Erb's palsy: Concepts of causation

In the past, obstetric textbooks have stated (without evidence) that Erb's palsy is caused by the birth attendant. The mechanism cited is stated to be the application of excessive lateral traction placed on the fetal head and neck. Recent research findings refute this unproven theory. Findings inclu de (1) only 50% of cases are associated with shoulder dystocia; (2) the 4.7 -fold increase in the condition was associated with a precipitate second st age compared with one of normal length; and (3) the same injury rate with d irect manipulation techniques (for resolving shoulder dystocia) was compara ble to that of McRobert's position and/or suprapubic pressure. The overwhel ming evidence indicts the propulsive nature of the stretching of the involv ed nerves over which the birth attendant has no control. (Obstet Gynecol 20 00;95:940-2. (C) 2000 by The American College of Obstetricians and Gynecolo gists).