these are a baby that is too large for the mother’s birth canal (macrosomia, most commonly defined as > 4500 grams) or a mother’s pelvis that is too small or poorly shaped for the birth of the baby (non-macrosomic baby) or a combination of the two." (Okay, I am trying to maintain my composure here
.....the baby is too large for a birth canal that they may have closed due to traditional birth positioning? Or is it our pelvis which is 'too small or poorly shaped'. It always is about us, isn't it? Hmmmm....I think it is time to look at female anatomy and the biomechanics of the pelvis, positioning during pushing, moving into alternative positions during an SD, etc. Interesting, can't find any mention of that.)Sorry if I seem a little spunky here. I just have a hard time with these distorted truths. It is just so sad to see the misinformation out there and to know that we are only perpetuating the cycle of birth injury.
Thanks for listening and letting me vent!
Lisa
