What Causes Erb’s Palsy? Understanding Medical Negligence During Birth

When your newborn can’t move one arm, the diagnosis of Erb’s palsy brings immediate questions: What happened during delivery? What causes Erb’s palsy, and could it have been prevented? This brachial plexus injury occurs when the delicate network of nerves controlling your baby’s arm and hand becomes damaged during birth. While some deliveries involve unavoidable complications, many cases of Erb’s palsy result from medical negligence—specifically, excessive force applied during difficult deliveries or failure to properly manage shoulder dystocia. Understanding what causes this devastating injury is the first step toward getting answers for your family.

If your baby was diagnosed with Erb’s palsy and you suspect that doctor-caused injury during delivery may be responsible, you have the right to seek answers. Birth injury attorneys can review your delivery records at no cost to determine whether medical malpractice occurred. Because statute of limitations deadlines restrict how long you have to take legal action, it’s important to explore your options sooner rather than later. Contact a birth injury lawyer today for a free, confidential case evaluation.

On this page:

• What is Erb’s palsy
• How the brachial plexus gets injured
• Primary causes during delivery
• When shoulder dystocia leads to injury
• Medical negligence and excessive force
• Risk factors doctors should recognize
• Preventable vs. unavoidable cases
• Warning signs of improper delivery techniques
• Filing an Erb’s palsy lawsuit
• Finding the right attorney
• Frequently asked questions

What Is Erb’s Palsy?

Erb’s palsy, also called Erb-Duchenne palsy, is a paralysis or weakness of the arm caused by injury to the upper brachial plexus nerves. These nerves—specifically the C5 and C6 nerve roots—control movement and sensation in the shoulder, elbow, and hand. When these nerves are stretched, compressed, or torn during delivery, your baby loses the ability to move their affected arm normally.

The condition manifests immediately after birth. You may notice your infant’s arm hanging limply at their side, rotated inward toward the body with the forearm extended. This characteristic “waiter’s tip” position signals damage to the nerve pathways that control arm movement. The severity ranges from temporary weakness that resolves within weeks to permanent paralysis requiring surgical intervention.

According to the American Academy of Orthopaedic Surgeons, brachial plexus birth injuries occur in approximately 1 to 3 per 1,000 births in the United States. While some cases involve circumstances beyond medical control, research indicates that a significant percentage result from preventable medical errors during labor and delivery.

How the Brachial Plexus Gets Injured During Birth

The brachial plexus is a complex network of nerves that emerges from the spinal cord at the neck and branches out to control the arm, hand, and fingers. During delivery, these nerves are vulnerable to injury when excessive lateral traction—sideways pulling—stretches them beyond their capacity.

There are four types of nerve damage that can occur:

Neuropraxia is the mildest form, involving nerve stretching that temporarily disrupts signal transmission. Most babies with neuropraxia recover fully within three to six months without surgical treatment.

Neuroma occurs when scar tissue forms around a stretched nerve during healing, creating pressure that interferes with nerve signals. Recovery is partial, and some permanent weakness may remain.

Rupture involves the nerve tearing but not at the spinal cord attachment point. This severe injury requires surgical repair, and recovery is often incomplete.

Avulsion is the most serious type, where the nerve root tears completely away from the spinal cord. Surgical intervention cannot reattach these nerves, resulting in permanent paralysis of the affected area.

The type and severity of injury your child sustained depends on how much force was applied during delivery and in what direction. Understanding the specific mechanism of injury is critical when evaluating whether Erb’s palsy resulted from necessary medical intervention or negligent application of excessive force.

Primary Causes of Erb’s Palsy During Delivery

What causes Erb’s palsy most frequently is mechanical trauma during the birthing process. The injury occurs when your baby’s head and neck are pulled or bent to the side while the shoulders remain lodged in the birth canal. This lateral stretching of the neck creates tension on the brachial plexus nerves, causing damage.

Several specific delivery scenarios commonly lead to this injury:

Shoulder dystocia is the leading cause of Erb’s palsy. This obstetric emergency occurs when your baby’s anterior shoulder becomes trapped behind your pubic bone after the head has delivered. The medical team must act quickly to deliver the shoulders, but applying excessive pulling force on the baby’s head increases the risk of nerve damage dramatically.

Breech deliveries create risk when the practitioner pulls on the baby’s feet or body while the arms remain extended above the head. The upward arm position stretches the brachial plexus as the body is pulled downward through the birth canal.

Large birth weight (macrosomia) makes delivery more difficult because the baby’s shoulders may not fit easily through the birth canal. When babies weigh more than 8 pounds, 13 ounces (4,000 grams), the risk of shoulder dystocia and resulting brachial plexus injury increases significantly.

Prolonged or difficult labor that requires instrumental assistance with forceps or vacuum extraction can result in excessive traction on the baby’s head and neck. Improper use of these instruments or applying force in the wrong direction can cause the very injuries they’re meant to help avoid.

Assisted pulling during delivery becomes negligent when the physician uses more force than necessary or pulls at an improper angle. While some traction is normal and appropriate during delivery, excessive lateral pulling that bends the baby’s neck beyond safe limits causes preventable nerve damage.

A birth injury attorney can help you understand whether the circumstances of your delivery involved recognized risk factors that should have been managed differently. Request a free case evaluation to learn whether medical negligence played a role in your child’s injury.

When Shoulder Dystocia Leads to Erb’s Palsy

Shoulder dystocia itself is not necessarily evidence of malpractice—it’s an unpredictable complication that can occur even during well-managed deliveries. However, how the medical team responds to shoulder dystocia determines whether your baby sustains a preventable injury.

When shoulder dystocia occurs, the standard of care requires physicians to follow established emergency protocols rather than simply pulling harder on the baby’s head. The American College of Obstetricians and Gynecologists (ACOG) provides clear guidelines for managing this emergency, including specific maneuvers designed to dislodge the shoulder without excessive force.

Appropriate maneuvers include:

The McRoberts maneuver involves flexing your legs back toward your abdomen, which changes the angle of your pelvis and often releases the trapped shoulder. This should be the first intervention attempted.

Suprapubic pressure means applying firm pressure just above your pubic bone to push the baby’s anterior shoulder downward and under the pubic bone. This pressure should never be applied to the top of your uterus (fundal pressure), which can worsen the impaction.

Internal rotation maneuvers involve the physician reaching into the birth canal to manually rotate the baby’s shoulders into a more favorable position for delivery.

Delivery of the posterior arm requires the physician to reach behind the baby and sweep the posterior arm across the chest and out of the birth canal, reducing the shoulder diameter that must pass through the pelvis.

What causes Erb’s palsy in shoulder dystocia cases is often the physician’s failure to follow these protocols. Instead of performing the appropriate maneuvers, some practitioners simply apply increasing traction to the baby’s head—pulling harder and harder in an attempt to force the shoulders through. This excessive pulling birth technique stretches the brachial plexus beyond its tolerance, causing the nerve damage that results in Erb’s palsy.

Medical records that document “significant traction applied” or “difficulty with delivery of shoulders” may indicate that your baby’s injury resulted from improper technique. An experienced attorney can have these records reviewed by medical experts who specialize in obstetric standards of care.

Medical Negligence and Excessive Force

Erb’s palsy medical negligence occurs when healthcare providers deviate from accepted standards of care in ways that directly cause brachial plexus injury. Not every case of Erb’s palsy involves malpractice, but certain circumstances strongly suggest that a doctor caused Erb’s palsy through negligent actions.

Applying excessive lateral traction is the most common form of negligence. While some pulling force is necessary during delivery, pulling with enough force to cause nerve damage exceeds what is medically appropriate. Physicians are trained to recognize when resistance indicates shoulder dystocia and to immediately switch to alternative maneuvers rather than increasing traction.

Failing to recognize risk factors constitutes negligence when doctors proceed with vaginal delivery despite clear indicators that cesarean section would be safer. If your medical records showed risk factors like suspected macrosomia, gestational diabetes, or previous shoulder dystocia, your physician had a duty to discuss delivery options and document informed consent.

Delaying cesarean section when labor is not progressing or fetal distress develops can lead to emergency situations where practitioners use excessive force attempting to achieve rapid vaginal delivery. What might have been a controlled surgical delivery becomes a rushed extraction that injures your baby.

Improper use of delivery instruments includes applying forceps or vacuum extraction with excessive force, at the wrong angle, or for too long. These instruments should assist—not replace—the natural delivery process. Using them to overcome significant resistance rather than addressing the underlying problem (such as shoulder dystocia) can cause severe injuries.

Ignoring signs of shoulder dystocia and continuing to apply traction rather than immediately implementing emergency protocols shows a dangerous lack of judgment. The “turtle sign”—when the baby’s head delivers but then retracts against the perineum—is a classic indicator that requires immediate intervention, not continued pulling.

Your delivery records may contain phrases that suggest excessive force was used, such as “significant traction required,” “difficulty delivering shoulders,” “moderate traction applied,” or documentation of multiple failed attempts at delivery. These notations can be critical evidence in establishing that medical malpractice during birth occurred.

Don’t wait to have your medical records reviewed by professionals who understand birth injury cases. Contact a qualified attorney to learn whether the force used during your baby’s delivery exceeded appropriate medical standards.

Risk Factors Doctors Should Recognize and Manage

What causes Erb’s palsy often involves the failure to properly account for known risk factors that increase the likelihood of shoulder dystocia and brachial plexus injury. While physicians cannot predict every difficult delivery, they have a duty to recognize risk factors and adjust their delivery plans accordingly.

Maternal diabetes significantly increases the risk of macrosomia because elevated blood sugar levels cause babies to grow larger than average, particularly in the shoulder and trunk area. When your medical records document gestational diabetes or pre-existing diabetes, your physician should discuss the increased risk of shoulder dystocia and consider recommending cesarean delivery if ultrasound estimates suggest your baby weighs more than 4,500 grams (9 pounds, 15 ounces).

Previous shoulder dystocia in an earlier delivery creates substantial risk for recurrence. If you experienced this complication before, your current delivery team should be prepared with a plan and potentially recommend a cesarean section to avoid repeating the injury.

Excessive maternal weight gain during pregnancy correlates with larger babies and increased shoulder dystocia risk. Your prenatal provider should monitor weight gain and discuss implications for delivery.

Suspected fetal macrosomia based on ultrasound measurements or fundal height should trigger discussions about delivery options. While ultrasound estimates aren’t perfectly accurate, measurements suggesting a baby larger than 4,000 grams require informed discussion about risks and alternatives.

Prolonged second stage of labor (the pushing phase) that extends beyond normal time frames may indicate that the baby is too large for the birth canal or malpositioned. Rather than allowing exhausted pushing for hours, practitioners should recognize when labor is not progressing and consider cesarean delivery.

Advanced maternal age and short stature are additional factors that, when combined with other risk indicators, should influence delivery planning.

Negligence occurs not just in how the delivery is managed but in failing to recognize these risk factors during prenatal care and labor. Your physician had a duty to identify concerning factors and discuss your options, documenting that you understood the risks and participated in decisions about your delivery method.

If your prenatal records show multiple risk factors but no documentation that cesarean delivery was discussed, or if your labor records show prolonged pushing without intervention, these may indicate departures from accepted standards of care. A birth injury lawyer can evaluate whether your medical team properly recognized and responded to the risk factors in your case.

Preventable vs. Unavoidable Cases of Erb’s Palsy

Not every case of Erb’s palsy results from medical negligence. Some deliveries involve truly unforeseeable complications or circumstances where even proper technique cannot prevent injury. Understanding the difference between preventable and unavoidable cases is important as you evaluate whether legal action may be appropriate for your family.

Preventable cases typically involve one or more of the following elements:

Clear risk factors were documented during prenatal care but not addressed in the delivery plan. When your medical records show that your physician knew about macrosomia, diabetes, or previous shoulder dystocia but proceeded with vaginal delivery without discussing alternatives, the resulting injury may have been preventable through different delivery planning.

Excessive force was applied rather than following established emergency protocols. If shoulder dystocia occurred but the medical team responded by pulling harder instead of immediately performing appropriate maneuvers, the injury resulted from improper technique.

Warning signs during labor were ignored. When fetal monitoring shows distress, labor fails to progress, or the “turtle sign” appears at delivery, immediate action should follow—not continued attempts at vaginal delivery with increasing force.

Unavoidable cases may involve circumstances such as:

True emergency situations where shoulder dystocia occurred without warning and despite proper management techniques, injury occurred. Some babies have anatomical variations or positioning issues that make injury difficult to prevent even with appropriate care.

Precipitous deliveries where the baby delivers so rapidly that normal controlled delivery technique isn’t possible. These rare circumstances can result in injury despite no fault of the medical team.

Cases where all appropriate maneuvers were performed correctly and in proper sequence, but injury still occurred due to the severity of the shoulder impaction.

The key distinction is whether your medical team met the standard of care—what a reasonably skilled practitioner would have done under the same circumstances. Even if shoulder dystocia occurred, if your physician failed to follow established protocols or used excessive force, the resulting injury was preventable and may constitute malpractice.

Medical experts who review birth injury cases can analyze your specific delivery records, including:

• Prenatal documentation of risk factors
• Labor progression notes and monitoring strips
• Delivery notes describing position, maneuvers performed, and force applied
• Time intervals between shoulder dystocia recognition and each intervention attempted
• Shoulder dystocia emergency protocol checklist completion (if documented)
• Nursery records describing your baby’s condition immediately after birth

This detailed analysis reveals whether the care you received met accepted standards or whether departures from proper technique caused your child’s injury.

Warning Signs of Improper Delivery Techniques

Certain indicators in your medical records or your memory of the delivery may signal that improper techniques contributed to your baby’s Erb’s palsy. While you shouldn’t attempt to interpret medical records on your own, being aware of these warning signs can help you recognize when professional legal review is warranted.

Delivery timing and urgency issues:

If you recall that delivery seemed rushed or that the medical team appeared panicked, this may indicate they were attempting to compensate for earlier delays or poor planning rather than following systematic protocols.

Multiple staff members pulling or pushing during delivery can suggest that excessive force was being applied—proper shoulder dystocia management doesn’t require numerous people applying traction.

Documentation red flags:

Phrases like “significant traction applied,” “moderate to severe traction,” or “difficult extraction” suggest force levels that may have exceeded appropriate limits.

Absence of documentation about which specific shoulder dystocia maneuvers were performed and in what order may indicate protocols weren’t followed.

Short time intervals between delivery of the head and body when shoulder dystocia is documented can indicate pulling was used instead of proper maneuvers.

Physical evidence:

Significant bruising on your baby’s head, neck, or shoulders after delivery can indicate excessive force or improper instrument use.

Facial nerve palsy occurring alongside Erb’s palsy suggests forceps may have been applied with too much pressure or at the wrong angle.

Fractured clavicle (collarbone) accompanying brachial plexus injury is common when excessive force is used attempting to deliver impacted shoulders.

Communication issues:

If healthcare providers were evasive when you asked what happened during delivery or provided inconsistent explanations, this can indicate they recognize the delivery didn’t go as it should have.

Lack of clear documentation about why certain interventions were chosen or why cesarean section wasn’t performed despite risk factors may suggest decision-making that didn’t meet standards of care.

You don’t need to understand all the medical terminology in your records to recognize that something may have gone wrong. If your instinct tells you the delivery wasn’t managed properly, or if the medical explanations you’ve received don’t fully make sense, consulting with a birth injury attorney costs nothing and can provide clarity.

Request copies of your complete medical records, including prenatal records, labor and delivery records, nursery records, and any subsequent treatment notes for your baby. A qualified legal team will have these reviewed by medical experts who can identify whether the care provided met accepted standards.

Filing an Erb’s Palsy Lawsuit for Medical Negligence

When medical negligence causes your child’s Erb’s palsy, you have the legal right to pursue compensation for the harm your family has suffered. While no amount of money can undo the injury, financial recovery can provide for your child’s extensive medical needs, therapy costs, and future care requirements.

An Erb’s palsy lawsuit must establish four legal elements:

Duty of care existed between your healthcare providers and you. This is typically straightforward—when a physician agrees to provide prenatal care and deliver your baby, they assume a duty to meet professional standards.

Breach of duty occurred when your providers failed to meet the standard of care. This requires demonstrating what a reasonably skilled practitioner would have done differently in the same situation. Medical expert testimony is necessary to establish this element.

Causation means the breach directly caused your baby’s Erb’s palsy. Your legal team must connect the improper technique or failed intervention to the specific nerve injury your child sustained.

Damages include all the harm resulting from the injury—medical expenses, therapy costs, future treatment needs, pain and suffering, reduced quality of life, and your child’s future lost earning capacity if the injury causes permanent limitations.

Proving these elements requires comprehensive investigation of your medical records, consultation with obstetric and neurological experts, and often reconstruction of exactly what occurred during the delivery. This is why working with attorneys who concentrate specifically on birth injury cases is critical—they have the resources and expert networks necessary to build strong cases.

The litigation process typically follows this timeline:

Free consultation and case review allow you to share your story and have attorneys evaluate whether the facts support a potential claim. This initial review costs nothing and creates no obligation.

Medical record review by experts occurs once you retain an attorney. Specialists in obstetrics, nursing, and neurology analyze every detail of your prenatal care, labor, delivery, and your baby’s initial treatment.

Filing the complaint initiates the lawsuit officially, putting defendants on notice of the specific allegations and legal theories supporting your claim.

Discovery phase involves exchanging documents, written questions (interrogatories), and depositions where parties and witnesses answer questions under oath. This process typically takes 12-18 months.

Settlement negotiations often occur once both sides have completed discovery and understand the strength of the evidence. Many birth injury cases settle before trial, providing compensation without the uncertainty of a jury verdict.

Trial occurs if settlement isn’t achieved. Your attorneys present evidence and expert testimony to a jury, who determines whether malpractice occurred and what compensation is appropriate.

The entire process typically takes two to four years from initial filing to resolution. While this seems long, your attorney will work to expedite the case while ensuring thorough preparation.

Because statutes of limitations restrict how long you have to file a lawsuit, don’t delay in seeking legal advice. Many states provide extended deadlines for injuries to minors, but these vary significantly by jurisdiction. Contact a birth injury attorney promptly to protect your family’s legal rights.

Finding the Right Erb’s Palsy Attorney

Choosing legal representation for your child’s birth injury case requires finding attorneys with specific experience in medical malpractice involving obstetric and neonatal care. Not all personal injury lawyers have the knowledge, resources, or expert connections necessary to handle complex birth injury litigation.

Look for these qualifications:

Specific experience with birth injury cases, not just general medical malpractice. Erb’s palsy cases require understanding of obstetric standards of care, shoulder dystocia management protocols, and brachial plexus anatomy and prognosis.

Track record of successful settlements and verdicts in birth injury cases. Ask potential attorneys about their results in cases similar to yours.

Resources to fully investigate and litigate complex medical cases. Birth injury lawsuits require funding for expert witnesses, medical record analysis, and sometimes medical illustrations or delivery simulations. Your attorney should have the financial resources to advance these costs.

Access to respected medical experts who can review your case and potentially testify. The strength of your case depends significantly on expert testimony establishing that standards of care were breached.

Compassionate communication that respects the emotional difficulty of your situation while keeping you informed throughout the process.

Important questions to ask during your consultation:

How many Erb’s palsy cases have you handled, and what were the outcomes?

Which medical experts will review my case, and what are their qualifications?

What is your fee structure? (Most birth injury attorneys work on contingency, meaning they only collect fees if you recover compensation.)

What is the likely timeline for my case?

What do you need from me, and how involved will I need to be in the process?

Based on your initial review of my situation, do you believe I have a viable case?

A reputable birth injury law firm will provide an honest assessment of your case during the initial consultation, even if that means explaining why your situation may not involve actionable malpractice. This honesty, while sometimes disappointing, reflects the integrity you want in legal representation.

Most birth injury attorneys offer free case evaluations and work on a contingency fee basis, meaning you pay no legal fees unless they recover compensation for your family. This arrangement makes legal representation accessible regardless of your financial situation and ensures your attorney is motivated to achieve the best possible outcome.

Don’t let financial concerns prevent you from exploring your legal options. Contact a birth injury attorney today to learn whether your child’s Erb’s palsy resulted from preventable medical negligence and what compensation may be available for your family’s needs.

Frequently Asked Questions About What Causes Erb’s Palsy