Erb’s palsy: hidden suffering that violates human rights

By: MSc. Lorena de la Garza, human rights expert

As a defender of women’s human rights in the field of obstetrics and a denouncer of the violence prevalent there, I currently have the opportunity to work with a non-minority group of women whose sons and daughters suffer from Obstetric Brachial Palsy ( OBP). ,

I have had the opportunity to hear their testimonies and witness their powerful stories, filled with experiences that could be considered scary and horror stories. Through their experiences in the delivery room, the suffering, frustration and helplessness can be seen, realizing that first of all, their human rights to health, life and information had been violated.

Although Erb’s Palsy or Obstetric Brachial Palsy is a common and chronic injury in Costa Rica, most mothers do not know about it until their children have it. The worst part is that apart from causing injury, they are not given information or adequate treatment, as there is no standardized protocol at the country level for the management of this anomaly.

What is this injury and why does it happen?

Erb’s palsy usually occurs when the brachial plexus (a group of nerves extending from the neck to the shoulder) is injured or damaged during childbirth. This usually occurs with difficult births, for example, when a large baby passes through the vaginal canal, when force is used to induce a breech birth or a prolonged birth. This also happens when the fetal shoulder gets stuck under the mother’s pelvic bone while the doctor tries to remove the baby.

It turns out that a pregnant woman has conditions that make her a candidate for cesarean section, such as having a macrosomic baby, having a narrow pelvis, suffering from gestational diabetes, having a high-risk pregnancy, having a history of complicated births. Having or having a history of dystocia, shoulders, previous cesarean section, and if the doctor – whether from a private or public health center – recommends a cesarean section, it should be scheduled and requested. This is to prevent an outcome where the life and physical and psychological health of both the mother and baby will be affected.

Given this reality, it is absolutely essential that healthcare workers who attend birth receive a mandatory multi-professional training program in the management of obstetric emergencies, with emphasis on the complexities associated with said emergencies , with special attention to PBO and humerus fractures and clavicle. So that, in this way, they can develop manual diagnostic skills, thereby reducing the incidence of related complications; And on the other hand, women who are pregnant and/or in labor receive clear, reliable and understandable information, which allows them to request specialized care and, in addition, allows them to comply with their rights. Gives the knowledge and empowerment to make requests. , rights.

Traumatized mothers and disabled children

The body of evidence collected for this article is a clear example of how important knowing and knowing the exact status of pregnancy can be for women’s health.

case 1, Anna, who was carrying a large baby, faced violent behavior since being admitted to hospital. According to him, he was the object of ridicule, neglect and lack of privacy. He separated the membranes containing amniotic fluid from the cervix by vaginal examination, and since the baby had still not descended, he applied the “Christeler maneuver”, which involved pressing the lower part of the uterus with the forearm to ease the delivery. goes. As a result, he suffered a rib injury and his son suffered a dislocated shoulder. It is worth clarifying that this maneuver is banned in many countries and the World Health Organization recommends avoiding this practice.

case 2, Maria revealed that her birth was traumatic. The doctor on duty climbed over her, pushed her elbow into her stomach, and told her that, although the baby was very big, if she had already given birth to three children, she could give birth to one more. Is. Due to abuse during childbirth, she later suffered a lack of control when walking, an injury to her right leg and a diminished bladder, while her newborn left a permanent disability in her right arm. In this tragic scenario, a woman and her daughter were physically, psychologically and socially abused, leaving them without medical follow-up or access to legal justice after giving birth. Their rights to health, decent treatment and life were both violated.

case 3, Patricia’s umbilical cord became trapped and she hemorrhaged. The child was very large, he was standing on their shoulders and when pushed – with the instruction of health workers – the child’s collarbone broke. She requested a medical report describing the condition and upon receiving it the annotation came out as “a birth without complications”. Although she had the same difficulties and gestational diabetes in her previous two deliveries, no one at the hospital listened to her request to get treated by a specialist who performed cesarean sections.

This ordeal experienced by women in some delivery rooms also includes the psychological consequences of fear and institutional violence, which explains the reasons that lead them to inaction in reporting, after which they have to face the fact that They are forced to admit that they have endured abuse. have been suffering; As well as the wear and tear and depression of walking the rocky path of a traumatic birth and holding a disabled child instead of a child who could have been healthy and well.

Because of this violation of the right to health, gynecological follow-up is required on the part of mothers; as well as physical therapy for their infants; However, in many cases follow-up is rare, if not non-existent.

What is the state of Costa Rica doing?

Our country has an administrative regulation of the Obstetric Violence Law, which is formulated in the General Health Law of Costa Rica, as well as in several national and international treaties that condemn obstetric violence. When this is compared to the reality in some hospital centers in our country, official documents seem non-existent and completely invisible.

With all due respect, I offer this statement that as a violation of obstetric violence, gender violence and human rights, I believe that no woman should be injured or attacked physically, nor mentally or Must be a victim of moral damage that prevents him from your psychological protection. or emotional stability; Likewise, this regulation protects the right to dignity and respect of women who are during pregnancy, labor or postpartum. (Campos Calvo Y. Magistrate Constitutional Chamber of Costa Rica, Vote No. 3354-2015)

As an expert on human rights and a defender of women and their sons and daughters in the maternity sector, I urge the government and health authorities of this country to understand the disease and comply with national and international standards. For humane delivery, so that newborns do not suffer unnecessary physical harm, and their human rights, which are non-negotiable, are respected.