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Scientists to explore if delivering big babies earlier will reduce birthing problems

Article By: Sue Learner

Academics are to carry out research to discover if delivering big babies earlier, before the pregnancy has reached full term, will reduce complications that can occur during the birth.

Samuel who has Erb's palsy due to complications at birth

If a baby is larger than predicted by a mother’s size, this can cause complications at birth. One of the major problems is the woman has difficulty delivering the shoulders after the head has come out.

The clinical trial will involve a nationwide study of 4,000 pregnant women, led by a partnership between University of Warwick, University Hospitals Coventry and Warwickshire (UHCW) NHS Trust and the Perinatal Institute.

Professor Siobhan Quenby of Warwick Medical School, University of Warwick and UHCW NHS Trust said: “As well as being extremely traumatic and painful for the mother it can cause children to be born with conditions such as Erb’s palsy, which is caused by damage to nerves in the neck during birth. This condition can debilitate the use of a baby’s arm, which in some cases can’t be rectified.”

Jackie Dewdney’s son, Samuel, who is now 13, suffers from Erb’s palsy due to complications at birth.

His birth weight was predicted to be 8lbs but when he was born he weighed 9lb 14oz.

She said: “About three hours into labour in the last 20 minutes I knew there were problems when the midwife said he was ‘turtling’ that is his head had delivered but his shoulder was stuck and as a result his head disappeared back into my pelvis.

“My contractions had failed so I needed help to get Samuel out. I heard a nurse shout ‘press the emergency button’ and I was surrounded by medical staff who were manually trying to remove Samuel.

“To get Samuel out I had to endure the agony of a double episiotomy - that is I was cut twice to release him. And due to advanced stage of labour it was too late to give me an anaesthetic so I had just gas and air. My husband Adrian who was present said I gave out huge scream and I think I passed out due to the pain.”

The following day she was told there may be problems with Samuel and he was diagnosed with Erb’s Palsy which affects one or all five of the primary nerves that supply movement and feeling to an arm.

“The doctor told us he’d recover by the time he was three months old and he may need a small amount of physiotherapy,” she said.

However now aged 13, Samuel still has the condition, which has affected the nerves in his shoulder.

“He is due an assessment soon in Leeds and there is the chance of an operation that will allow him to use his wrist with more ease. It takes Samuel longer than other children to perform everyday tasks such as getting dressed and he has to take written exams via computer as he has difficulty using a pen. Other problems include cutting up food and putting on a clip-on tie.

“This makes him more introverted because he realises he’s different to other children. He often keeps himself to himself and gets frustrated when he has difficulty using his hand. Both his arms are affected; it’s very slight in his wrist on his left and about 50% loss on his right, hardly any wrist movement and no shoulder movement but has good elbow flexion.”

The size of a baby can be predicted by routine tape measurements of the pregnant woman’s abdomen followed by an ultrasound scan.

However, Professor Jason Gardosi, director of the Perinatal Institute, said: “Many clinicians in our UK-wide network of obstetricians and midwives are often at a loss of what to advise the mother, as the evidence is not clear, and can be interpreted in different ways.”

The study will help decide what the safest method is to care for pregnancies where because of the large size of the baby complications may occur during labour. The trial will run over three and half years including a two year recruitment period of 4,000 large for gestational age pregnancies.

Karen Hillyer, chairperson of the Erb’s Palsy Group said: “We are proud to support the ‘Big Baby Trial’. We currently have over 2,400 families registered as members of our organisation which illustrates how many families are affected by this condition. We are looking forward to the study and hope it will help prevent or at least minimise the effect of Erb’s Palsy on children, mums and families.”

The study is funded by the National Institute for Health Research.


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