NEW PARENTS

If you are the parent or loved one of an infant with an obstetric brachial plexus injury, there a few important things you need to know:

Some brachial plexus injuries go away with time. Others will be permanent. It is difficult to tell at birth which category your child's injury falls in to. Be prepared for either.

Early evaluation and treatment is critical! It is in your child's best interest to have the injury evaluated immediately after birth by a physician or team of physicians specializing in brachial plexus injury. Many of the advances in bpi treatment have been made within the last 10 years. Doctors who do not keep current on medical literature may not be able to provide parents with all of the options available. Often, larger children's hospitals will have brachial plexus clinics staffed by surgeons, neurologists, rehabilitation specialists, behavioral health specialists, and therapists to address all of the issues related to the injury.

You should leave the hospital with specific instructions for the care of your infant's injury and recommendations for follow-up care. Many specialists recommend a short period of immobilization followed by physical therapy. You should be taught exercises to keep your infant's arm, hand and shoulder muscles moving while waiting for the nerve injury to heal. Since your baby cannot move his or her arm properly, you or the child's care-giver must move it for them. Lack of movement can cause shortening and wasting of the muscles and tendons as well as distortion of the arm bones. If and when the nerve heals, there won't be healthy muscles to move the arm, which will further affect recovery. Your child should be evaluated periodically by a brachial plexus specialist or team as well as a physical or occupational therapist.

Some injuries will be severe enough to require early surgery to repair torn nerves. Most primary surgeries, (nerve repair surgeries) will be done within the first three to nine months of life. It is important to act early before the muscles have atrophied or wasted away from lack of use. At that point, even if the nerves can be repaired, the muscles will not be able to move the arm in reaction to the nerve stimulation. This is why it is important to have your child evaluated by physicians working together to treat all aspects of the injury.

If you have given birth to a child with a brachial plexus injury or have encountered a shoulder dystocia in previous deliveries, you are more likely to have repeat problems with future deliveries. It is important that you talk with your doctor about what happened in your particular case and what could be done in the future to prevent injury to your infant. If your doctor is unwilling to discuss it with you or is unable to provide answers, you may want to request your delivery records from the hospital and seek an opinion from another physician or an attorney who specializes in medical cases.

If you are concerned that your child's injury may be the result of a medical malpractice or negligence by your doctor or midwife, you should consult an attorney specializing in medical malpractice as soon as possible. It may be difficult to uncover the truth as time goes by and you will have a better case if hospital staff members can recall the details of your delivery.

Realize that this injury to your child is the result of trauma during birth and is in no way your fault. The injury happens when the infant's shoulder gets caught on the mother's pubic bone during delivery. Sometimes, mothers especially, will blame themselves because no one will tell them what happened. Often, medical personnel will be vague about the cause of your child's injury because it can become a medical/legal issue. You are not responsible for your child's injury.

Brachal plexus injury is a birth injury, not a birth defect. Birth defects are anomalies such as cleft palate, cleft lip and spina bifida that occur during the growth and development of the fetus. BIrth injuries happen as a result of some type of trauma during delivery.

Take care of yourself too. If you find yourself having difficulty dealing with your child's injury emotionally, consult your doctor or mental health professional for help.