Birth injury litigation involving brachial plexus injuries remains one of the most significant and actively litigated areas of medical malpractice in the United States. These cases, which typically arise from complications during vaginal delivery, involve complex medical causation questions and can result in substantial jury verdicts reflecting the permanent, life-altering nature of the injuries sustained by affected children.
On July 14, 2026, a Wake County, North Carolina jury returned a verdict of $18.2 million in favor of a six-year-old child and his mother against WakeMed and treating obstetrician Dr. Brenner, finding that the physician’s deviation from the standard of care during delivery caused a complete brachial plexus avulsion resulting in permanent loss of function in the child’s left arm. The verdict included a non-economic damages award of $16 million dollars.
II. Medical Background: Brachial Plexus Injuries
A. Anatomy and Mechanism of Injury
The brachial plexus is a network of nerves originating from the cervical spine (nerve roots C5 through T1) that courses from the neck through the shoulder and controls all motor and sensory function in the shoulder, arm, and hand. These nerves can be injured in three ways: stretching (neuropraxia), rupturing (neuroma), or avulsion—complete tearing of the nerve root from the spinal cord. Avulsion injuries are the most severe and typically result in permanent loss of function, as the nerve cannot regenerate once torn from the cord.
B. Erb’s Palsy
Erb’s palsy (also called Erb-Duchenne palsy) is the most common form of brachial plexus birth injury, accounting for approximately 45–60% of cases. It involves injury to the upper nerve roots (C5–C6) and produces characteristic weakness or paralysis of the shoulder and upper arm—the affected infant cannot flex the elbow or lift the arm. More extensive injuries involving all five nerve roots (C5–T1), result in total loss of arm function.
C. Incidence and Relationship to Shoulder Dystocia
Brachial plexus birth injuries are rare, occurring in approximately 0.8 to 2.6 per 1,000 live births. The majority arise in the context of shoulder dystocia—a delivery complication in which the baby’s anterior shoulder becomes impacted behind the mother’s pubic bone after delivery of the head. Brachial Plexus injuries occur in approximately 1–20% of shoulder dystocia cases. While more injuries resolve spontaneously within months, approximately 3–10% result in permanent nerve damage. Permanent injury generally indicates avulsion of the nerve roots.
D. Risk Factors
Recognized clinical risk factors for shoulder dystocia and associated brachial plexus injury include:
- Fetal macrosomia (estimated birth weight greater than 4,000–4,500 grams)
- Maternal gestational diabetes or borderline gestational diabetes
- Prior history of shoulder dystocia in a previous delivery
- Maternal obesity
- Prolonged or precipitous second stage of labor
- Operative vaginal delivery (vacuum or forceps extraction)
- Multiparity
These risk factors are often present in cases involving birth injuries. The presence of these risk factors in the medical record should often prompt the obstetric team to plan for or (at least) discuss cesarean delivery.
III. Litigation of Brachial Plexus Birth Injury Claims
A. Common Liability Theories
Brachial plexus birth injury malpractice claims are typically brought under one or more of the following theories of liability:
1. Excessive Lateral Traction
The most common liability theory alleges that the delivering physician applied excessive lateral traction—pulling or twisting force—on the fetal head and neck during delivery in the presence of shoulder dystocia, rather than employing recognized release maneuvers. The standard-of-care maneuvers for shoulder dystocia management are commonly summarized by the “HELPERR” mnemonic and include the McRoberts maneuver (hyperflexion of maternal thighs), suprapubic pressure, rotational maneuvers (Woods or Rubin), delivery of the posterior arm, and episiotomy. Experts have opined that the degree of nerve damage (particularly avulsion) is inconsistent with proper technique and indicative of excessive force.
2. Failure to Plan for or Perform Cesarean Delivery
Where risk factors for shoulder dystocia are documented in the prenatal record, it may be alleged that an obstetric provider failed to counsel the patient regarding the risks of vaginal delivery and the option of a planned cesarean section.
3. Failure to Recognize and Respond to Shoulder Dystocia
Relatedly, some cases involve a provider failing to timely recognize shoulder dystocia when it occurs and failing to implement appropriate release maneuvers in a timely and sequential fashion, instead resorting to improper traction or rotation.
B. Factors Indicating Brachial Plexus Injuries Correspond to a Deviation from the Standard of Care
Cases involving Brachial Plexus Injuries often involve the following patterns and factual scenarios:
- Use of an unauthorized maneuver or excessive force. Evidence that the provider applied forceful rotation or lateral traction on the fetal head/neck rather than recognized release maneuvers (McRoberts, suprapubic pressure, shoulder rotation, posterior arm delivery, or episiotomy) is the single strongest liability factor.
- Eyewitness or contemporaneous evidence of the force applied. Cases with eyewitness testimony (e.g., a family member present at bedside observing pulling), documented time delays between delivery of the head and body, or neonatal resuscitation records tend to support the plaintiff’s narrative of a traumatic delivery.
- Documented but unaddressed risk factors. Where the prenatal record documents fetal macrosomia, gestational diabetes, or prior shoulder dystocia, and no cesarean section was offered or recommended, juries may find that the provider failed to exercise reasonable care in delivery planning.
- Informed-consent failure. Evidence that the mother was not counseled about shoulder dystocia risk or the option of cesarean delivery, despite documented suspicion of risk factors, strengthens the plaintiff’s case on both negligence and patient autonomy grounds.
- Expert testimony establishing the standard-of-care violation. As with all medical malpractice claims, plaintiff must present qualified expert testimony establishing the applicable standard of care and the provider’s deviation therefrom.
- Objective evidence of permanent injury. Permanent nerve avulsion (as opposed to stretch injuries that resolve), documented through imaging, EMG/nerve conduction studies, and surgical records (nerve transplant or reconstruction), both supports the negligence inference (the degree of force required to avulse a nerve) and establishes significant damages.
Conclusion
Brachial plexus birth injuries can permanently alter the course of a child’s life and that of their family. Brachial plexus birth injury litigation continues to produce significant verdicts and settlements nationwide, driven by the permanent nature of the injuries, the often-compelling liability narratives involving preventable harm to newborns, and the substantial lifetime economic and noneconomic damages associated with permanent loss of arm function.
The $18.2 million verdict in Lake v. WakeMed represents one of the largest reported brachial plexus verdicts in 2026 and highlights several key features of this litigation area: the importance of specific evidence regarding the maneuvers employed during delivery; the power of characterizing a deviation from the standard of care as a “never” event; and the role of statutory damages frameworks in determining whether a jury’s full assessment of damages will stand.
In these cases, as in all medical malpractice cases, it is important for a Plaintiff to retain counsel who understand the specific jurisdictional damages framework, the critical role of expert testimony on standard-of-care maneuvers, and the substantial exposure that exists. Contact the experienced team of attorneys at Wyche, P.A. to determine if you or a loved one may need skilled representation relating to a medical malpractice case.
