When a baby's shoulder gets stuck during delivery, there is a recognized sequence of maneuvers that protects the brachial plexus from injury. Excessive lateral traction on the baby's head is not on that list. When the standard response fails — or was never attempted — the result is often a permanently weakened or paralyzed arm. Our M.D./J.D. medical-legal team identifies exactly where the delivery went wrong.
The brachial plexus is a network of nerves running from the spinal cord through the neck, shoulder, and into the arm. When that network is stretched, torn, or pulled away from the spinal cord during delivery, the result is a brachial plexus birth injury. The most common form is Erb's palsy, which affects the upper trunk (C5-C6) and produces the classic “waiter's tip” positioning of the arm. Klumpke's palsy affects the lower trunk (C8-T1) and the hand. A global brachial plexus injury involves the entire network and is the most severe.
Brachial plexus injuries occur in roughly 1 to 3 of every 1,000 live births. The single most common scenario is shoulder dystocia — when the baby's anterior shoulder lodges behind the mother's pubic symphysis after the head has been delivered. The recognized response is well documented: McRoberts maneuver, suprapubic pressure, delivery of the posterior arm, the Woods corkscrew or Rubin maneuver, and as a last resort the Zavanelli maneuver. What is not on that list is excessive lateral traction on the baby's head. That is the maneuver that causes brachial plexus injury.
Some brachial plexus injuries resolve on their own. Many do not. Children with persistent deficits often face years of physical therapy, occupational therapy, and reconstructive surgery, and may live with permanent loss of function, asymmetric arm growth, and lifelong limitations. When the injury was caused by a delivery error, the family is entitled to compensation for all of it.
The most common preventable causes of Erb's palsy and brachial plexus birth injury we see in litigation.
When the shoulder is stuck, pulling sideways on the baby's head is the single biggest cause of brachial plexus injury. The recognized response is to release the stuck shoulder using established maneuvers — not to apply more force.
Hyperflexion of the mother's hips toward her abdomen is typically the first response to shoulder dystocia. It widens the pelvic outlet and often resolves the dystocia without further intervention.
An assistant presses just above the pubic bone to dislodge the impacted shoulder. The pressure must be suprapubic — not fundal — because fundal pressure actually worsens the dystocia.
Maternal diabetes, fetal macrosomia (estimated weight over 4,500 grams), a prior shoulder dystocia, or a prolonged second stage of labor should change delivery planning. ACOG guidelines recommend considering scheduled C-section when these factors are present.
Operative vaginal delivery in a baby who is already too large or already showing signs of obstruction can directly contribute to a brachial plexus injury. Operative delivery is not a substitute for an appropriate C-section.
Fundal pressure during shoulder dystocia drives the impacted shoulder more firmly against the pubic bone and worsens the injury. The standard is clear: do not apply fundal pressure once dystocia is recognized.
When initial maneuvers fail, sweeping the posterior arm across the baby's chest and delivering it first reduces the diameter of the shoulder girdle and resolves most dystocias.
When risk factors for shoulder dystocia exist, the mother is entitled to a discussion of the option of scheduled C-section. Failure to have that conversation can itself be a breach of the standard of care.
Shoulder dystocia is a recognized obstetric emergency that requires team-based simulation training. Hospitals that fail to train their L&D staff on the recognized maneuvers and chain of communication can be held liable.
These cases turn on the delivery record and the type of injury. Here is what our team does differently.
Prenatal records (looking for risk factors), the labor partogram, the delivery note, the nursing record, fetal weight estimates, the second-stage timing, and the documented sequence of maneuvers attempted. Herb reads it like the physician he is and pinpoints what should have happened differently.
Maternal-fetal medicine for the obstetric standard of care. Pediatric orthopedic surgeons for the injury classification, surgical options, and prognosis. Pediatric neurologists for the nerve injury workup. Life care planners and economists for the lifetime damages calculation.
The delivering OB. The OB who managed the prenatal course and failed to plan for known risk factors. The L&D nurses who applied or assisted with inappropriate maneuvers. The hospital for its training and protocol failures. Each defendant brings additional coverage to the case.
Alex Alvarez is a Board Certified Civil Trial Lawyer (NBTA) — a credential held by less than 1% of attorneys. That credibility means insurance carriers know we are prepared to put a brachial plexus case in front of a jury, and that produces stronger settlement offers.
The value of a brachial plexus case depends heavily on the severity and permanence of the injury. A child with permanent loss of arm function will require:
Non-economic damages address pain and suffering, loss of enjoyment of life, embarrassment over the visible difference in arm size and function, and the parents' emotional distress. In cases involving extreme deviations from the standard of care, punitive damages may also be available.
Even when an injury is partial, the cumulative cost of years of therapy, surgery, and lost opportunity can be significant. We build every case around a detailed life care plan and an economist's calculation of the lifetime financial impact.
It is one of the most common things doctors say after a brachial plexus birth injury — and it is generally not accurate. Brachial plexus injuries are most often the result of how shoulder dystocia is managed at the moment of delivery. The maneuvers that resolve dystocia without injuring the brachial plexus are well established, and applying excessive lateral traction on the baby's head is not one of them. We take a careful look at the delivery record before drawing any conclusions.
Yes. Some brachial plexus injuries appear to be improving in the first months of life and then plateau, leaving permanent weakness. The full extent of the injury often is not clear until 12 to 24 months of age. Speaking with a lawyer early protects evidence, secures medical records before they are lost or altered, and preserves your options regardless of how the recovery progresses.
Children with persistent deficits past three to six months often benefit from evaluation by a pediatric brachial plexus surgical team. Procedures include nerve grafting, nerve transfers, tendon transfers, and corrective bone surgery. Multiple operations over many years are common in severe cases.
Statutes of limitations vary by state, and most states extend the filing window for injuries to minors. Some states toll the clock until the child reaches a certain age. The most important step is to call us so we can evaluate your case under the deadline that applies where the injury occurred.
Nothing upfront. The Alvarez Law Firm handles every brachial plexus case on a contingency fee basis. No Fees Unless We Recover Money for You. The case review itself is free and confidential.
Herb Borroto, M.D., J.D., will personally review the prenatal, labor, and delivery records. No cost. No obligation. Just an honest read from a doctor and a trial lawyer on whether your child's injury was preventable.
