Plain-English guide for Kentucky families about brachial plexus birth injuries, shoulder dystocia, and the evidence used to evaluate whether an injury was preventable.
Updated August 2026
When a baby is born with weakness or paralysis of one arm after a difficult delivery, parents may be told the child has a brachial plexus birth injury, sometimes called brachial plexus birth palsy.
When the upper portion of the brachial plexus is affected, the condition is commonly called Erb’s palsy.
One of the first questions families ask is:
Could this injury have been prevented?
That question cannot be answered simply by showing that:
- Shoulder dystocia occurred
- The baby was large
- Vacuum or forceps were used
- The baby’s arm was weak after birth
- A brachial plexus injury became permanent
In a Kentucky medical-negligence case, the medical records and qualified expert testimony generally must address several separate questions:
Was shoulder dystocia reasonably predictable before delivery?
Once it occurred, was it recognized and managed appropriately?
Was excessive or inappropriate traction applied?
Were accepted maneuvers used appropriately?
Could the nerve injury have occurred despite appropriate care?
What medical evidence supports the claimed mechanism of injury?
Those distinctions matter because shoulder dystocia and brachial plexus injury are not the same thing.
Shoulder Dystocia Itself Is Usually Difficult to Predict
The current ACOG Practice Bulletin on shoulder dystocia, reaffirmed in 2024, describes shoulder dystocia as an unpredictable obstetric emergency and notes that antepartum and intrapartum risk factors have extremely poor predictive value.
Known risk factors can include:
- Fetal macrosomia
- Maternal diabetes
- Prior shoulder dystocia
- Maternal obesity
- Prolonged second stage
- Operative vaginal delivery
But none reliably predicts whether shoulder dystocia will actually occur.
Many shoulder dystocias happen:
- Without diabetes
- Without a previous shoulder dystocia
- In babies who are not extremely large
- Without a clear warning immediately before delivery
That makes an important distinction in a birth injury case:
Failure to predict shoulder dystocia is different from failure to manage shoulder dystocia appropriately once it occurs.
What Is Shoulder Dystocia?
Shoulder dystocia occurs after the fetal head has delivered but the shoulders do not deliver with normal gentle traction and additional obstetric maneuvers are required.
Usually, the anterior shoulder becomes impacted behind the mother’s pubic bone.
Less commonly, the posterior shoulder may become impacted against the sacral promontory.
Shoulder dystocia is an emergency because the baby’s chest remains compressed in the birth canal while the shoulders are impacted.
The delivery team therefore needs to:
- Recognize what is happening
- Call for appropriate help
- Avoid unnecessary force
- Use maneuvers designed to release the impacted shoulder
- Continue escalating until the baby is delivered
- Prepare for newborn resuscitation
The objective is prompt, controlled delivery—not simply pulling harder.
What Is a Brachial Plexus Birth Injury?
The brachial plexus is the network of nerves extending from the neck that controls movement and sensation in the shoulder, arm, hand, and fingers.
Brachial plexus birth palsy occurs when some of those nerves are stretched, damaged, ruptured, or—in the most severe cases—avulsed from the spinal cord.
The American Academy of Orthopaedic Surgeons describes several broad types of brachial plexus injury:
- Neurapraxia: stretched or shocked nerve that remains intact
- Neuroma: nerve injury with scar formation
- Rupture: nerve torn away from itself but not the spinal cord
- Avulsion: nerve root torn from the spinal cord
The severity affects the likelihood of recovery.
Many babies improve substantially or completely.
Others have permanent weakness, limited range of motion, abnormal shoulder development, or need surgery and long-term therapy.
Is Erb’s Palsy the Same as a Brachial Plexus Injury?
Erb’s palsy is one type of brachial plexus birth palsy.
It most commonly involves the upper nerve roots, especially C5 and C6.
A newborn may have:
- Weak shoulder movement
- Difficulty lifting the arm
- Reduced elbow flexion
- An arm that rests internally rotated against the body
- Preserved finger movement
More extensive injuries can involve additional nerve roots and affect the hand as well.
The precise injury pattern can matter when physicians and experts evaluate prognosis and possible mechanism.
Does a Brachial Plexus Injury Prove Excessive Traction?
No.
This is one of the most important corrections to older, oversimplified discussions of Erb’s palsy litigation.
Brachial plexus injuries can occur:
- With documented shoulder dystocia
- Without documented shoulder dystocia
- During deliveries where clinician traction was used
- During deliveries where excessive clinician traction cannot be established
- Rarely, even after cesarean delivery
AAOS specifically notes that brachial plexus birth palsy can occur in babies without obvious risk factors and even following C-section.
A 2025 biomechanical review concluded that both endogenous forces—including uterine contractions and maternal pushing—and clinician-applied forces can stretch the brachial plexus. The authors also noted that there is currently no reliable biomechanical method for determining which type of force caused many less-severe brachial plexus injuries.
That means:
Brachial plexus palsy does not automatically prove that a clinician pulled too hard.
But the opposite conclusion would also be too broad.
Clinician-applied force can contribute to brachial plexus injury, particularly when inappropriate lateral or downward traction is used during shoulder dystocia.
Why Technique Still Matters
Although not every brachial plexus injury is preventable, shoulder-dystocia management is designed in part to minimize unnecessary stretching of the baby’s neck and brachial plexus.
Clinical guidance emphasizes maneuvers rather than force.
The American Family Physician review of shoulder-dystocia management, reflecting ACOG and other specialty guidance, cautions against aggressive lateral or downward traction because it can injure the brachial plexus.
This is where a preventability analysis often becomes case-specific.
An expert may ask:
- What happened when the head delivered?
- Was shoulder dystocia immediately recognized?
- What traction was attempted?
- Was aggressive lateral or downward traction used?
- Were appropriate maneuvers started?
- Did the team continue pulling while the shoulder remained impacted?
- Did maneuvers successfully create additional room or rotate the shoulders?
- How quickly did the baby deliver?
- What condition was the baby’s arm in immediately after birth?
What Should Staff Do When Shoulder Dystocia Occurs?
There is no single maneuver that works every time.
There also is not one rigid sequence that must be followed identically in every case.
But there are well-recognized principles.
1. Recognize and Announce the Emergency
When the head delivers but the shoulders do not follow with ordinary gentle traction, the clinician should recognize that shoulder dystocia may be occurring.
The team should clearly communicate that an emergency exists.
That allows staff to:
- Call additional obstetric help
- Notify anesthesia
- Prepare newborn-resuscitation personnel
- Track time
- Record maneuvers
- Prepare additional resources if needed
AAFP recommends an unequivocal announcement of shoulder dystocia, calling for assistance, and tracking the time from delivery of the head until complete birth.
2. Avoid Aggressive Pulling on the Head and Neck
Normal gentle axial traction may be used initially to determine whether the shoulders will deliver.
Once the shoulder is impacted, increasing traction is not the appropriate solution.
Aggressive lateral or downward traction can increase brachial plexus stretch.
That does not mean experts can later calculate from the medical chart precisely how many pounds or Newtons of force were used.
Usually they cannot.
There is no routine bedside force gauge documenting traction.
Instead, experts may rely on:
- Physician testimony
- Nurse testimony
- Parent or witness observations
- Delivery documentation
- The maneuvers recorded
- Fetal position
- Injury pattern
- Associated fractures or injuries
- Biomechanical and clinical literature
Even then, causation can remain disputed.
3. McRoberts Maneuver
A widely recommended first maneuver is McRoberts positioning.
The mother’s legs are sharply flexed toward the abdomen.
This changes the maternal pelvic orientation and can help free the impacted anterior shoulder.
McRoberts is:
- Simple
- Rapid
- Noninvasive
- Often effective
ACOG-linked guidance and AAFP recommend McRoberts as an initial maneuver.
4. Suprapubic Pressure
If McRoberts alone does not resolve the dystocia, suprapubic pressure may be applied.
Pressure is directed just above the pubic bone in a manner intended to move or rotate the impacted shoulder.
This is different from fundal pressure.
Fundal pressure is not suprapubic pressure.
Fundal pressure pushes downward on the top of the uterus.
It can worsen shoulder impaction and is not considered an appropriate shoulder-dystocia release maneuver.
The distinction can be important when reviewing nursing and delivery records.
5. Posterior Arm or Posterior Shoulder Delivery
If initial maneuvers do not work, delivery of the posterior arm or shoulder may create additional space.
The clinician reaches into the pelvis and attempts to free the posterior arm or shoulder.
AAFP notes that posterior-arm delivery should be considered when McRoberts and suprapubic pressure are unsuccessful. It also cites modeling suggesting relatively low brachial-plexus stretch with posterior-arm delivery compared with some alternatives.
The precise order of internal maneuvers can depend on:
- Fetal position
- Space available
- Operator experience
- Which shoulder is impacted
- Maternal position
- What has already been attempted
6. Internal Rotational Maneuvers
Internal maneuvers attempt to rotate the shoulders into a position that permits delivery.
Examples include:
- Rubin maneuver
- Woods corkscrew maneuver
- Reverse Woods maneuver
Another possible maneuver is the Gaskin all-fours position, in which the mother moves onto hands and knees when feasible.
No single technique is universally successful.
The important principle is systematic progression through appropriate release maneuvers rather than escalating traction on the baby’s head.
Does the Team Have to Follow One Exact Maneuver Order?
No.
This is an area where a legal article can easily become too rigid.
McRoberts and suprapubic pressure are widely used early because they are quick and relatively noninvasive.
After that, the best next maneuver can depend on the individual anatomy and what the operator finds.
For example, an experienced clinician might move to:
- Posterior-arm delivery
- Posterior-shoulder delivery
- Internal rotation
- Hands-and-knees positioning
depending on the circumstances.
The legal question ordinarily is not:
“Did the doctor follow one internet checklist in exactly this order?”
The better questions are:
Were appropriate maneuvers used?
Were they performed competently?
Was harmful force avoided?
Did the team respond effectively to maneuvers that failed?
Why Documentation Matters
A well-documented shoulder-dystocia record can substantially clarify what occurred.
Important details include:
- Time the fetal head delivered
- Time shoulder dystocia was recognized
- When additional help was summoned
- Maternal position
- Maneuvers attempted
- Order of maneuvers
- Who performed each maneuver
- Whether suprapubic pressure was used
- Whether posterior-arm delivery was attempted
- Whether internal rotation was attempted
- Time the body delivered
- Neonatal condition at birth
AAFP specifically recommends precise documentation of the head-to-body delivery interval and maneuvers performed.
Sparse documentation does not automatically prove that care was negligent.
But missing details may make it harder to reconstruct the emergency later.
The Head-to-Body Delivery Interval
The head-to-body interval is the time between delivery of the baby’s head and delivery of the rest of the body.
It can help establish:
- Duration of the dystocia
- Timing of maneuvers
- Neonatal hypoxia risk
- Whether the documented sequence is internally consistent
But there is no simple rule that says:
“More than X seconds means malpractice.”
Shoulder dystocias differ dramatically in severity.
A long interval can occur despite skilled management of a severe impaction.
A shorter interval does not automatically establish that excessive traction was absent.
The complete sequence matters.
What About Fetal Monitoring?
Unlike an HIE or delayed-C-section case, the fetal-heart-rate tracing is usually not the central evidence proving a brachial plexus mechanism.
It can still matter.
For example, the tracing may help explain:
- Why expedited delivery was being attempted
- Whether vacuum or forceps were used before the dystocia
- How urgent the fetal condition appeared
- Whether cesarean delivery was being considered
- Events immediately before delivery
But fetal compromise does not make excessive traction on an impacted shoulder medically appropriate.
Urgency may explain why rapid delivery was necessary.
It does not eliminate the need for appropriate shoulder-release maneuvers.
What If Vacuum or Forceps Were Used Before Shoulder Dystocia?
Operative vaginal delivery is a recognized risk factor associated with shoulder dystocia.
If vacuum or forceps preceded the shoulder dystocia, records may help answer a separate set of questions:
- Was operative vaginal delivery appropriate to attempt?
- Was the fetal head engaged?
- Was fetal position known?
- What was the station?
- How many vacuum pulls occurred?
- Were there cup detachments?
- Was descent occurring?
- Was the attempt abandoned appropriately?
- Was there sequential instrument use?
These questions concern the operative vaginal delivery before the shoulder dystocia.
They should not be confused with the maneuvers used after the shoulders became impacted.
Is a Large Baby Proof That Shoulder Dystocia Was Preventable?
No.
Fetal size increases the risk, but prediction remains imperfect.
ACOG’s 2025 quality-improvement guidance notes that third-trimester ultrasound estimates of fetal weight are imprecise and calls for individualized counseling about vaginal versus cesarean delivery when macrosomia is suspected.
Many large babies are delivered vaginally without shoulder dystocia.
Many shoulder dystocias occur in babies who are not extremely large.
Therefore:
Macrosomia is a risk factor—not proof that shoulder dystocia should necessarily have been predicted or prevented.
But Can Prenatal Decision-Making Still Matter?
Yes.
The fact that shoulder dystocia cannot be reliably predicted does not mean prenatal facts are always irrelevant.
Experts may evaluate:
- Estimated fetal weight
- Maternal diabetes
- Prior shoulder dystocia
- Prior birthweights
- Prior brachial plexus injury
- Pelvic and labor history
- Accuracy and limitations of ultrasound estimates
- Counseling about delivery options
- Whether circumstances met accepted criteria for considering planned cesarean delivery
The evaluation is individualized.
A risk factor alone does not establish negligence.
Can Brachial Plexus Injury Happen Without Shoulder Dystocia?
Yes.
This is a medically important point jurors may hear from defense experts—and sometimes from plaintiff experts as well.
Brachial plexus palsy has been documented:
- Without recognized shoulder dystocia
- After otherwise uncomplicated vaginal birth
- Following cesarean birth
A published review of obstetric cases has also found a substantial proportion of brachial plexus injuries without documented shoulder dystocia.
That evidence is one reason courts cannot simply infer:
brachial plexus injury = excessive physician traction.
A case usually requires expert analysis of the individual delivery.
What Does the Newer Biomechanical Research Say?
A 2025 review of the biomechanics of brachial plexus injury provides a useful current perspective.
The authors concluded that:
- Shoulder dystocia is the strongest risk factor for brachial plexus palsy
- Both maternal and clinician-applied forces can generate brachial-plexus strain
- More severe applied forces are consistent with more severe nerve injury
- Existing biomechanical models have limitations
- There is currently no reliable biomechanical method to determine whether endogenous or clinician-applied forces caused many less-severe injuries
- Reductions in severe permanent injuries following clinician training suggest that clinician-applied forces during shoulder dystocia can contribute to severe injury risk
That is considerably more nuanced than either extreme:
“Every injury was caused by the doctor pulling.”
or
“Doctor-applied traction never causes brachial plexus injury.”
Both are too simplistic.
Why Shoulder-Dystocia Training Matters
Shoulder dystocia can occur suddenly and with little warning.
That makes simulation particularly important.
Teams can practice:
- Recognizing the emergency
- Calling for help
- Assigning roles
- Tracking time
- McRoberts positioning
- Suprapubic pressure
- Posterior-arm delivery
- Rotational maneuvers
- Communication
- Documentation
- Neonatal preparation
ACOG states that systematic management and simulation training can improve outcomes and documentation.
A 2022 observational study involving more than 113,000 vertex deliveries reported a 55% reduction in permanent brachial plexus birth injury after implementation of systematic multiprofessional shoulder-dystocia simulation training. The authors also noted greater use of successful posterior-arm delivery after training.
Earlier long-term training research likewise found marked reductions in brachial plexus injury as guideline compliance improved.
These studies support the importance of training.
They do not mean that an injury automatically proves a hospital lacked adequate training.
What Evidence May Matter in a Kentucky Brachial Plexus Case?
A jury does not receive the baby’s diagnosis and simply decide whether the result “feels preventable.”
In a typical Kentucky medical-negligence case, qualified experts explain:
- The applicable medical standard of care
- What the records show
- Whether care breached that standard
- Whether any breach caused the injury
Kentucky’s Supreme Court reaffirmed this framework in Diagnostic X-Ray Physicians, PSC v. Lloyd, decided June 25, 2026. The Court explained that a typical medical-malpractice plaintiff must present expert testimony concerning the applicable standard of care, breach, and resulting injury.
For a brachial plexus case, evidence may include several categories.
1. The Shoulder-Dystocia Delivery Note
This is often the starting point.
Look for:
- Head-delivery time
- Recognition of dystocia
- Head-to-body interval
- Maneuvers
- Sequence
- Personnel involved
- Maternal position
- Description of traction
- Delivery time
- Newborn condition
2. Nursing Documentation
Nursing records may independently document:
- When shoulder dystocia was announced
- Calls for additional staff
- Maneuvers
- Positions
- Timing
- Neonatal personnel
- Delivery
- Newborn arm findings
Nursing notes can be especially useful when the physician’s delivery note is brief.
3. Operative Vaginal Delivery Records
If vacuum or forceps were used, collect:
- Reason for instrument use
- Fetal position
- Station
- Vacuum or forceps type
- Number of pulls
- Cup detachments
- Descent
- Duration
- Reason for abandonment
- Sequential instrument use
These records can show what occurred immediately before the shoulder dystocia.
4. Fetal-Monitoring Records
The complete fetal tracing can help establish the urgency surrounding the delivery and any decision to use operative assistance.
Ask for:
- Complete tracing
- Uterine-contraction record
- Annotations
- Nursing assessments
- Provider notification
Again, fetal monitoring usually helps establish context, not the mechanical cause of the brachial plexus injury.
5. Newborn Examination
The first newborn examinations can provide important information about:
- Which arm is affected
- Shoulder movement
- Elbow flexion
- Wrist movement
- Hand and finger movement
- Moro reflex
- Sensation
- Clavicle fracture
- Humerus fracture
The precise pattern may help physicians identify which brachial-plexus nerve roots are affected.
6. Pediatric Neurology and Brachial Plexus Specialty Records
Long-term evaluation may involve:
- Pediatric neurology
- Pediatric orthopedics
- Brachial plexus specialty clinics
- Physical therapy
- Occupational therapy
- Rehabilitation medicine
These records document:
- Recovery
- Persistent weakness
- Contractures
- Shoulder development
- Functional limitations
- Need for surgery
7. EMG and Nerve-Conduction Testing
Electromyography and nerve-conduction studies may sometimes be used to evaluate nerve function.
They can help physicians assess the location or severity of injury.
They do not necessarily identify the precise force that caused the injury during delivery.
That distinction is important.
8. Imaging
Depending on the child’s condition, doctors may use:
- X-rays
- Ultrasound
- MRI
- Other imaging
Imaging may identify:
- Fractures
- Shoulder abnormalities
- Nerve-root injury
- Associated musculoskeletal conditions
Again, the findings should be interpreted by appropriate specialists.
Do Fractures Prove Excessive Force?
No.
Clavicle and humerus fractures are recognized complications of difficult birth and shoulder dystocia.
A fracture may be relevant evidence, but it does not automatically establish negligent force.
In some situations, an intentional clavicle fracture is even recognized as a last-resort maneuver in a catastrophic unresolved shoulder dystocia.
Experts must evaluate:
- Which bone fractured
- Where it fractured
- When it was recognized
- The other delivery circumstances
- Maneuvers used
- Injury pattern
What Does a Plaintiff’s Expert Usually Focus On?
Depending on the facts, a plaintiff’s obstetric expert may evaluate whether:
- Shoulder dystocia was recognized promptly
- Excessive lateral or downward traction was applied
- Appropriate maneuvers were delayed
- The team repeatedly used traction rather than release maneuvers
- Fundal pressure was improperly used
- The delivery team failed to call for appropriate assistance
- An operative vaginal attempt should have been abandoned earlier
- Prenatal circumstances warranted different counseling or delivery planning
- The documented management differed from accepted obstetric practice
A causation expert may separately address whether the identified conduct more likely caused the particular nerve injury.
The two questions are related but not identical:
Was the care negligent?
and
Did that negligence cause this injury?
What Does the Defense Usually Focus On?
Defense experts may emphasize that:
- Shoulder dystocia could not reliably have been predicted
- The baby’s size did not mandate cesarean delivery
- Appropriate maneuvers were used
- Only ordinary gentle traction was applied
- The emergency was resolved promptly
- Brachial plexus injuries can occur despite proper management
- Endogenous maternal forces can stretch the brachial plexus
- Brachial plexus palsy occurs without shoulder dystocia in some births
- The injury pattern does not reliably identify clinician traction as the cause
- The child’s outcome was an unavoidable complication rather than negligent care
That is why the actual records matter more than generic statements about Erb’s palsy.
Can a Permanent Injury Make the Case Stronger?
Permanence can establish the seriousness of the injury.
It does not automatically establish negligence or causation.
Brachial plexus injuries exist on a spectrum.
Some children recover rapidly.
Others experience:
- Permanent weakness
- Limited shoulder motion
- Joint contractures
- Abnormal shoulder development
- Differences in arm length or size
- Difficulty with daily activities
- Need for nerve surgery
- Tendon-transfer surgery
- Orthopedic procedures
- Ongoing therapy
AAOS notes that the severity of the underlying nerve injury affects the potential for recovery and future treatment.
Those facts are important to damages even when liability remains disputed.
What Kentucky Judges Decide Before the Jury Hears an Expert
Kentucky’s expert-evidence rule changed effective July 1, 2024.
Under amended KRE 702, the proponent of expert testimony must demonstrate to the court that it is more likely than not that:
- The testimony is based on sufficient facts or data
- The testimony is the product of reliable principles and methods
- The expert’s opinion reflects a reliable application of those principles and methods to the facts of the case
The judge therefore serves as a gatekeeper before disputed expert opinions reach the jury.
This can be particularly important in brachial plexus cases because experts may disagree about:
- Biomechanics
- Traction
- Alternative causes
- Prenatal predictability
- Nerve injury mechanisms
- Whether medical literature supports a particular causal opinion
What the Jury Does After Expert Testimony Is Admitted
Once expert testimony is properly admitted, jurors weigh it along with the other evidence.
That can include:
- Medical records
- Physician testimony
- Nursing testimony
- Parent testimony
- Expert testimony
- Imaging
- Therapy records
- Demonstrative evidence
- Hospital policies when properly admitted
- Other relevant evidence
Kentucky’s 2026 Lloyd decision reiterates that expert testimony is ordinarily necessary in a medical-negligence case to define the applicable standard, breach, and resulting injury.
The jury is not simply asked:
“Was this a terrible outcome?”
It is asked to decide the legal claims based on admissible evidence.
Kentucky’s Certificate-of-Merit Requirement
Kentucky KRS 411.167 generally requires a claimant filing a covered medical-malpractice action to file a certificate of merit.
The certificate ordinarily states that the claimant:
- Reviewed the facts
- Consulted at least one appropriately qualified expert
- Has a reasonable basis to commence the action
The statute contains exceptions for certain claims in which expert testimony is not required.
A brachial plexus case involving shoulder-dystocia management and causation will ordinarily involve medical questions requiring expert review.
Does the Doctrine of Res Ipsa Loquitur Automatically Apply to Erb’s Palsy?
Families sometimes encounter the phrase res ipsa loquitur, meaning roughly that the circumstances themselves permit an inference of negligence.
That doctrine should not be casually applied to brachial plexus birth injury.
Kentucky’s Supreme Court explained again in Lloyd that most medical-negligence claims require expert evidence, with limited exceptions when negligence falls within ordinary lay understanding or when expert evidence supplies the foundation for a res ipsa inference.
Because brachial plexus palsy has multiple possible mechanisms and can occur without shoulder dystocia or demonstrable excessive traction, a diagnosis of Erb’s palsy does not automatically mean “the injury speaks for itself.”
Records Kentucky Families Should Request
If your child has a brachial plexus birth injury, consider requesting both the maternal labor-and-delivery record and the baby’s newborn record.
Useful documents can include:
Maternal Labor and Delivery
- Admission records
- Labor flowsheets
- Complete fetal-monitoring record
- Nursing notes
- Physician and midwife notes
- Medication records
- Operative vaginal delivery documentation
- Shoulder-dystocia note
- Delivery record
- Cesarean operative record if applicable
- Anesthesia record
Shoulder-Dystocia Details
Look specifically for:
- Time head delivered
- Time shoulder dystocia recognized
- Turtle sign documentation, if present
- When help was called
- McRoberts maneuver
- Suprapubic pressure
- Posterior-arm or posterior-shoulder delivery
- Rubin/Woods or other rotational maneuvers
- Gaskin maneuver
- Any fundal pressure documentation
- Head-to-body interval
- Time baby delivered
Vacuum or Forceps Details
If applicable:
- Device
- Fetal position
- Station
- Number of pulls
- Number of pop-offs
- Progress with traction
- Duration
- Reason for stopping
- Sequential instruments
Newborn Records
Request:
- Delivery-room assessment
- Apgar scores
- Resuscitation record
- Newborn physical examinations
- Moro reflex documentation
- Arm movement
- Clavicle/humerus assessment
- Imaging
- Neurology consultation
- Orthopedic consultation
- Therapy referrals
Records That May Be Obtained Later
Additional evidence may exist outside the routine patient medical record.
Depending on the case, attorneys may investigate:
- Hospital shoulder-dystocia policies
- Training requirements
- Simulation records
- Staffing records
- Personnel assignments
- Communication logs
- Debrief documentation
- Other administrative evidence
These records should not be described as though Kentucky’s ordinary patient-record statute automatically requires their release before litigation.
Their relevance and availability depend on the specific circumstances.
Build a Shoulder-Dystocia Timeline
Use the records to complete this timeline.
Admission:
Estimated fetal weight:
Maternal diabetes: Yes / No / Unknown
Prior shoulder dystocia: Yes / No / Unknown
Vacuum or forceps used:
Fetal position before delivery:
Fetal station before operative delivery:
Head delivered:
Shoulder dystocia announced:
Help called:
McRoberts:
Suprapubic pressure:
Posterior arm/shoulder:
Rotational maneuver:
Other maneuver:
Body delivered:
Head-to-body interval:
Right or left arm affected:
Initial arm movement:
Clavicle/humerus fracture:
Neurology/orthopedic evaluation:
Physical therapy started:
Recovery to date:
If you cannot determine a fact from the records, write:
Unknown
rather than guessing.
Frequently Asked Questions
Does shoulder dystocia mean the doctor was negligent?
No.
ACOG describes shoulder dystocia as generally unpredictable, and risk factors predict it poorly.
Negligence depends on the care provided under the circumstances—not merely on the occurrence of the emergency.
Does permanent Erb’s palsy prove excessive traction?
No.
A permanent injury can be significant evidence of damages and injury severity, but it does not automatically establish the force or mechanism that caused it.
Experts may disagree about causation.
Can excessive traction cause brachial plexus injury?
Yes.
Aggressive lateral or downward traction can stretch the brachial plexus and is discouraged in shoulder-dystocia management.
But the existence of an injury does not establish that excessive clinician traction occurred.
Can maternal pushing cause a brachial plexus injury?
Endogenous forces from contractions and maternal pushing can generate brachial-plexus strain.
Current biomechanical literature recognizes both endogenous and clinician-applied forces as possible contributors.
For many less-severe injuries, there is no reliable retrospective method for determining the precise proportion attributable to each.
Can Erb’s palsy happen without shoulder dystocia?
Yes.
Brachial plexus birth palsy has been documented without recognized shoulder dystocia and after cesarean delivery.
Does a large baby prove the delivery should have been a C-section?
No.
Estimated fetal weight is imprecise, and most large babies do not experience shoulder dystocia.
The appropriate delivery plan depends on the complete maternal and fetal circumstances.
Should McRoberts always be first?
McRoberts is widely recommended as an initial maneuver because it is quick, simple, and noninvasive.
After initial measures, however, the appropriate sequence may vary according to the circumstances and operator judgment.
Is fundal pressure appropriate during shoulder dystocia?
Fundal pressure is different from suprapubic pressure and is generally avoided in shoulder-dystocia management.
The aim is to release or rotate the impacted shoulder rather than push it more firmly into the pelvis.
Does the doctor have to document how hard they pulled?
There is generally no objective force measurement during an ordinary delivery.
Documentation may describe traction as gentle or routine, but the actual mechanism often becomes an issue for expert testimony and witness evidence.
Do shoulder-dystocia drills matter in a lawsuit?
They may provide relevant systems context.
Research has associated systematic simulation training with improved management and reductions in brachial plexus injury.
But the absence or presence of a particular drill does not independently establish negligence in one delivery.
Do juries simply choose between two experts?
Expert testimony is important, but jurors may also consider the medical records, witness testimony, physical evidence, and other admissible evidence.
Before an expert opinion reaches the jury, the judge also has a gatekeeping role under KRE 702.
Can the medical records alone tell us whether the injury was preventable?
Sometimes the records answer important questions clearly.
Often they do not answer the ultimate question without expert analysis.
A meaningful review usually evaluates:
prenatal risk → delivery circumstances → shoulder-dystocia response → neonatal injury pattern → long-term outcome
Questions About a Brachial Plexus Birth Injury in Kentucky?
If your child was diagnosed with Erb’s palsy or another brachial plexus birth injury after a difficult delivery, Morrin Law Office can help identify the records needed to understand what happened.
A review can examine:
- Whether shoulder dystocia occurred
- What risk factors were known beforehand
- Whether vacuum or forceps were used
- How the dystocia was recognized
- Which maneuvers were performed
- How the delivery was documented
- The newborn examination
- The type and severity of nerve injury
- Whether further qualified expert review is appropriate
The goal is not to assume that every brachial plexus injury was preventable.
It is to determine what the specific medical evidence supports.
Call Morrin Law Office for a free consultation
859-358-0300
214 W Main St., Richmond, KY 40475
Sources and Public Resources
- American College of Obstetricians and Gynecologists — Practice Bulletin No. 178: Shoulder Dystocia (2017; reaffirmed 2024). Current ACOG bulletin addressing the poor predictability of shoulder dystocia, recognized management techniques, systematic response, documentation, and simulation training.
ACOG — Shoulder Dystocia Practice Bulletin - American Family Physician — Shoulder Dystocia: Managing an Obstetric Emergency (2020). Public clinical review covering recognition, McRoberts positioning, suprapubic pressure, posterior-arm delivery, rotational maneuvers, avoidance of aggressive traction, simulation, and documentation.
AAFP — Shoulder Dystocia: Managing an Obstetric Emergency - **American Academy of Orthopaedic Surgeons — Erb’s Palsy (Brachial Plexus Birth Palsy). ** Explains brachial plexus anatomy, neurapraxia, neuroma, rupture, avulsion, diagnosis, recovery, and treatment; also notes that brachial plexus palsy may occur without traditional risk factors and after cesarean delivery.
AAOS OrthoInfo — Erb’s Palsy / Brachial Plexus Birth Palsy - Siegmund & Roberts — Biomechanics of Brachial Plexus Injuries Due to Shoulder Dystocia (2025). Current review of endogenous and clinician-applied forces, injury severity, biomechanical evidence, and the limits of retrospectively determining the precise force responsible for many brachial plexus injuries.
PubMed — 2025 Brachial Plexus Biomechanics Review - Gurewitsch et al. / BJOG — Impact of Simulation Training on Shoulder Dystocia and Permanent Brachial Plexus Birth Injury (2022). Observational study reporting improved management and a 55% reduction in permanent brachial plexus birth injury after systematic multiprofessional simulation training.
PubMed — Shoulder Dystocia Simulation and Permanent BPBI - Crofts et al. — Prevention of Brachial Plexus Injury—12 Years of Shoulder Dystocia Training (2015). Long-term study reporting greater compliance with recognized maneuvers and substantial reductions in brachial plexus injury after embedded shoulder-dystocia training.
PubMed — 12 Years of Shoulder Dystocia Training - Pathophysiologic Origins of Brachial Plexus Injury (2020). Clinical study reporting brachial plexus injuries both with and without shoulder dystocia, illustrating why injury alone does not establish a single mechanism.
PubMed — Pathophysiologic Origins of Brachial Plexus Injury - ACOG — Quality-Improvement Strategies for Safe Reduction of Primary Cesarean Birth (2025). Notes that third-trimester ultrasound estimates of fetal weight are imprecise and recommends individualized counseling when macrosomia is suspected.
ACOG — Quality-Improvement Strategies for Safe Reduction of Primary Cesarean Birth - Kentucky Revised Statutes — KRS 411.167. Kentucky’s certificate-of-merit statute for covered medical-malpractice actions, including the general requirement for consultation with a qualified expert before filing.
Kentucky Legislature — KRS 411.167 - Kentucky Supreme Court — Diagnostic X-Ray Physicians, PSC v. Lloyd (June 25, 2026). Current published Kentucky Supreme Court decision explaining the general requirement for expert evidence concerning the applicable medical standard of care, breach, and resulting injury in medical-negligence litigation.
Read Diagnostic X-Ray Physicians v. Lloyd - Kentucky Supreme Court Order 2024-19 — Amendment of KRE 702. Effective July 1, 2024, Kentucky’s expert-evidence rule requires the proponent to establish to the court that the reliability requirements of KRE 702 are more likely than not satisfied.
Kentucky Court of Justice — Supreme Court Order 2024-19
Disclaimer
This page provides general educational information about shoulder dystocia, brachial plexus birth injuries, and Kentucky medical-negligence litigation.
It is not medical advice and should not be used to make decisions about a child’s current medical care. Families with questions about Erb’s palsy, arm weakness, or a suspected brachial plexus injury should consult appropriate pediatric medical specialists.
It is also not individualized legal advice. Shoulder dystocia, brachial plexus palsy, a permanent nerve injury, vacuum or forceps use, or a poor outcome does not by itself establish medical negligence or causation.
The significance of any birth injury depends on the prenatal history, labor and delivery records, maneuvers used, newborn findings, injury pattern, expert evidence, applicable Kentucky law, and other case-specific facts.
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