When a baby is injured during labor and delivery, parents are often left with more questions than answers. Many families are told their child’s injury was “just one of those things” or that it was unavoidable.
But in some cases, an injury like Erb’s palsy or a brachial plexus injury happens because something went wrong during delivery, and it could have been prevented.
At Blasingame, Burch, Garrard & Ashley, P.C. (BBGA), we have represented families in complex birth injury cases involving serious harm during pregnancy, labor, and delivery. One of the most common injuries we see in cases involving difficult deliveries is damage to the brachial plexus, the group of nerves that controls movement and sensation in the shoulder, arm, and hand.
This blog post explains what Erb’s palsy is, how brachial plexus injuries happen, what shoulder dystocia means, what symptoms parents should watch for, and when medical malpractice may be involved.
What Is Erb’s Palsy?
Erb’s palsy is a type of birth injury that affects a baby’s arm and shoulder. It occurs when the nerves that control the shoulder and upper arm are stretched, torn, or otherwise damaged during delivery.
These nerves are part of the brachial plexus, a network of nerves extending from the neck through the shoulder and into the arm.
Parents often first notice Erb’s palsy because their newborn does not move one arm normally, or because one arm seems weaker than the other.
What Is the Brachial Plexus?
The brachial plexus is the nerve network that connects the spinal cord to the shoulder, arm, and hand. These nerves control both movement and sensation.
That is why brachial plexus injuries can affect more than strength. A baby may have trouble lifting an arm, bending the elbow, or moving the hand normally. In some cases, the baby may also have reduced sensation, meaning they may not feel touch the same way in the affected arm.
Because the brachial plexus is made up of multiple nerves, injuries can range from mild to severe paralysis depending on how many nerves were affected and how much damage occurred.
Is Erb’s Palsy the Same as a Brachial Plexus Injury?
Not exactly, but the terms are closely related.
A brachial plexus injury is the broader category. It simply means that the nerves in the brachial plexus have been damaged.
Erb’s palsy is one specific type of brachial plexus injury. It typically involves the upper portion of the nerve network and most often affects shoulder and upper arm function.
Another, less common type of brachial plexus injury is called Klumpke’s palsy. This form affects the lower portion of the brachial plexus and may cause weakness or loss of movement in the wrist and hand.
In more severe cases, the entire nerve network may be involved. When that happens, a child may have limited movement or paralysis throughout the entire arm.
What Causes Erb’s Palsy During Childbirth?
The most common cause of Erb’s palsy is excessive stretching of a baby’s neck and shoulder during delivery. This usually happens when the baby’s shoulder becomes stuck behind the mother’s pelvic bone.
This complication is called shoulder dystocia.
During a difficult delivery, a provider may pull too hard on the baby’s head or use improper techniques to deliver the shoulders. When too much force is applied, the brachial plexus nerves can be stretched or torn.
What Is Shoulder Dystocia?
Shoulder dystocia occurs when a baby’s shoulder becomes stuck after the head has already been delivered. When this happens, the delivery team must respond quickly because the baby cannot deliver normally without intervention.
Shoulder dystocia is taken seriously because it can lead to severe injuries. It can cause nerve damage like Erb’s palsy, fractures such as a broken collarbone, and in extreme cases, oxygen deprivation that can cause a brain injury.
It also creates a high-pressure situation in the delivery room. When shoulder dystocia occurs, the medical team must respond quickly and correctly.
Why Shoulder Dystocia Matters in Erb’s Palsy Cases
Shoulder dystocia is one of the most common delivery complications associated with Erb’s palsy. However, the key issue is not simply that shoulder dystocia occurred.
The most important question is whether the medical team followed the proper protocols and responded safely.
In many cases, Erb’s palsy occurs because the delivery team pulled too hard on the baby’s head and neck, used unsafe maneuvers, or failed to take the appropriate steps to resolve the emergency without causing injury.
What Are the Symptoms of Erb’s Palsy?
The symptoms of Erb’s palsy are often noticeable shortly after birth. Many parents notice that one arm hangs limp or does not move normally. The baby may not lift the arm at the shoulder or may have difficulty bending the elbow.
Some babies show a posture where the arm appears rotated inward and held in an unusual position. Others may have bruising, swelling, or other signs of trauma from a difficult delivery.
What Are the Symptoms of a Brachial Plexus Injury?
Brachial plexus injury symptoms depend on which nerves were affected and how severe the injury is.
Some babies have mild weakness that improves within weeks or months. Others have more serious nerve damage that affects the shoulder, arm, wrist, and hand.
Parents may notice that their baby has limited movement, decreased strength, or an arm that seems less responsive. Some children may also have reduced sensation in the affected arm.
As a child grows, muscle imbalance and weakness can cause long-term complications. In severe cases, the shoulder joint can develop abnormally, which may require orthopedic care later in childhood.
Is Erb’s Palsy Permanent?
Sometimes, but not always.
Many mild brachial plexus injuries improve within the first several months of life, especially when the nerve was stretched but not torn.
More serious injuries can involve nerve rupture, where the nerve tears, or nerve avulsion, where the nerve is pulled away from the spinal cord. These injuries are far more likely to cause permanent disability.
Even in cases where a child regains some movement, they may still experience lifelong weakness, limited range of motion, and functional limitations.
Can Erb’s Palsy Be Healed?
Some children recover fully. Others do not.
Treatment often begins with physical therapy and occupational therapy to maintain range of motion and strengthen muscles. Therapy can also help prevent stiffness and joint problems.
In more severe cases, surgery may be necessary. Some children require nerve grafts or nerve transfers in infancy. Others may need orthopedic surgery later in childhood to correct shoulder deformities or improve function.
The long-term outcome depends on how severe the nerve damage was, how early treatment begins, and how well the nerves heal over time.
Is Erb’s Palsy Genetic?
In most cases, no.
Erb’s palsy and brachial plexus injuries are typically not genetic conditions. They are usually caused by physical trauma during labor and delivery.
Parents sometimes worry they did something wrong or that the injury runs in the family. But in most cases, brachial plexus injuries happen because of mechanical forces during childbirth, not heredity.
There are, however, risk factors that can increase the likelihood of shoulder dystocia. These can include maternal diabetes, a large baby, prolonged labor, or a history of shoulder dystocia in a prior delivery. Even when risk factors exist, doctors are expected to plan appropriately and respond safely.
Does Shoulder Dystocia Always Mean Malpractice?
No.
Shoulder dystocia can occur even when a provider does everything correctly. It is a known complication of childbirth.
However, a severe brachial plexus injury may be malpractice if it occurred because the provider used excessive force, failed to follow accepted maneuvers, or made preventable errors in the delivery process.
Shoulder dystocia may be unavoidable. But the injury that follows may not be.
What Should Doctors and Nurses Do to Prevent These Injuries?
Preventing Erb’s palsy and brachial plexus injuries often comes down to recognizing risk factors, preparing for complications, and responding correctly if shoulder dystocia occurs.
Medical teams are trained to avoid pulling forcefully on the baby’s head or neck. They are also trained to use specific maneuvers designed to deliver the baby safely when the shoulders become stuck.
In high-risk situations, the standard of care may also include making appropriate delivery plans, including considering whether a cesarean section is safer.
When a team is unprepared, fails to respond quickly, or uses improper force, the brachial plexus nerves can be permanently damaged.
When Is Erb’s Palsy Considered Medical Malpractice?
Erb’s palsy may be considered medical malpractice when a doctor, nurse, or hospital fails to follow the accepted standard of care and that failure causes the injury.
Examples may include failing to recognize a high-risk delivery, failing to recommend a timely C-section when appropriate, mismanaging shoulder dystocia, pulling too hard during delivery, or using forceps or a vacuum improperly.
Birth injury cases are always based on the specific facts. The details matter. Proving malpractice requires a careful review of the medical records and expert analysis. An experienced Erb’s Palsy attorney can help.
What Is Necessary to Prove an Erb’s Palsy or Brachial Plexus Injury Case?
To prove a birth injury malpractice claim, it must generally be shown that the medical provider failed to meet the standard of care and that this failure directly caused the brachial plexus injury.
These cases typically require medical experts who can explain what should have happened during the delivery and what went wrong.
It must also be shown that the injury resulted in real harm, such as the need for therapy, surgery, long-term medical care, disability, or limitations that will affect the child’s life.
What Medical Records Should Be Reviewed?
A strong investigation usually requires more than a discharge summary. It requires a complete picture of the pregnancy, labor, delivery, and what happened in the hours and days after birth.
Important records often include prenatal records, labor and delivery notes, nursing documentation, *fetal monitoring strips, medication administration records, and delivery summaries.
If a C-section was performed or attempted, operative reports and timing documentation are also critical.
After birth, the baby’s neonatal records, NICU records, pediatric records, and therapy records can help show the full extent of the injury and the long-term impact.
In some cases, diagnostic studies such as imaging or nerve testing may also be relevant.
*Fetal monitoring strips are continuous printouts generated during labor that track the baby’s heart rate alongside the mother’s contractions. Medical providers rely on these strips to identify warning signs that a baby may not be receiving enough oxygen.
How BBGA Handles Erb’s Palsy and Brachial Plexus Injury Cases
Brachial plexus cases require significant investigation and medical expertise. Hospitals and insurers often defend these cases aggressively, and families deserve a legal team with the resources to build a strong claim.
At BBGA, our attorneys handle these cases by gathering and analyzing the complete medical record, reconstructing the delivery timeline, and working with respected medical experts who can evaluate whether the injury was preventable.
When the injury is severe, we also work with life care planners and financial experts to determine the true long-term cost of care. A life care planner is a professional who evaluates the medical and support services a child may need over a lifetime. This can include therapy, surgery, follow-up medical care, assistive devices, adaptive equipment, and, in more serious cases, home or vehicle modifications.
In serious cases, economists can also help calculate future costs and lost earning capacity. The purpose of this process is to ensure that a child has access to the resources they will need, not just today, but throughout their life.
What Is the Statute of Limitations for Birth Injury Cases in Georgia?
Georgia law places strict deadlines on medical malpractice cases, including birth injury claims.
Under Georgia Code § 9-3-71, parents generally have two years from the date of the injury to bring a medical malpractice claim. When the injured patient is a child, the law may allow additional time. In many cases, a child’s claim must be filed within two years of his or her fifth birthday.
Even with these extensions, important legal limits still apply, and waiting too long can affect your ability to pursue a claim. In addition, medical records and evidence can become more difficult to obtain as time passes.
If you suspect malpractice, it is important to speak with an attorney as soon as possible to protect your family’s rights.
Click here to learn more about the statute of limitations for medical malpractice in Georgia.
What Should Parents Do If They Suspect Medical Negligence?
Parents often feel overwhelmed after a traumatic birth. It is normal to feel uncertain about what happened, especially when doctors give vague explanations.
If you believe your child’s Erb’s palsy or brachial plexus injury may have been preventable, it can help to request complete copies of the prenatal, labor and delivery, and newborn medical records.
It is also important to keep copies of therapy records, specialist visits, and any recommendations for surgery or long-term care.
An experienced birth injury attorney can review these records, consult with qualified experts, and help determine whether the standard of care was followed.
Contact BBGA’s Birth Injury Attorneys
Blasingame, Burch, Garrard & Ashley, P.C. routinely represents parents whose children were severely injured or killed during labor and delivery.
If your child has been diagnosed with Erb’s palsy or a brachial plexus injury and you suspect medical negligence played a role, contact our team today.
Call 706-354-4000 or reach out through our online contact form.
This article is the third in a blog series focused on BBGA’s birth injury practice. In this series, we explore various types of childbirth injuries and address the critical questions parents often ask when their child is seriously injured during pregnancy, labor, or delivery. Our goal is to help families better understand how these injuries happen, whether they may have been preventable, and when medical negligence may be involved. Future posts will take a deeper look at specific birth injuries, warning signs of medical error, and practical guidance for parents navigating the aftermath of a traumatic birth.
Related Articles in our Childbirth Injury Series
Leaders in Birth Injury Litigation: BBGA Attorneys Evan Jones and Lee Atkinson
Cerebral Palsy and Birth Injuries: What Parents Should Know
Fetal Heart Monitoring Strips: What They Show and Why They Matter in Birth Injury Cases
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