How Shoulder Dystocia Leads to Brachial Plexus Injuries—and Why Maneuver Selection Matters

Childbirth should be a moment of joy, but when complications like shoulder dystocia occur, they can lead to serious, often permanent injuries such as brachial plexus damage. These injuries can result in Erb’s palsy, loss of movement in the arm, or lifelong disability.

Unfortunately, some of these injuries are preventable. In certain cases, they are the result of medical negligence — when a doctor or delivery team fails to follow established protocols or uses excessive force during delivery. This article will walk you through how these injuries happen, what signs to look for, and whether you may have grounds for a legal claim.

What Is Shoulder Dystocia?

Shoulder dystocia occurs during vaginal delivery when a baby’s shoulders become lodged behind the mother’s pelvic bone after the head has emerged. This creates an obstetric emergency that must be managed quickly and correctly to avoid injury to the infant.

Causes and Risk Factors

Although it can happen unpredictably, certain conditions make shoulder dystocia more likely:

1. Large babies (macrosomia), particularly those weighing over 4,000 grams
2. Gestational diabetes, which increases fetal weight
3. Maternal obesity
4. Prolonged labor, especially during the second stage
5. Previous deliveries involving shoulder dystocia

However, it is important to note that many cases occur without any of these risk factors. This is why obstetric providers are trained to anticipate and respond quickly regardless of the situation.

What Is the Brachial Plexus?

The brachial plexus is a network of nerves that extends from the spinal cord in the neck to the shoulders, arms, and hands. These nerves control movement, sensation, and muscle strength in the upper limbs.

During a difficult delivery — especially one involving shoulder dystocia — the brachial plexus is particularly vulnerable to injury. If the baby’s head is pulled too forcefully in an attempt to free the shoulders, the nerves can be stretched, torn, or detached from the spinal cord.

Types of Brachial Plexus Injuries

1. Erb’s Palsy – Affects the upper portion of the brachial plexus, leading to arm weakness or paralysis.
2. Klumpke’s Palsy – Affects the lower portion, often causing hand and wrist dysfunction.
3. Global Palsy – A severe form involving the entire nerve network, resulting in full arm paralysis.

These injuries can range from temporary and mild to permanent and disabling, depending on the severity of the nerve damage.

How Do Brachial Plexus Injuries Happen During Birth?

The most common cause of a brachial plexus injury during delivery is improper or excessive traction — when the delivering physician pulls too hard on the baby’s head in an attempt to dislodge the shoulder.

Common Medical Errors Leading to Injury

1. Excessive lateral traction applied during shoulder dystocia
2. Delayed or failed use of standard delivery maneuvers
3. Inappropriate use of tools or force during delivery
4. Inadequate anticipation or monitoring of risk factors
5. Lack of coordination between delivery staff during the emergency

These errors may result in nerve stretching, tearing, or avulsion (complete nerve root detachment), especially when proper shoulder dystocia management protocols are not followed.

Shoulder Dystocia Maneuvers: What Should Be Done?

When shoulder dystocia occurs, healthcare professionals are trained to follow a specific order of maneuvers that can relieve the obstruction without causing injury.

Examples of Safe Delivery Maneuvers

1. McRoberts Maneuver – Bending the mother’s legs sharply to widen the pelvis.
2. Suprapubic Pressure – Applying pressure just above the pubic bone to dislodge the shoulder.
3. Wood’s Screw Maneuver – Rotating the baby’s shoulders using internal rotation techniques.
4. Delivery of the Posterior Arm – Carefully freeing the baby’s other arm to reduce shoulder width.

When these maneuvers are used improperly, too late, or skipped entirely, the risk of brachial plexus injury increases significantly. The failure to use these techniques correctly may also form the basis of a medical malpractice claim.

Was the Injury Preventable?

Many families only learn about shoulder dystocia and brachial plexus injuries after the fact — when their newborn isn’t moving an arm or receives a diagnosis like Erb’s palsy. But in many of these cases, the injury was avoidable with proper care.

Signs of Medical Negligence 

1. The delivery team applied visible or documented excessive force
2. The baby had known risk factors and no preventive measures were taken
3. There was a delay in using emergency maneuvers
4. Poor or missing delivery room documentation
5. The hospital failed to explain how the injury occurred

Medical experts and birth injury attorneys can review these details to determine whether the standard of care was breached during delivery.

What Legal Options Do You Have?

If your child suffered a brachial plexus injury during birth and it appears the delivery was mismanaged, you may have grounds for a medical malpractice lawsuit.

How to Pursue Legal Action

1. Request medical records including labor and delivery notes, nursing reports, and fetal monitoring strips.
2. Consult a birth injury attorney with experience in obstetric malpractice.
3. Obtain a medical expert review to assess whether accepted medical standards were followed.
4. Document your child’s injury thoroughly — including photos, doctor visits, and therapy reports.

Legal compensation can help cover the cost of medical treatment, therapy, adaptive devices, future surgeries, and even emotional distress or loss of quality of life.

Frequently Asked Questions

Can I sue for a brachial plexus injury caused during delivery?

Yes. If your baby suffered a brachial plexus injury due to excessive traction or poor handling of shoulder dystocia during birth, you may have a valid medical malpractice case. A successful lawsuit can help you secure compensation for medical expenses, therapy, and long-term care needs related to your child’s injury. It’s important to act quickly and consult a lawyer familiar with obstetric injury claims.

What’s the difference between Erb’s palsy and a brachial plexus injury?

Erb’s palsy is a specific type of brachial plexus injury that affects the upper nerves in the network, often resulting in paralysis or weakness in the shoulder and upper arm. A brachial plexus injury is a broader term that can affect different parts of the nerve network, including those controlling the hand or full arm. Not all brachial plexus injuries are classified as Erb’s palsy, but Erb’s palsy is one of the most common types in newborns.

Is every shoulder dystocia injury considered malpractice?

Not necessarily. Shoulder dystocia can occur unpredictably, even when proper precautions are taken. However, if your baby was injured because the healthcare team failed to recognize risk factors, delayed maneuver execution, or applied excessive traction, it may constitute negligence. Each case must be reviewed individually to determine whether malpractice occurred.

What kind of evidence is needed for a birth injury claim?

To pursue a birth injury lawsuit, you’ll need detailed medical records from the labor and delivery, a diagnosis of the injury, and expert medical testimony confirming that proper procedures weren’t followed. Evidence may also include witness statements, prenatal care documentation, and proof of long-term injury effects such as physical therapy records or developmental delays.

How long do I have to file a lawsuit?

The statute of limitations varies by state but typically ranges from 1 to 3 years from the date the injury was discovered. Some states extend this time for minors, giving parents additional years to file on behalf of their child. It’s crucial to consult an attorney as soon as you suspect that medical negligence may have caused your child’s injury to ensure you don’t miss the legal deadline.

Final Thoughts: Take Action to Protect Your Child’s Future

Brachial plexus injuries caused by shoulder dystocia can have lifelong consequences for your child — but they are often preventable. If your baby experienced nerve damage during birth, and you believe the delivery team may have made a mistake, you deserve answers.

You don’t have to navigate this alone. An experienced birth injury attorney can investigate the circumstances of the delivery, gather expert testimony, and help you determine whether your family is entitled to financial compensation.

Contact Rafferty Domnick Cunningham & Yaffa Today

If your child was diagnosed with Erb’s palsy, brachial plexus palsy, or any other injury following a complicated delivery, you may be eligible to file a malpractice claim.

Speak with our qualified birth injury lawyer today to review your case, protect your rights, and help secure the care your child needs.

Time limits apply, so don’t wait — early legal consultation can make all the difference.