United Brachial Plexus Network, Inc.

Med Law. 2005 Dec;24(4):655-61.Links
Erb's palsy after delivery by Cesarean section. (A medico-legal key to a vexing problem.).Iffy L, Pantages P.
Department of Obstetrics & Gynecology, UMDNJ, New Jersey Medical School, Newark, New Jersey, USA.

Despite impressive progress in perinatology, fetal injuries from arrest of the shoulders at birth have not decreased in recent decades. Based upon sporadic reports of Erb's palsy in neonates born by Cesarean section, some obstetricians embraced the theory recently that brachial plexus lesions often derive from spontaneous forces acting in utero. Having reviewed three hundred malpractice claims involving fetal injuries attributed to shoulder dystocia at birth, the authors found only two cases connected with abdominal deliveries. One followed manual replacement of the already delivered fetal head into the pelvis after sequential vacuum and forceps procedures and failed manual extraction of the body. The other was an elective repeat Cesarean section where extensive adhesions limited the available space for the lower segment transverse uterine incision. Coincidental fracture of the clavicle and absence of contractures or deformities indicated that the brachial plexus injury was acute, having resulted from forceful traction at delivery.

ACK!!! Here I am getting ready to deliver my 4th child which will be most likely my second C-section which is considered an elective repeat c/s and this is because an on-call doctor scared me away from trying a vag after having had my 2nd born child end up with BPI!

I have known for sometime that BPI can occur with a c/s but I still consider it less risky than a vag birth....

what do you think? I am curious as to why you posted the info?

Thanks,
Kristie

Actually I think this article supports c-sect honestly after there is no progress being made in preventing these injuries vaginally. With c-section babies the born with BPI had special circumstances. There is risk in everything. But if you are worried about what is the bigger risk in having another child with BPI c-sect vs vag delivery I feel your chances are much better with a c-sect. I hate to see you doubt your decision. Good luck and I hope you have an uneventful delivery and recovery and wish you the best. What an exciting time.

Actually, I think the data posted shows pretty clearly that BPI does NOT occur with C-sections except in very unusual deliveries. Basically, doctors have claimed that "because BPIs also occur in C-sections, they must not be due to excessive force by the OBs". This study clearly debunks that line of reasoning.

Kristie, I think you have nothing to worry about. I would only make sure the doctor understands that you do NOT want a "minimum" incision but that he should definitely allow enough room to get the baby out without any force. This is *just in case* there is an element of "predisposition towards BPI" in your case. I don't think we know why some kids can withstand large amounts of traction and some cannot. Just to be safe, I would request that the c-section also be done so that a minimum amount of 'wrestling' is necessary to get the baby out.

Kate

Thank you for your words of comfort and for helping to explain that the article was not saying that I need to worry about BPI with c/s.

We have not really come to a decision about whether to deliver with a Vbac or c/s. Surprisingly my doc somewhat recommended a Vbac. I had assumed with my history and the fact that we did a c/s last time he would just think c/s was the way to go but that isn't the case. Last time I really did want a vag birth. But as I said before an on-call doc who was suppose to start my induction used what I would call bad bedside manner and scare tactics to change my mind. And it worked. In the end I was very happy with my c/s. Most things about that birth were way better than the other two that were vag. So now I don't really know how I want to have this baby! I just want her born!

Anyway all that is off topic! So thanks for letting me ramble as well.