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Brachial Plexus Birth Injury (Erb's Palsy)

Nerve injury to baby's arm during difficult delivery causing weakness or paralysis - most recover with physiotherapy by age 2, severe cases may need nerve surgery or tendon transfers

πŸ“…Last reviewed: December 2025πŸ₯Bones & Joints

πŸ“–What is Brachial Plexus Birth Injury (Erb's Palsy)?

Nerve injury to baby's arm during difficult delivery causing weakness or paralysis - most recover with physiotherapy by age 2, severe cases may need nerve surgery or tendon transfers

πŸ”¬What Causes It?

  • Shoulder dystocia during vaginal delivery (baby's shoulder stuck behind mother's pubic bone - most common cause 70-80%)
  • Excessive lateral neck flexion during delivery (pulling baby's head sideways stretches nerves - iatrogenic injury)
  • Breech delivery (feet-first delivery with arms trapped overhead - stretches upper nerve roots)
  • Prolonged second stage labor (extended pushing phase >2 hours increases injury risk)
  • Forceps or vacuum-assisted delivery (increased traction forces on baby's head and neck)

⚠️Risk Factors

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You may be at higher risk if:

  • Large baby (macrosomia >4.5kg or 10 lbs - 3-5x increased risk, shoulder too wide for birth canal)
  • Maternal diabetes (gestational or pre-existing - causes fetal macrosomia, shoulder dystocia risk)
  • Maternal obesity (BMI >30 - larger babies, difficult delivery positioning)
  • Previous shoulder dystocia delivery (recurrence risk 10-15% in subsequent pregnancies)
  • Prolonged labor (>12-18 hours total labor, especially prolonged second stage)
  • Assisted delivery (forceps or vacuum - increase traction forces on baby)
  • Post-term pregnancy (>42 weeks - larger babies)

πŸ›‘οΈPrevention

  • βœ“Optimal prenatal care (manage gestational diabetes to prevent macrosomia - reduces shoulder dystocia risk 30-50%)
  • βœ“Delivery planning for high-risk pregnancies (large baby >4.5kg on ultrasound - consider elective cesarean section discussion)
  • βœ“Experienced obstetric care during delivery (skilled management of shoulder dystocia if occurs - McRoberts maneuver, suprapubic pressure, reduce traction forces on baby's head)
  • βœ“Avoid excessive lateral neck flexion during delivery (pulling baby's head sideways main mechanism of nerve injury)
  • βœ“Early recognition and management of shoulder dystocia (reduces duration of impaction, minimizes nerve stretch)
  • βœ“Cesarean section for previous shoulder dystocia (recurrence prevention - discuss risks/benefits with obstetrician)