Risk Factors and Medical Negligence that Can Cause Macrosomic Complications

Posted by Anapol Weiss on Jun 7, 2016 1:13:34 PM

Macrosomic babies, or babies that are “large for gestational age,” have a birth weight of over 4,000 grams (8 lb 13 oz). Approximately nine percent of babies are born macrosomic. Macrosomia can lead to severe complications during pregnancy including shoulder dystocia and ensuing brachial plexus injuries, oxygen deprivation and brain damage, lacerations of the birth canal, uterine rupture, and urinary incontinence.

macrosomic_risks.pngBabies born at weights over 4,500 grams (9 lb 15 oz) are at an even higher risk. Expectant mothers should be aware that certain risk factors make a baby more likely to be macrosomic, including the following:

  • Obesity or significant weight gain during pregnancy. Obesity is one of the largest risk factors for macrosomia. Expectant mothers should follow nutritional guidelines and maintain a healthy weight throughout pregnancy.
  • Maternal diabetes. Both pre-gestational diabetes and gestational diabetes (diabetes developed both before pregnancy and during pregnancy) are major risk factors for macrosomia. Increased blood sugar and insulin production lead to excessive growth, large shoulders, and fat deposits in a fetus. Expectant mothers with diabetes should discuss their situation with a doctor to manage diabetes during pregnancy. All expectant mothers should maintain good nutrition and a healthy weight to avoid developing gestational diabetes.
  • Genetics. Babies with taller and larger parents are predisposed to be large themselves.
  • Overdue pregnancy. Pregnancies that continue more than two weeks after the due date have increased risk of macrosomia.
  • Previous pregnancies. Birth weight tends to increase somewhat in each of a woman’s pregnancy; thus, the incidence of macrosomia increases in babies whose mothers have given birth before. Prior delivery of a macrosomic baby increases the risk even more.
  • Male baby. Male infants tend to weigh more than females. Most macrosomic babies are male.
  • Maternal age. Women over 35 years of age are more likely to delivery a macrosomic baby.
Macrosomia can be very difficult to detect; a baby can only be weighed and macrosomia diagnosed after birth. However, doctors can predict a baby’s weight through a few tests, such as
  • Ultrasound. An ultrasound can help a doctor to determine the size of a baby’s head, abdomen, and femur. These measurements can predict the baby’s weight with some degree of reliability.
  • Height of the fundus. The fundal height, measured from the top of the pubic bone to the top of the uterus, usually corresponds with the length of the pregnancy. If the measurement of the fundus seems unusually large for the number of weeks of pregnancy, the baby may be larger than normal.
Macrosomic babies can be delivered safely, but special awareness and attention to detail is important. Expectant mothers should discuss macrosomia with their doctors if they have any of the risk factors detailed above. Doctors may consider early delivery, cesarean sections, and other methods to reduce the risk of birth injury from macrosomia. Failure to take necessary steps such as these can lead to serious and lifelong consequences. If you or your baby suffered from birth injury related to macrosomia, you may be able to gain the support you need and protect future mothers from suffering the same injuries. Contact our birth injury lawyers if you or your baby was injured due to macrosomic complications.

Topics: Medical Malpractice, Brachial Plexus Palsy, Birth Injuries, Erb's Palsy

Common Causes of Erb’s Palsy Birth Injuries

Posted by Anapol Weiss on Jun 1, 2016 11:30:00 AM

Erb’s palsy, a form of brachial plexus palsy, is a lifelong birth injury that causes weakness and loss of motion in the arm, wrist and/or hand. One to two of every 1,000 babies have been diagnosed with Erb’s palsy, but the condition is preventable.

Erb’s palsy can develop when a brachial plexus nerve is stretched so badly that it ruptures or tears from the root altogether. A nerve that sustains this type of damage will not heal on its own. Even if surgery is able to restore some function, a baby’s arm may not fully recover.

Erbs Palsy and Brachial Plexus nerve injury

Irreparable brachial plexus birth injuries can occur during a difficult delivery involving a large (macrosomic) baby, a breech birth or a prolonged labor. The injuries can also result during a complicated birth in which an obstetrician must exert force to deliver the baby quickly.

Physicians can take action to prevent these problems from resulting in Erb’s palsy. In addition to performing an emergency caesarian section, there are specific delivery maneuvers that can aid in a successful delivery. Failure to act quickly can mean permanent consequences for a newborn.

We can help if your child developed Erb’s palsy because a physician did not adequately respond to a difficult birth. Filing a birth injury lawsuit can hold responsible parties accountable for their negligence, and it can help future babies and mothers from suffering the same physical and emotional distress. Contact Anapol Weiss to speak with a birth injury attorney if your child was diagnosed with Erb’s palsy or suffered a brachial plexus injury at birth.

Topics: Medical Malpractice, Brachial Plexus Palsy, Birth Injuries, Erb's Palsy, Medical Negligence

Stephen Pokiniewski Obtains $4 Million Medical Malpractice Verdict

Posted by Anapol Weiss on Mar 28, 2016 3:30:00 PM

Doctors, nurses and other health care professionals are expected to provide the highest quality care during a mother's pregnancy, labor, and delivery of her baby. Failure to do so can result in lifelong birth injuries. For decades, Anapol Weiss has been committed to successfully advocating and obtaining justice for families whose children were harmed during birth.

Attorney Stephen Pokiniewski obtained a $4 million medical malpractice lawsuit verdict for a mother and her baby who both suffered severe and permanent injuries during a prolonged and difficult labor involving shoulder dystocia.

Medical malpractice attorney Stephen Pokiniewski

The 29-year-old mother underwent a vaginal delivery of her daughter despite voicing concerns that her child was abnormally large – as predicted by a sonogram four days before the delivery. The resulting 16-hour labor and delivery nearly killed the infant and left the mother with a substantial vaginal tear. The baby had no heartbeat, wasn't breathing or moving and was blue after the traumatic delivery. She required immediate lifesaving resuscitation in the delivery room and was later transferred to Thomas Jefferson Hospital for emergency head cooling treatment.

The 2013 case, which was tried in Allentown, Pennsylvania before the Honorable Lawrence Brenner, asserted the obstetrician did not offer to perform a cesarean section at any time during the labor. He disregarded clear warning signs that the baby was suffering from shoulder dystocia, a condition in which her shoulder was trapped behind the mother's pubic bone. The obstetrician instead used forceps to try to deliver the baby. The result was severe birth trauma.

"This case makes clear that a physician must listen to his patient's concerns and not disregard the risk of injury to his patients when he is rendering treatment," Pokiniewski said. "Patient safety has to come first."

The child still has weakness on her left side as well as cognitive and expressive speech delays. Her mother suffers from anal and urinary incontinence and other injuries as a result of the laceration she suffered during delivery. Both the mother and her daughter have suffered agonizing pain and emotional distress in addition to physical disfigurement.

What is Shoulder Dystocia?

Shoulder dystocia can occur when a
large infant, called a macrosomic baby,
is too big to deliver normally.
Obstetricians must act quickly when
this condition happens, as too much
pressure or pulling too hard can lead to
oxygen deprivation or severe birth

The jury awarded Pokiniewski’s client a total of $1,960,780 in compensatory damages as follows: $6,530 for past medical expenses, $64,250 for past loss of earnings, $650,000 for past non-economic damages, $650,000 for future non-economic damages, and $550,000 for future loss of earnings. The jury found damages for the injuries to the baby in the amount of $2,160,000 as follows: $160,420 for past medical expenses, $1 million for non-economic past damages and $1 million for non-economic future damages.

The child is currently undergoing treatment including occupational therapy, physical therapy, and speech therapy and is enrolled in a special education program. The impact of her delivery on the remainder of her life remains unknown.

The carelessness with which the obstetrician delivered the baby was made clear to the jury, and a unanimous verdict was reached five days after the trial began. The mother and daughter may never fully recover from their injuries, but Pokiniewski was able to obtain some justice for the family.

Topics: Medical Malpractice, Brachial Plexus Palsy, Birth Injuries, Erb's Palsy

Common Erb's Palsy Exercises for Infants and Children

Posted by Anapol Weiss on Mar 24, 2016 11:30:00 AM

Erb’s palsy is a form of brachial plexus palsy that primarily affects the upper nerves in the shoulder and arm. This birth injury occurs when there is difficulty delivering a baby's shoulder and his or her brachial plexus nerves are ruptured or torn.

Erb’s palsy symptoms in the affected arm range from weakness and limited range of motion to paralysis. Although the effects of severe brachial plexus palsy can never be totally reversed, exercise can alleviate pain and increase a person’s range of motion. Below are a few common exercises a doctor may recommend.

gaps_in_medical.pngErb's Palsy Exercises for Infants

A physician and/or pediatric therapist will evaluate the infant’s specific injuries and weakness in order to create an appropriate exercise program. Parents will likely be instructed to do passive range of motion (PROM) exercises with their baby to alleviate stiffness in the shoulder and prevent joint contracture. PROM exercises may involve gently stretching the arm away from the baby’s body, rotating the wrist, and raising the arm overhead. Depending on whether the infant has had surgery to repair some of the nerve damage, parents may be instructed to wait a few weeks to resume exercises.

Erb's Palsy Exercises for Children

Older children with brachial plexus palsy will be encouraged to complete exercises on their own to maintain range of motion and alleviate stiffness. Recommended at-home PROM tasks may shift attention to developing independence as well as trying recreational activities that double as strengthening exercises.

Please note that this information is not intended to replace medical advice. Consult with your physician or physical therapist before making any decisions about your health or your child’s health.

Brachial Plexus Injuries during Birth are Preventable

Physicians are expected to take appropriate action when a baby is suffering from shoulder dystocia during delivery. Failure to do so can result in permanent injury from the rupture or tearing of these delicate nerves.

Contact our firm for assistance if your baby is showing signs of brachial plexus palsy. Our birth injury attorneys what happened during labor and delivery and determine whether medical malpractice may be to blame.


Topics: Medical Malpractice, Brachial Plexus Palsy, Birth Injuries, Erb's Palsy, Medical Negligence

Surgical and Non-Surgical Erb's Palsy Treatment

Posted by Anapol Weiss on Mar 15, 2016 11:30:00 AM

Most newborns who sustained brachial plexus injuries during birth will recover on their own. The process is typically slow, as the nerves could take months or years to totally recover. As an injured infant grows, a physician will monitor the recovery and determine whether further treatment is necessary.

Below are a few treatment options a physician may recommend if a baby seems to be suffering from permanent brachial plexus nerve damage.

erbs_palsy_treatment.pngNon-surgical Treatment: Range-of-Motion Exercises at Home

Daily physical therapy involves exercises parents can do at home with their infant to maintain the range-of-motion in the shoulder, elbow, wrist and hand. These exercises typically begin when a baby is about three weeks old and will also prevent joint contracture, which causes the joint to become permanently stiff, according to the American Academy of Orthopaedic Surgeons (AAOS).

Surgical Treatment to Restore Some Function

A doctor may suggest nerve surgery if there is no apparent improvement during the newborn’s first three to six months. A nerve transfer or nerve graft uses a donor nerve to repair some of the damage and return some arm function. While it does not typically restore total function, nerve surgery may help improve the baby’s ability to move the affected arm.

It may take months or years for the repaired nerves at the neck to reach the muscles of the lower arm and hand. At-home rehabilitation exercises will help improve strength and range of motion. Additional surgical procedures performed when the child is older may further improve the function of a child’s shoulder, arm or hand.

How Does Permanent Damage Happen During Birth?

Brachial plexus injuries leading to Erb’s palsy may occur when a baby is suffering from shoulder dystocia – meaning his or her shoulder is stuck behind the mother’s pubic bone during delivery. Too much pressure or pulling too hard can tear a newborn’s brachial plexus nerves and cause this permanent damage.

Brachial plexus palsy and Erb’s palsy – referring to damage sustained specifically to the upper nerves during birth – are preventable conditions, and they often point to a medical malpractice issue. Contact our firm if your child suffers from permanent damage to the shoulder, arm or hand. We can investigate your situation and answer your questions.


Topics: Medical Malpractice, Brachial Plexus Palsy, Birth Injuries, Erb's Palsy, Medical Negligence

4 Types of Brachial Plexus Injuries During Birth

Posted by Anapol Weiss on Mar 7, 2016 3:30:00 PM

A newborn can suffer nerve damage when his or her shoulder gets stuck behind the mother’s pubic bone during birth. If the delivering physician fails to recognize and respond to this condition, called shoulder dystocia, the infant can sustain nerve injuries ranging from mild to permanent.

The brachial plexus nerves are located near the neck and are connected to all the nerves of the arm. Below are four general types of brachial plexus nerve injuries that can occur alone or simultaneously when a baby is born, according to the American Academy of Orthopaedic Surgeons (AAOS). Treatment and recovery depend on the severity of the damage.


A newborn can sustain a stretch injury that shocks the nerve but does not tear it. This type of injury typically heals on its own within a few months.


Scar tissue from a stretch injury that damages some nerve fibers may press on the remaining healthy nerve. Some recovery usually occurs.


A nerve will not heal on its own when it is stretched so badly it tears. Surgery involving a donor nerve graft from another child’s nerve may be able to repair a rupture.


A nerve that has been torn from the spinal cord cannot be repaired.  Surgery using a donor’s nerve may restore some function in the arm.

Erb’s palsy refers to damage sustained to the upper nerves during birth; a child with Erb’s palsy may not be able to move the affected shoulder but may be able to move his or her fingers. Damage to both the upper and lower brachial plexus nerves usually results in more severe disabilities.

One or two out of every 1,000 babies have brachial plexus palsy, but the condition is preventable. Contact our firm for assistance if your child was diagnosed with Erb’s palsy or sustained long-term brachial plexus damage during birth. We can help.


Topics: Medical Malpractice, Brachial Plexus Palsy, Birth Injuries, Erb's Palsy, Medical Negligence

Macrosomic Complications Resulting in Birth Injuries

Posted by Anapol Weiss on Jan 11, 2016 11:30:00 AM

macrosomic_complications_-_vert.jpgWhen diagnosed and treated appropriately, a macrosomic infant – one that weighs more than eight pounds, 15 ounces – can be delivered without problems. Failure to take appropriate action may result in macrosomic complications and lifelong consequences to both the mother and child.

Macrosomic complications for the mother may include:

  • Lacerations of the birth canal
  • Uterine atony, which can cause serious bleeding after delivery
  • Uterine rupture along the scar from a prior cesarean delivery
  • Urinary or fecal incontinence

For the newborn, problems may include:

  • Shoulder dystocia, which can lead to brachial plexus injuries, arm deformities, and problems controlling the arm
  • Oxygen deprivation and permanent brain damage

Cesarean delivery of a very large baby is often recommended to avoid injury. If an obstetrician continues with vaginal delivery, the baby’s shoulder may get stuck behind the mother’s pelvic bone (shoulder dystocia), which can result in brachial plexus injury to the newborn. In addition, the mother can suffer serious injuries and bleeding as a result of the delivery of a large baby.

When Obstetricians Ignore Warning Signs

The medical malpractice team at Anapol Weiss obtained a $4 million verdict for a mother and baby who were permanently injured when their obstetrician negligently delivered the 10-pound infant. The physician disregarded clear warning signs that the baby was suffering from shoulder dystocia. The resulting 16-hour labor left the baby in critical condition and the mother with a severe vaginal tear causing incontinence. The baby required emergency resuscitation and head cooling treatment, and she now suffers from weakness as well as cognitive and expressive speech delay.

Protecting Others from Preventable Macrosomic Complications

If you or your child suffered injuries because a physician failed to respond to your baby’s large size, you can help future mothers from suffering the same physical and emotional agony that you experienced. Holding responsible parties accountable for their negligence sends the message that it’s unacceptable to let mothers and babies get hurt.

Contact the birth injury lawyers at Anapol Weiss if macrosomic complications injured you or your child.


Topics: Medical Malpractice, Brachial Plexus Palsy, Birth Injuries, Erb's Palsy

Delivery Maneuvers to Prevent Brachial Plexus Injuries

Posted by Anapol Weiss on Dec 29, 2015 3:30:00 PM

A stressful situation arises quickly during a difficult birth. When it involves a macrosomic or abnormally large baby, shoulder dystocia threatens permanent injury. Proper action must be taken immediately by hospital staff to ensure a safe delivery for both the mother and her child.

delivery_maneuvers.jpgFortunately, there are specific delivery maneuvers that can prevent brachial plexus injury at birth caused by shoulder dystocia – when the baby is stuck behind the mother’s pubic bone. These maneuvers include:
  • McRoberts Maneuver: The doctor flexes the mother’s legs tightly to her abdomen to widen the pelvis and flatten the spine in the lower back.
  • Woods Corkscrew: One of the infant’s shoulders is pushed towards the baby’s chest and the other shoulder is pushed towards the baby’s back.
  • Suprapubic pressure: The doctor applies pressure to the mother’s lower abdomen.

These maneuvers are widely known as ways to safely delivering a macrosomic baby whose size wasn’t discovered before delivery.

Thanks to these and other actions obstetricians can take – such as performing a Caesarian section –permanent nerve damage is avoidable. Failure to act can cause a baby’s brachial plexus nerves to tear from the root and lead to a lifelong condition called Erb’s Palsy.

Contact Anapol Weiss if a difficult birth resulted in permanent injuries for your child. Our lawyers have advocated for injured children for decades, and they can get the answers you need.


Topics: Medical Malpractice, Brachial Plexus Palsy, Birth Injuries, Erb's Palsy, Medical Negligence

Brachial Plexus Palsy Prognosis: What to Expect

Posted by Anapol Weiss on Dec 28, 2015 3:30:00 PM
erbs_palsy_prognosis.jpgThe physical difficulties of brachial plexus palsy may go away in a few months, or they can last a lifetime. 

About one-third of infants who suffer from brachial plexus palsy do not recover, according to a 2009 study published in the Journal of Children's Orthopaedics. Those whose birth injuries are permanent may face a lifetime of doctor appointments, treatments and therapy.

When your child is suffering the consequences of medical malpractice, you need an advocate on your side to discuss your options and obtain the stability your family needs.

A brachial plexus palsy prognosis depends largely on the extent of the birth injury. While stretched brachial plexus nerves can heal with time, avulsed nerves – those that are ripped from the root – can leave lasting damage to the shoulder, arm, wrist and hand that surgery may not even fix.

Brachial plexus palsy treatment may include:

  • Surgery
  • Neurosurgeon visits
  • Pediatric appointments
  • Intensive physical therapy
  • Occupational therapy

Infants with a severe brachial plexus injury can be identified as early as one month of age by testing elbow extension and flexibility, a 2011 Dutch study reported. Once a prognosis is noted, parents will learn the extent of therapy needed and possible surgeries their child may have to undergo to get the best outcome for his or her injury.

Oftentimes, the whole situation could be prevented. When a baby suffers from shoulder dystocia during delivery, it’s a physician's job to carefully dislodge the shoulder from the pubic bone without causing injury. Pulling too hard or applying too much pressure can lead to nerve avulsion that will not heal. This is not a simple stretch injury.

An avulsed brachial plexus nerve during delivery is likely a medical malpractice issue. Contact our firm for assistance if your baby diagnosed with brachial plexus palsy.

Topics: Medical Malpractice, Brachial Plexus Palsy, Birth Injuries, Erb's Palsy, Medical Negligence

Erb's Palsy Treatment

Posted by Anapol Weiss on Dec 21, 2015 4:29:36 PM

After a child is diagnosed with Erb's palsy, he or she faces a long road ahead full of doctor visits, physical therapy and possible surgery. On top of the mounting bills that follow, families must deal with the heartbreak of a lifelong condition that could have been prevented.

To determine the severity of a child’s Erb's palsy, a physician may order an X-ray, electromyography (EMG), magnetic resonance imaging (MRI), and/or computerized tomography (CT) scan. If the results show that the brachial plexus nerves have been torn from the spine, a conversation about surgery may follow.

erbs_palsy_treatment.jpgTo care for the affected arm, babies with Erb's palsy need to be held and positioned in a certain way through infancy. Dressing, feeding and bathing also require special attention, and parents may have to exercise the child to strengthen muscles and improve range of motion. These activities are imperative to some infants, so they can reach normal milestones such as rolling over. A child may then require physical therapy into adulthood to maintain best use of his or her arm.

Erb's palsy treatment may include:

  • Nerve surgery
  • Tendon transplant surgery
  • Plastic surgery
  • Physical therapy
  • Occupational therapy
  • Hydrotherapy
  • Muscle and joint flexibility exercises

Families shouldn’t be left to endure the stress and bills that accompany Erb's palsy treatment. An experienced advocate can help. Contact our firm for assistance if your child was diagnosed with Erb's palsy.

Topics: Medical Malpractice, Brachial Plexus Palsy, Birth Injuries, Erb's Palsy, Medical Negligence

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