Is the incidence of Erb’s palsy being reduced?
As we look at raising awareness of Erb’s palsy injuries, (also known as obstetric brachial plexus injuries (OBPI), I was interested to find out the current midwifery perspective in relation to it. Although now just over a year old, the British Journal of Midwifery provided an overview of OBPI and a really useful insight in their article [02/10/2023, Vol.31 Issue 10] which I consider here.
How many cases of Erb’s palsy are there per year?
According to a study by Annika et al (2019) the prevalence of OBPI in the UK at that time was 0.49 per 1000 births. This would equate to around 350 babies with either a transient or permanent Erb’s palsy injury that year based on 712,680* lives births in the UK in 2019. *According to Statista.
The review also highlighted that with shoulder dystocia there was a 100 times greater risk of OBPI than if there was no shoulder dystocia. In addition there was a further increased risk with an exceptionally large baby (>4.5kg) and also with a forceps delivery.
How can OBPI be prevented?
It was recognised that there was a need to understand the aetiology of injury in order to then help to prevent it. One of the biggest impacts on the reduction in the number of injuries seen came about following the introduction of an obstetric emergencies training programme known as PROMPT for all midwives and obstetricians. This was introduced in 2008 across the UK although had been in progress for many years previously.
With a robust training programme that was repeated regularly, there was a significant reduction in brachial plexus injuries at various hospitals, both in the UK and abroad, with an ultimate achievement of trying to eradicate all permanent injuries. This was achieved in some hospitals. This of course didn’t happen overnight and it is so important that the training continues regularly.
Knowledge is power… and so is training.
The very clear message in relation to dealing with these obstetric medical emergencies is that the midwife [or obstetrician] delivering the baby needs appropriate training. Knowledge is power and improves not only an individual’s ability to deal with a difficult situation but for the team to work together for the best outcome. Most importantly they should not use excessive traction: “Do not pull hard, do not pull quickly and do not pull down.”
It is only with the appropriate training and knowledge of how OBPI occurs and how it can be avoided will we see the ultimate aim of no permanent Erb’s palsy injuries in any of our hospitals in the UK and across the world.
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