Erb’s Palsy Causes

Erb’s palsy is a birth injury that occurs when the network of nerves around an infant’s shoulder is injured. This injury usually happens when the baby’s shoulders become stuck during labor and delivery. Doctors can stretch and tear these nerves when pulling the newborn from the birth canal when they use too much force.

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What Causes Erb’s Palsy in Newborns?

Erb’s palsy usually occurs when a doctor stretches a newborn’s neck to the side and exerts a downward force on the baby’s shoulder or upper arm during a difficult delivery.

The nerve damage that results can cause the baby’s arm to hang by their side and their wrist to bend inward into a position known as the “waiter’s tip.” Other symptoms of Erb’s palsy include muscle weakness or paralysis in the injured arm.

Erb’s palsy can occur during a vaginal delivery or Cesarean section (C-section), but it is much rarer in C-section births.

A baby can also develop Erb’s palsy from the way they were lying in the womb during pregnancy and at the start of labor.

Did you know?

As many as 2 of every 1,000 babies are born with Erb’s palsy.

While Erb’s palsy and cerebral palsy are both types of birth injuries that affect movement, Erb’s palsy is caused by an injury to the nerves in the neck and shoulder, and cerebral palsy is caused by a brain injury.

Erb’s Palsy Nerve Damage

In the shoulder area there are a group of five nerves called the brachial plexus that connect the spinal cord to the arm and hand. These nerves run from the neck to the shoulder and then down the arm and into the hand. They allow a person to move and feel their shoulder, arm, and hand.

If these nerves are injured, a person has suffered a brachial plexus palsy. Palsy is a medical term for partial or total loss of muscle function. Erb’s palsy is also known as Erb-Duchenne palsy.

“Erb’s palsy is the most common type of brachial plexus palsy.”

– Cleveland Clinic

Infants with Erb’s palsy have suffered an injury to the upper brachial plexus nerves in the neck and shoulder area. When the injury happens to the lower nerves, it is known as Klumpke’s palsy.

Depending on the type of injury, the baby may have muscle weakness or paralysis in the affected arm. They may need physical therapy, occupational therapy, or in more severe cases, surgical treatment to restore range of motion. While most infants make a complete recovery, some suffer permanent nerve damage.

In many cases, Erb’s palsy is caused by a doctor’s negligence in delivering the child.

If you believe your child’s Erb’s palsy was caused by a medical mistake, our team at may be able to help.

What Are Some Risk Factors for Erb’s Palsy?

Erb’s palsy in newborns is almost always linked to a difficult or complicated delivery. In many cases, the obstetrician or midwife must deliver the baby quickly and use some force to extract them from the birth canal.

Here is a list of risk factors that often lead to Erb’s palsy in newborns.

Breech Delivery

Babies born breech (buttocks or feet first) have a higher risk of Erb’s palsy because their arms may be raised and more easily hurt by extra pressure.

Prolonged Labor

When the second stage of labor (the pushing stage) lasts more than an hour, the newborn has a greater chance of Erb’s palsy.

“A long-lasting ‘pushing stage’ may put an infant at greater risk of Erb’s palsy and other brachial plexus injuries.”

– Baptist Health

An extremely long first stage of labor (contraction phase) also places a baby at risk of Erb’s palsy.

Shoulder Dystocia

Shoulder dystocia occurs when one or both of the baby’s shoulders get stuck behind the mother’s pubic bones during a vaginal delivery. In Greek, “dys” means difficult and “tokos” means birth.

Shoulder dystocia is considered a medical emergency, according to Cleveland Clinic.

This obstetric complication occurs in only 0.6% to 1.4% of babies weighing between 5 pounds, 8 ounces and 8 pounds, 13 ounces at birth, but 5% to 9% of babies born weighing more than 8 pounds, 13 ounces, the hospital reports.

These factors can also cause shoulder dystocia:

  • A baby in the wrong position
  • A mother with a small pelvic opening
  • A mother in a position that restricts the room in the pelvis

Although shoulder dystocia usually occurs during vaginal births, a baby’s shoulder can also get stuck during a C-section delivery.

Size of Baby or Mother

Erb’s palsy is more common when an infant is larger than normal — more than 8 pounds — or a mother is especially petite. In these cases, an obstetrician or midwife may need to pull a newborn out of the birth canal.

The two most important risk factors for Erb’s palsy are shoulder dystocia and an abnormally large infant, according to one medical report.

Use of Medical Instruments

During a complicated delivery, a doctor may use equipment like forceps or a vacuum extractor to help with a birth and remove the baby from the birth canal. Improper use of these tools can injure the baby’s neck and shoulder and cause Erb’s palsy and other types of birth injuries.

Doctors sometimes use forceps or a vacuum extractor when there is shoulder dystocia, increasing the risk of injury in these complicated delivery cases.

Other Risk Factors

A mother who had a previous pregnancy involving an infant with shoulder dystocia is at greater risk of having a baby with Erb’s palsy as is a mother who is pregnant with more than one baby.

Some other risk factors include a mother who is overweight or has diabetes or gets medications like oxytocin or an epidural during labor.

Mothers with diabetes have a 1 in 5 chance of delivering a baby weighing more than 8 pounds, 13 ounces at birth.

If your child was born with Erb’s palsy, contact our team today to learn about potential legal options you may have.

Causes of Erb’s Palsy & Medical Malpractice

Medical malpractice occurs when a doctor or other medical professional acts negligently and causes harm to a patient.

“Medical malpractice is negligence committed by a professional health care provider — a doctor, nurse, dentist, technician, hospital or hospital worker — whose performance of duties departs from a standard of practice of those with similar training and experience, resulting in harm to a patient or patients.”

– American Bar Association

Erb’s palsy is often caused by a physician’s failure to follow the standard of care.

A medical professional can cause Erb’s palsy by:

  • Delivering a child vaginally instead of performing a C-section
  • Misusing medical equipment such as forceps or a vacuum extractor
  • Using excessive force to deliver a newborn from the birth canal

If your child has Erb’s palsy, it may be because of medical negligence. If that’s the case, you may be able to pursue financial compensation through an Erb’s palsy lawsuit.

While most children make a full recovery from Erb’s palsy, some are not so lucky. Children with the most serious type of Erb’s palsy may have a lifelong disability. In these cases, which are known as avulsion, the child’s nerve roots have been completely torn from the spine.

Financial compensation from a medical malpractice suit can help parents pay for different Erb’s palsy treatment options, lost wages, and more. Many Erb’s palsy cases have ended in settlements awarding families more than $1 million in compensation.

If you believe a medical error played a role in your child’s Erb’s palsy, contact today. One of our team members can help you take the first step in pursuing compensation — and justice — with a free, no-obligation case review.

Can Erb’s Palsy Be Prevented?

Many cases of Erb’s palsy are preventable with medical training and proper planning.

For example, if during a routine baby check an obstetrician finds that a baby is larger than normal or is in the incorrect position, they can prepare for a complicated birth. They should ensure that qualified medical personnel are in the delivery room and induce labor or perform a Cesarean section (C-section), if needed.

The doctor should have a safety checklist prepared to treat a mother who is delivering vaginally and at risk for shoulder dystocia, according to Cleveland Clinic.

Safety steps that a health care provider may take include:

  • Call for help from other medical professionals like an anesthesiologist, neonatal specialist, and extra labor and delivery team members
  • Decide if the mother needs an episiotomy to help with the delivery
  • Use certain maneuvers to move the mother or infant into a better position

In cases in which the above techniques fail to work, the doctor may:

  • Break the infant’s clavicle (collarbone) to deliver the shoulders
  • Make a cut in the cartilage between the mother’s pubic bones to widen the pelvic opening
  • Perform a C-section

The bottom line is that doctors should monitor their patients for shoulder dystocia and other Erb’s palsy risk factors and take appropriate action during delivery to lessen the likelihood that a child will be affected by a brachial palsy injury.

Every member of the labor and delivery team should be trained on what to do. When they fail to meet the standard of care, they can and should be held accountable.

If you suspect that your child’s Erb’s palsy was caused by a preventable medical mistake, may be able to help. Contact one of our team members right now for a free case review.

FAQs About Causes of Erb’s Palsy in Newborns

What causes brachial palsy in newborns?

Brachial plexus birth palsy, also known as Erb’s palsy, is typically caused by a stretch injury to an infant’s neck and shoulder during childbirth.

In many cases, doctors who pull or tug on the baby’s head to deliver them from the birth canal cause brachial palsy. Other Erb’s palsy causes include medical professionals who misuse equipment such as forceps or vacuum extractors to deliver a child.

What nerve causes Erb’s palsy?

Erb’s palsy is caused by injury to a network of nerves known as the brachial plexus nerves. These nerves run from the neck to the shoulder and then down the arm and into the hand.

In the case of Erb’s palsy, the nerve injury is in the infant’s neck and shoulder area.

What are three common Erb’s palsy causes?

Three common causes of Erb’s palsy are:

  • A doctor who uses excessive force in delivering a newborn from the birth canal
  • An unusually large infant (birth weight more than 8 pounds)
  • Shoulder dystocia, a condition in which the baby’s shoulders get stuck behind the mother’s pubic bones

Is Erb’s palsy the doctor’s fault?

Possibly. In many cases, doctors and other members of the labor and delivery team make medical errors that lead to Erb’s palsy in the newborn. For example, they may proceed with a vaginal birth when risk factors are present instead of performing a C-section or misuse assistive birthing tools such as forceps or a vacuum extractor.

When a doctor makes a preventable medical mistake that causes harm, they can be held accountable through a medical negligence or malpractice claim. Icon

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  1. Baptist Health. “Erb’s Palsy.” Retrieved from: Accessed on March 14, 2023.
  2. Basit H, Ali CDM, Madhani NB. “Erb Palsy.” Retrieved from: Accessed on March 14, 2023.
  3. Cleveland Clinic. “Erb’s Palsy.” Retrieved from: Accessed on March 14, 2023.
  4. Cleveland Clinic. “Shoulder Dystocia.” Retrieved from: Accessed on March 6, 2023.
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