Item: Miller & Zois, Attorneys at Law
Rating: 5
Author: Terry Waldron

Our lawyers handle brachial plexus malpractice lawsuits. These birth injuries have declined in recent years, but they still occur.

Obstetricians still make delivery mistakes involving excessive force, and some children are left with lifelong injuries. This page looks at brachial plexus lawsuits and settlement compensation amounts in these sometimes tragic cases. It also explains what shoulder dystocia is, how doctors should respond to a shoulder dystocia birth, and when lateral traction on the neck during delivery may support a malpractice claim.

What Is the Brachial Plexus?

The brachial plexus is a network of nerves that transmits signals from the spine to the shoulder, arm, and hand. Brachial plexus birth injuries cause damage – sometimes, but not always permanently – to those nerves.

These injuries are hard on children when they do not resolve. The outcome depends heavily on which nerves were injured and whether the nerves were stretched, ruptured, or avulsed. Children with persistent injuries may struggle with poor movement, sensation loss, weakness, and pain in the affected arm.

Common Risk Factors for Brachial Plexus Injuries

Brachial plexus injuries during childbirth are often preventable when doctors take appropriate steps to identify and manage known risk factors. These injuries, which result from excessive force during delivery, are more likely to occur when certain conditions are present. Understanding these risk factors helps us better understand what medical professionals need to do to meet the standard of care to anticipate possible complications and take measures to avoid harm.

Fetal Macrosomia

Fetal macrosomia generally refers to a baby weighing more than 4,000 grams (about 8.8 pounds). Size is a leading risk factor for brachial plexus injuries. Larger babies are more prone to complications during vaginal delivery, particularly shoulder dystocia, where the baby’s shoulder becomes stuck behind the mother’s pelvic bone. In such cases, improper delivery techniques can overstretch or tear the delicate nerves of the brachial plexus.

Doctors have a responsibility to evaluate fetal growth and consider the mother’s diabetes status, prior delivery history, and other risk factors. Ultrasound estimates are imperfect, and a baby weighing more than 4,000 grams does not automatically require a cesarean section. When the estimated weight and the full clinical picture create a substantial delivery risk, the doctor should discuss the available delivery options and the risks of proceeding vaginally.

Maternal Diabetes

Maternal diabetes, including gestational diabetes, increases the risk of delivering a larger baby, which in turn raises the chance of brachial plexus injuries. Uncontrolled blood sugar levels can contribute to fetal macrosomia and other complications that make vaginal delivery riskier.

Medical professionals must monitor maternal blood sugar levels closely throughout the pregnancy and provide guidance on managing diabetes. When fetal size and the other clinical facts create a significant delivery risk, doctors should discuss whether a planned C-section is appropriate.

Prolonged Labor or Difficult Delivery

Prolonged labor or delivery that does not progress as expected can increase the risk of brachial plexus injuries. Extended labor creates more opportunities for complications, including the need for forceful maneuvers or tools like vacuum extractors or forceps, which can cause nerve damage when improperly used.

Doctors have an obligation to monitor the progress of labor and intervene when the baby is telling them through the fetal heart monitor that there is a problem. This may involve a vacuum or forceps. But they must be ready to switch to a C-section when the risk to the baby becomes significant. Failure to act promptly or appropriately can lead to preventable injuries.

Abnormal Fetal Position

The position of the baby during delivery also plays a critical role in the risk of brachial plexus injuries. Babies in breech (feet-first) or posterior (facing up) positions may face additional challenges during birth, increasing the likelihood of nerve damage if excessive force is applied.

Doctors should assess the baby’s position during prenatal care and use techniques such as external cephalic version (ECV) to reposition a breech baby when possible. If the baby’s position poses too great a risk for a safe vaginal delivery, planning a C-section is often the safest option.

Shoulder Dystocia

Shoulder dystocia, where the baby’s shoulder becomes trapped during delivery, is one of the most common causes of brachial plexus injuries that doctors are trained to manage. This complication requires immediate and skillful management to avoid harm. Excessive traction or force during delivery can cause severe nerve injuries, including avulsions, which are particularly devastating and often permanent.

Doctors must be prepared for the possibility of shoulder dystocia and have a clear plan for managing it. Well-established techniques include the McRoberts maneuver, suprapubic pressure, delivery of the posterior arm, and internal rotational maneuvers. These techniques often resolve the emergency, although a brachial plexus injury can occur even when the medical team responds appropriately. The malpractice question is whether the team recognized the emergency, used accepted maneuvers, avoided fundal pressure and excessive lateral traction, and moved through the available options with appropriate urgency.

Brachial plexus injuries involving shoulder dystocia were 2.5 times more likely to become permanent.

Brachial Plexus Lawsuits Our Lawyers See

Most brachial plexus injuries our law firm sees are from childbirth. Our lawyers occasionally encounter adult brachial plexus cases as well, including injuries caused when a shoulder belt violently loads the neck and shoulder during a crash.

Our law firm also sees motorcycle and four-wheeler brachial plexus injury crashes. Brachial plexus injuries during childbirth often occur from excessive lateral traction on the infant’s head during birth. Excessive traction to free the shoulder pulls the child’s delicate head and can cause injuries to nerve roots, commonly the C5, C6, and C7 nerve roots of the brachial plexus.

Infants delivered with excessive traction can suffer rupture or avulsion injuries. These are the most troubling. Our ability to repair brachial plexus injuries is improving, but a root avulsion will not heal on its own. Treatment may involve nerve grafts, nerve transfers, or other reconstructive procedures. The child should be evaluated promptly by a multidisciplinary brachial plexus team so the family does not lose a valuable treatment window.

Brachial Plexus Injuries and Medical Negligence

Brachial plexus injuries are a frequent subject of birth injury malpractice lawsuits. Many claims involve allegations that an OB/GYN or midwife applied excessive lateral traction after the child’s anterior shoulder became impacted behind the mother’s pelvic bone. But the diagnosis by itself does not prove negligence. Our lawyers look for evidence in the delivery record, the maneuvers used, the injury pattern, imaging, surgical findings, and the accounts of everyone present in the delivery room.

If your baby is born with a brachial plexus injury, it is reasonable to investigate whether medical negligence occurred during the delivery. That investigation becomes especially important when the records document shoulder dystocia, difficult use of forceps or a vacuum extractor, fundal pressure, unusual traction, fractures, bruising, or an avulsion injury.

Obstetric instruments can cause injury when they are used improperly, but the use of an instrument does not establish malpractice by itself. Severe nerve damage deserves close investigation because it can provide important biomechanical evidence. It still must be considered with the complete delivery record.

The most severe type of brachial plexus nerve injury is called an avulsion. In an avulsion, the nerve root is torn away from the spinal cord. This injury can give plaintiffs powerful causation evidence, particularly when the records also document shoulder dystocia and traction on the baby’s head or neck.

An avulsion indicates a severe stretch injury, but it does not identify the responsible person or prove negligence standing alone. That conclusion requires qualified experts to connect the injury anatomy with the mechanics and documentation of the particular delivery.

Brachial Plexus Settlement Value

If your child has suffered a brachial plexus injury, you are looking for answers for your child. One answer may be getting compensation to help your child cope with this injury. If you want the best for your child, it is a very reasonable question to ask what the average settlement value of brachial plexus birth injury cases is and what your child’s claim might be worth.

Some of the reported verdicts and settlements below exceed $2 million. But these injuries vary wildly in severity, and several of the largest awards also involve brain damage, fractures, or other catastrophic injuries. An average drawn from this group would not tell you what an isolated brachial plexus claim is worth.

Ultimately, the answer to the range of settlement amounts for your family’s brachial plexus lawsuit lies in your child’s medical records. (Our lawyers will review these for you at no charge.)

Below we have provided sample claims to help you better understand the value range of these cases. If a case sounds just like yours, can you assume the settlement or trial compensation payout will be the same? Of course not. The examples show how injury severity, permanency, additional injuries, liability evidence, jurisdiction, damages caps, and future care needs can change the result.

Bringing a birth injury case in Maryland

Brachial Plexus Injury Compensation Amounts

Below are summaries of verdicts and reported settlements in actual brachial plexus birth injury cases.

2026, North Carolina: $18,200,000 Verdict. During the delivery of a baby whose shoulder became lodged behind his mother’s pelvic bone, a WakeMed resident physician allegedly performed a maneuver that should not have been used to relieve shoulder dystocia. The child’s five brachial plexus nerve roots were avulsed, leaving him with permanent loss of function in his left arm, shoulder, and hand. A Wake County jury found negligence and awarded $17.7 million to the child and $500,000 to his mother. The award included approximately $2.2 million in economic damages and $16 million in noneconomic damages. Because the jury did not find gross negligence, North Carolina’s medical malpractice cap is expected to reduce the noneconomic portion substantially. The reported verdict is therefore not the same as the final collectible judgment.
2024, Illinois: $75,859,000 Verdict. The baby allegedly suffered multi-level injuries to her brachial plexus, a complete transverse fracture of her right humeral shaft, a metaphyseal fracture of her proximal left humerus, scalp swelling, a fracture of her right occipital bone, and intracranial bleeding, including a subdural hematoma, cerebellar hemorrhage, and subarachnoid hemorrhage. She also suffered permanent brain damage and required extensive future care. The plaintiff asserted medical negligence, including executing an internal podalic version when there was no clinical indication, failing to properly supervise the resident, failing to confirm the resident was pulling the plaintiff’s feet instead of her hand, failing to provide the mother with uterine relaxation medication, and using excessive force to deliver the plaintiff. This was not an isolated Erb’s palsy award, and it should not be used as a direct valuation comparison for a child whose only injury is to the brachial plexus.
2023, Missouri: $2,840,000 Verdict. The infant suffered a brachial plexus injury to his right upper extremity during delivery. The lawsuit alleged that shoulder dystocia was encountered during labor and that the defendant OB/GYN was negligent in her response to this complication. The lawsuit claimed that the defendant used excessive force in trying to dislodge the baby, resulting in the nerve injury.
2023, New Jersey: $150,000 Settlement. The plaintiff, a female infant, suffered a brachial plexus injury allegedly resulting in permanent impairment when shoulder dystocia was encountered during delivery. The lawsuit accused the doctor of negligently handling the complication.
2022, Louisiana: $15,800,000 Verdict. During delivery, the baby suffered a brachial plexus injury to his left shoulder and C5-C7 spinal nerve damage. The injury allegedly left him permanently disabled with a left arm significantly smaller than the other. The lawsuit asserted that the defendants were negligent in failing to recognize that the pregnancy was at high risk for fetal macrosomia and shoulder dystocia, and failing to opt for a C-section.
2022, New York: $2,537,354 Settlement. An OB/GYN was delivering a baby when shoulder dystocia was encountered. The plaintiff suffered a brachial plexus injury and was diagnosed with Erb’s palsy and underwent two surgeries to treat his injury. The lawsuit claimed that the defendant was negligent in failing to prepare for the possibility of shoulder dystocia, despite multiple risk factors, and then mishandling it when it occurred.
2021, New York $250,000 Settlement. Medical malpractice action was brought on behalf of male infant N.S., who reportedly suffered a brachial plexus injury during his birth at defendant’s hospital. The lawsuit alleged that shoulder dystocia was encountered during the delivery, which the defendant’s staff failed to correctly manage. The lawsuit claimed that the defendant used excessive force while delivering the infant vaginally when shoulder dystocia was encountered; failed to assess fetal size and maternal pelvic outlet size; applied excessive traction, rotation, and pressure to the infant’s head and cervical spine; failed to properly perform maneuvers, and performed inadequate maneuvers
2021, New Jersey $1,300,000 Settlement. The infant plaintiff suffered cervical spine and right brachial plexus injuries resulting in a permanently debilitating condition of Erb’s Palsy, during his labor and delivery, performed by the defendant.
2020, New York: $365,000 Settlement. A baby girl sustained a brachial plexus injury during her delivery. She eventually developed Erb’s palsy. Her father alleged that the obstetrician’s negligence caused her permanent injury. The parties disputed the damages, and the case settled for $365,000. We do not have enough information to know why the settlement was comparatively low. Liability, permanency, insurance limits, venue, liens, and disputed medical proof could each have affected the result.
2019, New York: $18,079,716 Verdict. This is a pretty classic fact pattern. A baby girl was born with Erb’s palsy and permanent brain damage from respiratory distress. Because of her injuries, the girl experienced limited right arm use, cognitive impairments, and an inability to speak. She required the permanent assistance of an aide. The family hired a birth injury lawyer and filed a lawsuit alleging that the hospital staff failed to treat her brachial plexus injury and respiratory distress. She argued that a timely ordered C-section would have reduced the brachial plexus injury risk. The woman also argued that timely administration of steroid medications would have treated respiratory distress. The hospital argued that a C-section would not have diminished the brachial plexus injury risk. The hospital also argued that the baby’s brain damage and respiratory distress were unrelated. A jury found the hospital liable and awarded $18,079,716.
2018, California: $9,900,000 Settlement. A baby girl suffered a brachial plexus injury and brain damage during delivery. She ultimately developed spastic quadriplegia. Her parents filed a brachial plexus injury lawsuit that alleged that the mismanaged vacuum-assisted delivery caused her permanent injuries. They claimed the hospital staff failed to timely treat fetal distress and timely order a C-section. As you are seeing and will see, the failure to order a Cesarean section is a common motif in Erb’s palsy injury medical malpractice claims. The case settled for $9,900,000.
2018, Indiana: $2,000,000 Verdict. A macrosomic baby suffered a subdural hematoma, a brachial plexus injury, and a permanent brain injury during delivery. He developed left arm paralysis. His mother alleged that the hospital mismanaged the delivery. She claimed the obstetrician failed to recognize the macrosomia risk, negligently administered Pitocin, and improperly treated shoulder dystocia. The obstetrician denied liability. He argued he met the standard of care. A jury awarded a $2,000,000 verdict.
2018, Virginia: $2,320,335 Verdict. A baby boy sustained a right brachial plexus injury during his delivery. Because of this injury, he had limited use of his right arm. His mother alleged that the hospital’s mismanagement of his birth caused his permanent injury. She claimed the obstetrician negligently used excessive force to treat shoulder dystocia. The obstetrician argued that the woman’s contractions and pushing caused the injury. A jury awarded $2,320,335.
2017, New Jersey: $900,000 Settlement. An OB/GYN allegedly used excessive lateral traction while delivering a baby after shoulder dystocia occurred. The plaintiff claimed that the obstetrician should have anticipated the delivery risk and offered a C-section before labor reached that point. The case resolved for a $900,000 settlement.
2016, Florida: $4,821,000 Verdict. Plaintiff is giving birth to her daughter at the hospital. During the birth, the defendants encounter shoulder dystocia and apply excessive traction to the infant’s head. The infant is diagnosed with a brachial plexus injury and a rupture of two discs in her back due to the excessive traction applied during the delivery. The infant has a permanent loss of function in her right arm. A jury found that the midwife was 60% negligent and that the doctor was 40% negligent and awarded the plaintiff $4,821,000.
2016, Connecticut: $4,200,000 Verdict. A woman is under the care of the defendants for pregnancy and delivery. The midwife fails to diagnose the infant’s shoulder dystocia during labor and delivery. During the delivery, it becomes apparent that the shoulders are not delivering, so the midwife uses lateral traction to push the infant’s head down and twist the head to release the shoulder. This results in a brachial plexus injury to the infant, and the infant has limited use of her arm and shoulder. The parents hire a brachial plexus lawyer and file a lawsuit alleging negligence in failing to diagnose and properly manage the shoulder dystocia. As a result, the infant suffered permanent injuries due to excessive traction during delivery. A jury awards the infant and her parents $2,360,000 for loss of enjoyment of life, $840,000 for pain and suffering, and $1,000,000 for permanent injury.
2016, Illinois: $2,814,338 Verdict. A woman is giving birth to her son when the defendant doctors fail to check prenatal blood sugar levels and fail to recommend or offer the woman a Cesarean section. Instead, the defendants use excessive traction during the birthing process, and the infant suffers a brachial plexus injury due to shoulder dystocia that he endured during the delivery. The defendants deny, but a jury awarded the plaintiffs $2,814,338.
2016, Texas: $2,700,000 Verdict. A woman receives treatment from the defendants during her pregnancy. When it comes time to deliver her infant, the fetus is found to be larger than average. Despite this finding, the defendants do not recommend a C-section. The defendant encounters shoulder dystocia during the delivery, and the fetus is delivered with a severe brachial plexus injury. Plaintiffs allege that the infant is permanently disabled and that the defendants should have performed a C-section once they realized the size of her fetus. The defendants denied negligence, but a jury awards the plaintiffs $2,700,000.
2016, New York: $2,000,000 Settlement. A woman gives birth to her daughter via vaginal delivery under the defendants’ care. Shoulder dystocia is encountered, but the defendants fail to perform the appropriate maneuvers to deliver the girl. The woman claims that the defendants should have recognized the increased risk of shoulder dystocia due to the size of her fetus and her gestational diabetes. As a result, the infant suffers right Erb’s palsy, a brachial plexus injury, and a left humerus fracture. The defendants denied liability but settled the case for $2,000,000.
2016, New York: $1,228,261 Settlement. Plaintiff receives prenatal care from the defendants. They fail to diagnose and treat fetal distress. The infant is not delivered via C-section, and shoulder dystocia is encountered. The infant suffers a birth-related neurological injury, brain damage, Erb’s palsy, brachial plexus injury, seizure disorder, and stroke. The hospital settled with the plaintiff for $1,228,261. The case against the doctor went to trial, and a jury found in favor of the defendant.
2016, New York: $1,184,162 Settlement. A woman is giving birth to her son under the care of the obstetrician/gynecologist. Defendant fails to perform a C-section promptly, and as a result, the infant suffers a left brachial plexus injury and mid-shaft humeral fracture during the delivery. The parents file this lawsuit, and the parties settle the claims for $1,184,162.
2016, New Jersey: $1,000,000 Settlement. A woman is giving birth to her baby when the defendant uses excessive traction. He uses a vacuum to deliver the baby to avoid brain damage, but he encounters shoulder dystocia as well. As a result, the infant suffers a right brachial plexus injury and Erb’s Palsy. The defendant argues that the brachial plexus injury did not occur due to excessive force. At four months old, the child had surgery, which provided her with relatively good movement at waist level, but she cannot move one of her arms. The parties settle before the trial started for the defendants’ insurance policy limits of $1,000,000.
2016, California: $950,000 Settlement. A woman is admitted to the defendant hospital to deliver her infant. Defendants diagnose gestational diabetes, but they do not inform the mother. They fail to inform the woman of the risks of gestational diabetes or the fact that since during a prior birth, shoulder dystocia was involved so her risks of reencountering it are increased. Additionally, the infant is heavier than average, which also points to the requirement of a C-section instead of vaginal birth. They fail to offer her a C-section. During delivery, shoulder dystocia occurs. This leads to severe brachial plexus paralysis of the infant’s arm, shoulder, and hand. The parties settled the case for $950,000.
2016, New York: $709,485 Settlement. A woman is giving birth to her daughter, during which shoulder dystocia is encountered. The defendants fail to properly address this and fail to deliver the infant by C-section, causing a brachial plexus injury. As a result, the infant suffers neurological damage, brain damage, and cognitive delays. The parties settle the case for $709,485.
2016, California: $450,000 Settlement. During delivery, the baby’s shoulder became stuck. Classic case. They failed to deliver the baby safely, resulting in shoulder dystocia and permanent right brachial plexus paralysis. The defendants argue they did not deviate from the standard of care, but they settle the case for $450,000.
2015, Oregon: $1,012,000 Verdict. While a woman is giving birth to her daughter, the defendants apply pressure and urge her to continue to push harder. Defendants use excessive traction during the delivery, and as a result, the infant suffers brachial nerve root avulsions leaving her with minimal use of her left arm and shoulder. A jury awards the woman $312,000 for economic damages and $700,000 for non-economic damages.
2015, Pennsylvania: $975,000 Settlement. A woman has several ultrasounds towards the end of her pregnancy, indicating that her fetus is large. She is allowed to continue her pregnancy without scheduling an induction. Her membranes rupture, and she goes to the hospital, where she comes under the defendants’ care. They deliver her baby, during which shoulder dystocia is encountered. Defendants use a vacuum and push on the woman’s stomach, breaking the infant’s arm. The baby suffers a broken arm and a permanent brachial plexus injury, and the woman claims that the defendants should have recognized that her fetus would be large and offered a C-section. The parties settled for $975,000.
2015, New York: $950,000 Settlement. The defendant is delivering a woman’s baby when he encounters shoulder dystocia. The defendant is unsuccessful in alleviating the shoulder dystocia, and he applies excessive traction. As a result, the infant suffers from Erb’s Palsy, a permanent injury to her brachial plexus nerve, and developed elbow contraction from Erb’s Palsy. The defendant denied liability but settled the claims for $950,000.
2014, California: $5,510,757 Verdict. A mother is giving birth to her daughter when the defendants fail to diagnose the obstructed delivery. Defendants use suction cups to assist the delivery, without diagnosing the reason for the block. As a result, the infant suffers damage to her brachial plexus nerve group, and she permanently loses mobility in her left arm. A jury awards the plaintiffs compensation of $5,510,757, later reduced to $801,205 by California’s malpractice cap.
2014, Massachusetts: $1,000,000 Settlement. The plaintiff had a history of shoulder dystocia that was not documented in her medical records. The defendants allegedly failed to inform her of the risks associated with another vaginal birth. Her infant then suffered a permanent brachial plexus injury. The woman claimed that she would have selected a C-section if she had received an adequate warning. Cesarean delivery substantially reduces the risk of a brachial plexus birth injury, although it does not eliminate the risk. The parties settled the case for $1,000,000.
2014, Illinois: $500,000 Settlement. A woman is giving birth to her child at the hospital when the doctors place excessive traction on the infant’s head and neck, failing to recognize the woman’s risk factors for shoulder dystocia. As a result, the girl suffers a brachial plexus injury. The defendants deny liability but settle the claim for $500,000.

FAQs

What is the Brachial Plexus?

The brachial plexus is a network of nerves in our neck and shoulders. These nerves carry electrical signals from the brain and spine to the muscles in the shoulder, arm, and hand. An injury to the brachial plexus occurs when these nerves are compromised. These nerves send messages that allow movement and sensation to reach the arm. If the path of the nerve is compromised, the signals from the brain will not reach the individual muscles in the arm which will limit the normal use of the arm. If the damages are severe, there can be paralysis of an entire arm.

How Does the Brachial Plexus Get Injured During Childbirth?

Some babies suffer brachial plexus injuries when a shoulder becomes stuck during birth, and excessive lateral traction is applied to the head or neck. That force can overstretch, rupture, or avulse the nerves. Shoulder dystocia and brachial plexus injury are closely associated, but not every brachial plexus birth injury proves that the doctor used excessive force. The delivery records and the specific anatomy of the injury must be examined.

How Much Are Brachial Plexus Injury Cases Worth?

Our lawyers believe that a viable birth injury malpractice case involving a permanent brachial plexus injury may have a settlement value ranging from several hundred thousand dollars to several million dollars. That is a valuation estimate, not a verified national average. The range is wide because these injuries differ dramatically in severity and permanency. Some children are left with permanent arm paralysis and substantial future care needs. Others recover useful function and have a much smaller permanent impairment. Liability evidence, jurisdiction, damages caps, insurance coverage, and additional injuries can also change the value.

How Common Are Brachial Plexus Injuries?

Brachial plexus injuries occur in approximately 1.5 to 1.7 out of every 1,000 live births, although reported rates vary by population and study design. Most children improve, but approximately 20% to 30% may not recover fully. The prognosis is considerably worse for a global C5 through T1 injury than for a less severe upper plexus injury. Our brachial plexus palsy malpractice attorneys review many of these cases every year.

How Much Force Is Necessary to Cause a Brachial Plexus Injury?

Excessive lateral traction on the baby’s head or neck can cause a brachial plexus injury, particularly when the shoulder is impacted during delivery. The exact force required is not known and likely varies with the child’s anatomy, position, and other circumstances. A severe rupture or avulsion can support a claim that substantial traction occurred, but the injury alone does not establish who applied the force or whether the standard of care was violated.

There is no accepted formula in which a particular amount of force always produces a brachial plexus injury. The analysis depends on the child’s anatomy, the location and extent of the nerve damage, the position of the baby, the delivery maneuvers, and the medical documentation.

What Is Shoulder Dystocia in Birth?

Shoulder dystocia is an obstetric emergency in which the baby’s head is delivered but one of the shoulders remains trapped behind the mother’s pubic bone or, less commonly, against the sacrum. Ordinary gentle traction does not complete the delivery, so the medical team must use additional maneuvers to free the shoulder. Common maneuvers include McRoberts positioning, suprapubic pressure, internal rotation, and delivery of the posterior arm.

How Common Is Shoulder Dystocia?

Published rates vary, but shoulder dystocia occurs in roughly 0.2% to 3% of vaginal births. It cannot be predicted reliably. Fetal macrosomia, maternal diabetes, a prior shoulder dystocia delivery, and operative vaginal delivery increase the risk, but many cases occur without an obvious warning.

What Is the Shoulder Dystocia Death Rate?

Death from shoulder dystocia is rare, and the reported rate varies by study, population, and how the event is defined. A prolonged delay can deprive the baby of oxygen and cause hypoxic-ischemic brain damage or death. The more useful question in an individual case is how long the head-to-body interval lasted, what maneuvers were attempted, whether the team called for help, and what the fetal and neonatal records show.

When Do You Know a Brachial Injury Is Permanent?

Healing of nerve damage may continue over an extended period, although one study suggests that 93% of patients who reach full recovery will do so within four months. Serial examinations during the first weeks and months are essential. MRI can provide evidence of a nerve root avulsion, but no single test answers every question about severity, prognosis, and future function.

Surgical exploration may also reveal the extent of the damage. More typically, the answer becomes clearer through time, repeated clinical examinations, imaging, electrodiagnostic testing, and the child’s response to therapy. Permanency is relevant to damages and may provide important causation evidence, but a temporary injury can still result from excessive traction.

When the injury is permanent, our lawyers work with qualified medical and biomechanical experts to determine whether the pattern is consistent with the forces documented during delivery.

A Good Test for Brachial Injury

A test called electrodiagnostic testing (EDX) is used in evaluating brachial plexus injuries. EDX can help doctors localize the injury, assess its severity, and estimate prognosis. It may detect abnormalities that are not obvious during a routine examination, but it ordinarily does not establish the legal cause of the injury.

Doctors can also use EDX after surgery to see if the nerves are healing properly. During surgery, this test can tell surgeons if nerve signals are passing through injured areas, which helps them decide the next steps in treatment.

However, using this test can be tricky. Sometimes there can be multiple injuries, and the doctor has to check both the injured and the non-injured arm to compare them. The results of the test need to match with the type and seriousness of the injury.

EDX can be valuable when it is performed and interpreted at the appropriate time. It is one part of the evaluation, together with serial clinical examinations, imaging, and the child’s functional progress.

What Causes Parents to Suspect a Problem?

A brachial plexus injury commonly presents as weakness or lack of movement in one arm. A severe injury may cause a completely flaccid arm that remains limp at the child’s side. Less extensive injuries can produce weakness in only some movements or muscle groups.

Will a Brachial Plexus Injury Occur in Utero?

A brachial plexus birth injury is a stretch injury to the network of nerves controlling the shoulder, arm, and hand. Many cases occur during labor and delivery, particularly when shoulder dystocia is followed by excessive lateral traction. The medical literature also reports injuries without clinically recognized shoulder dystocia and, rarely, after cesarean delivery.

Defense experts may contend that maternal forces, fetal position, or an anatomical vulnerability caused the injury without negligent physician traction. Plaintiffs should not concede that explanation merely because it is possible. The question is whether it fits this child’s injury anatomy and the contemporaneous delivery evidence. Many obstetric brachial plexus injuries are associated with traction during childbirth, but the medical literature does not support saying that every permanent injury has the same mechanism.

How Often Is Shoulder Dystocia the Cause of a Brachial Plexus Injury?

Brachial plexus injuries can occur without documented shoulder dystocia and, rarely, after cesarean delivery. Shoulder dystocia remains one of the strongest recognized risk factors, and many severe plaintiff cases involve a shoulder dystocia delivery followed by documented traction or a disputed maneuver.

The absence of a shoulder dystocia notation does not resolve causation. Delivery records can be incomplete, and the parties may dispute whether a shoulder was actually impacted or whether traction was applied. Our lawyers compare the records with the nerve levels involved, fractures or bruising, imaging, operative findings, fetal position, and expert biomechanical analysis.

Is Surgery to Repair Brachial Plexus Injury the Best Option?

Surgery for a brachial plexus injury has become more common with improved surgical techniques, such as micro neurosurgical technique and nerve grafting. The decision for surgery with brachial plexus injuries in babies depends on several factors, including the severity and location of the injury, the baby’s age, and the potential for nerve regeneration.

If the injury is mild, surgery may not be necessary, and the baby may recover with therapy alone. However, surgery may be recommended if the injury is severe, recovery stalls, or testing shows rupture or root avulsion. An infant whose recovery remains incomplete at one month should be referred promptly to a multidisciplinary brachial plexus team. That does not mean every child should undergo immediate surgery.

When primary nerve surgery is recommended, it is often considered during the first several months of life. The timing depends on the nerve roots involved, serial examinations, return of elbow and shoulder function, imaging, electrodiagnostic findings, and the judgment of the specialist team. Unnecessary delay can reduce the opportunity for muscle reinnervation and useful recovery.

Surgical Options for a Brachial Plexus Injury

Several surgical options for brachial plexus injuries in babies include nerve grafts, nerve transfers, and muscle transfers. The specific surgical approach will depend on the location and severity of the injury.

When deciding on the timing and type of surgical intervention, several factors need to be considered, such as the level and extent of the injury. In general, proximal muscle groups have a better prognosis for recovery than distal muscle groups, so attention on brachial plexus reconstruction has focused on proximal muscle groups and those groups that can provide the most useful upper extremity function. Restoration of elbow flexion is the priority in treating the injured plexus, followed by shoulder stabilization and, lastly, wrist and hand prehension (dexterity).

Recent Studies on Brachial Plexus Injuries

Siegmund, G. P., and Roberts, C. W. (2025). Biomechanics of Brachial Plexus Injuries Due to Shoulder Dystocia. Critical Reviews in Biomedical Engineering, 53(4), 1-24. PMID: 40752021. doi: 10.1615/CritRevBiomedEng.v53.i4.10. This review examined the biomechanical, clinical, and epidemiological evidence concerning how brachial plexus injuries occur during childbirth. The authors found a dose-response relationship in which higher delivery forces are associated with increasingly severe nerve damage, ranging from temporary weakness to complete and permanent disruption of the brachial plexus. Although maternal pushing and contractions can place strain on the nerves, the authors concluded that the rarity of severe permanent injuries, combined with the reduction in injuries after clinician training, suggests that clinician-applied force during shoulder dystocia increases the risk of permanent injury. This study supports the plaintiff’s argument that a permanent avulsion injury may be evidence of excessive traction rather than an unavoidable result of labor.

Iaconianni, J. A., et al. (2025). Studying the effects of McRoberts and neonate-focused maneuvers on the neonatal brachial plexus during shoulder dystocia. Frontiers in Bioengineering and Biotechnology, 13, 1474154. PMID: 40375977. doi: 10.3389/fbioe.2025.1474154. This computational study examined how recognized shoulder dystocia maneuvers affect the amount of traction needed for delivery and the resulting stretch on the baby’s brachial plexus. Moving the mother into the McRoberts position reduced both clinician-applied traction and nerve stretching. Suprapubic pressure, rotating the baby into an oblique position, and delivering the posterior arm reduced the strain even further. Posterior arm delivery produced the lowest brachial plexus stretch in the simulations and required no clinician-applied traction. The findings support the plaintiff’s argument that proper positioning and maneuvers can relieve shoulder dystocia while limiting dangerous traction on the baby’s head and neck.

Kaijomaa, M, et al: (2021). Impact of simulation training on managing shoulder dystocia and incidence of permanent brachial plexus birth injury: An observational study. BJOG: An International Journal of Obstetrics & Gynaecology. PMID: 36052568. doi: 10.1111/1471-0528.17278. This Finnish study aimed to investigate the effect of a simulation training program on managing shoulder dystocia (SD) and the incidence of permanent brachial plexus birth injury (BPBI) at Helsinki University Women’s Hospital. So does being a better-trained doctor limit the number of brachial plexus injuries. The study analyzed the data from 2010 to 2019, dividing the period into pre- and post-training phases. The results showed that despite an increase in SD risk factors, the number of permanent BPBI cases decreased significantly after implementing the simulation training program. The most significant change in SD management was the increased incidence of successful delivery of the posterior arm.
Dixit, N. N., et al. (2021). Preganglionic and postganglionic brachial plexus birth injury effects on shoulder muscle growth. The Journal of Hand Surgery, 46(2), 146-e1. This study looked at whether the preganglionic and postganglionic brachial birth plexus injuries had different effects on shoulder muscle growth. The researchers found that babies with postganglionic brachial plexus injuries experienced more restricted shoulder mobility. However, they also found that affected muscles in the preganglionic experienced more severe alterations. The researchers concluded that the presence of contracture also depended on post-injury muscle mass loss and restricted muscle growth.
Grahn, P., et. al (2021). A protocol-based treatment plan to improve shoulder function in children with brachial plexus birth injury: a comparative study. Journal of Hand Surgery (European Volume). This study examined whether a protocol-based treatment plan improved shoulder function in children with brachial plexus birth injuries. The treatments included early passive exercises, botulinum toxin-A injections, ultrasound screening, shoulder splinting, and targeted surgeries. The researchers’ data showed that 48 percent of patients developed posterior shoulder subluxation. However, they also found that they could detect the condition at less than five months instead of at five years old. There was also less need for relocation surgery. The researchers concluded that their protocol could potentially reduce the chances of shoulder subluxation in infants who suffered from brachial plexus injuries.
Manske, M. C., et al. (2021). Long-Term Outcomes of Biceps Rerouting for Flexible Supination Contractures in Children With Brachial Plexus Birth Injuries. The Journal of Hand Surgery. This study examined the long-term outcomes of children with brachial plexus birth injuries and forearm supination who underwent biceps rerouting. The researchers concluded that biceps rerouting improved forearm positioning without exacerbating elbow flexion contractures or decreasing shoulder mobility. The authors suggested that this procedure could preclude severe supination contractions and decrease the demand for forearm osteotomies.
Morrow, et al. (2021). Long-Term Hand Function Outcomes of the Surgical Management of Complete Brachial Plexus Birth Injury. The Journal of Hand Surgery. This study investigated long-term hand function outcomes of children suffering from brachial plexus birth injuries that underwent a primary nerve reconstruction. The researchers found that over 80% of patients could adequately perform bimanual tasks by the age of eight. They concluded that primary nerve reconstructions improved hand function in children with brachial plexus birth injuries.
Nickel, K. J., et al. (2021). Nerve Transfer Is Superior to Nerve Grafting for Suprascapular Nerve Reconstruction in Obstetrical Brachial Plexus Birth Injury: A Meta-Analysis. HAND. This review examined whether nerve transfers were superior to nerve grafting in treating a brachial plexus birth injury. The researchers examined four studies on this subject. They found nerve transfers associated with greater shoulder rotation than nerve grafting. The researchers also found that nerve graft patients were more at risk of undergoing a secondary shoulder procedure. They concluded that nerve transfers were associated with improved shoulder rotations and lower rates of secondary shoulder procedures.

Talk to the Birth Injury Lawyers at Miller & Zois for a Free Case Evaluation

If your child has a brachial plexus injury and you are unsure if it was caused by medical negligence during childbirth, we can help. The birth injury lawyers at Miller & Zois can help investigate whether you have a viable medical malpractice lawsuit – and deliver results if you do. Call our Maryland birth injury malpractice lawyers at 800-553-8082 today or get a free online consultation.

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