Attacking the Brachial Plexus Injury Defense

Some obstetricians say that brachial plexus injuries in newborns are caused solely by uterine contractions. However, this self-serving theory has no proof.

The brachial plexus network of nerves conducts signals from the brain to the shoulder, arm, and hand. When excessive force or lateral traction is applied to the baby’s shoulder stuck behind the mother’s pelvic bone, injuries can occur. In most cases, injuries are temporary but some infants suffer permanent nerve damage, loss of muscle control, and paralysis.

Pennsylvania trial lawyers who represent these children must be savvy about the brachial plexus literature. Older literature reflects the cause as excessive force and lateral traction. However, in the past few years obstetric researchers have published reports hypothesizing that these researchers are unpredictable and are caused by uterine contractions.

One researcher in Wisconsin noted that propulsive action in the uterus is so strong it can stretch the brachial plexus causing erb’s palsy, a weakness in the upper arm. With no substantial backings, these articles may have been published to help doctors defend lawsuits.

Based on the theory that brachial plexus theory can occur in births uncomplicated by shoulder dystocia (stuck shoulder), these researchers attempted to create a mathematical model to show that these injuries were caused by uterine compression on brachial plexus nerves. The researchers used data from a 1960 study that measured the amount of pressure contractions on exerted on the largest part of the fetal head during the first and second stages of labor. The study only examined 36 patients.

They attempted to hypothesize force to the part of the fetal neck overlying the roots of the brachial plexus. The authors say their model likens the uterus and the fetus to a hard piston. The authors readily admit their model doesn’t take into consideration how soft tissue would absorb and dissipate the force of uterine contractions.

The study was heavily refuted by noted by obstetricians who wrote a letter to the American Journal of Obstetrics and Gynecology detailing the flaws and pointing out that it violates Newton’s equilibrium law.

Sources: Information for this article is based on materials in, an article written by Les Weisbrod and Pat Stein for Association of Trial Lawyers of America and the Nurse Service Organization.

Michael Monheit, Esquire is the managing attorney for Monheit Law, located in Philadelphia, Pennsylvania. Monheit Law, P.C. concentrates its practice in the field of plaintiff personal injury cases on a contingency fee basis. They can be found at


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