A brachial plexus injury claim may arise where a baby suffers damage to the nerves controlling movement and sensation in the shoulder, arm and hand during birth. Some injuries recover with time, while others can result in lasting weakness or disability. Coleman Legal LLP examines how the delivery was managed and whether avoidable injury may have occurred.
What the brachial plexus is
The brachial plexus is a network of nerves running from the neck through the shoulder and into the arm.
If these nerves are stretched or damaged during birth, a baby may have reduced movement, weakness or loss of sensation in the affected arm. More serious injuries can involve a nerve tear or an avulsion, where the nerve is separated from the spinal cord.
Erb’s palsy is the term commonly used where the upper nerves of the brachial plexus are affected.
Many babies with a mild stretch injury make a substantial recovery. More severe injuries may require physiotherapy, specialist monitoring or surgery and can leave permanent limitations in the affected arm.
How a brachial plexus injury can arise at birth
Brachial plexus injury is associated with shoulder dystocia, an obstetric emergency in which the baby’s shoulders do not deliver after the head and additional manoeuvres are required.
The Royal College of Obstetricians and Gynaecologists reports that brachial plexus injury occurs in approximately 2.3% to 16% of births affected by shoulder dystocia. However, the injury can also occur without shoulder dystocia and has been reported following caesarean delivery.
When shoulder dystocia occurs, the maternity team should recognise the emergency promptly and use accepted manoeuvres to release the impacted shoulder. Excessive downward or lateral traction on the baby’s head should be avoided because it may increase the risk of nerve injury.
When a brachial plexus injury claim may arise
Neither shoulder dystocia nor a brachial plexus injury automatically means that medical negligence occurred.
A claim requires evidence that the care provided fell below the standard reasonably expected and that this caused or materially contributed to the child’s injury.
The investigation may consider how the delivery was planned, how shoulder dystocia was recognised and managed, what manoeuvres were used and whether inappropriate traction was applied.
Factors associated with an increased likelihood of shoulder dystocia include a previous shoulder dystocia, maternal diabetes, a larger baby, prolonged labour and assisted vaginal delivery. These factors do not reliably predict every case, and shoulder dystocia frequently occurs unexpectedly.
What evidence is needed
The maternity records are central to investigating a brachial plexus injury claim. These may include antenatal records, CTG traces, labour and delivery notes, shoulder dystocia documentation and neonatal assessments.
An independent obstetric expert can review how the birth was managed and whether the care met the appropriate standard.
Where the child has an ongoing disability, additional expert evidence may be required to assess the extent of the injury, prognosis, treatment needs and any long-term requirement for therapy, care or assistance.
Time limits where a child is injured
Different limitation rules apply where the injured person is a child.
A claim can be brought on behalf of a child while they are under 18, usually through a parent or guardian acting as their next friend. If no claim is brought during childhood, the Courts Service states that the injured person generally has two years after turning 18 to bring the personal injury claim themselves.
Families do not therefore have to wait until the child reaches adulthood. Early investigation can also help ensure that maternity records, CTG traces and other important evidence are obtained promptly.
Medical negligence claims are not assessed by the Injuries Resolution Board and are pursued through the courts.
