• gestational diabetes
• obesity in the mother
• excessive weight gain during pregnancy
• macrosomia (a baby weighing more than 4000 grams or approximately 9 lbs.)
• a previous large baby
• a post-term pregnancy
• a small pelvis.

• Not recognizing or properly responding to fetal distress,
• Allowing the pregnancy to go beyond 41 weeks without proper testing, or 42 weeks in any event,
• Failing to act on changes in the mother's condition during pregnancy,
• Causing or failing to respond to the umbilical cord being entrapped or compressed,
• Misuse of a vacuum extractor or forceps,
• Misuse of the labor-stimulating drug Pitocin (Oxytocin),
• Delay in ordering or performing a C-section,
• Poor resuscitation and newborn care after birth.

The process of childbirth is extremely complicated and requires a high level of care on the part of doctors. Childbirth is extremely unpredictable, in fact, 80% of childbirths have some form of complication. All of these potential complications mean that doctors must make sudden split-second decisions to react to problems during childbirth. Unfortunately, too often a doctor or nurse may make the wrong decision under pressure and that error could cause Erb's Palsy (Brachial Plexus).

Modern medical technology and techniques make Erb's Palsy largely preventable. There are several things doctors can do to decrease the risk of an Erb's Palsy childbirth:

Estimate the baby's weight before delivery (higher-weight babies are more at risk and parents should be informed of this risk).

If there is a high risk of Erb's Palsy, perform a caesarean section, which removes the risk of the shoulder getting caught.

If the doctor sees that the baby is not properly aligned, the doctor should use appropriate techniques to prevent the shoulder from getting caught. There are numerous techniques doctors know to prevent the shoulder from getting caught. For example, if the shoulder or the baby is gently shifted, the risk of the shoulder getting caught can be greatly reduced. Or, the doctor could press down on the mother's belly to push the baby's shoulder into the correct position.

This is not to say that all Erb's Palsy cases are the result of negligence. Often there is little or nothing a doctor can do. Nevertheless, parents should consider the possibility that a doctor may not have done all that is possible to prevent Erb's Palsy and at least request some form of inquiry.

It is essential that treatment for a Brachial Plexus injury be obtained as soon as possible from experienced medical professionals who specialize in treating Brachial Plexus injuries. Early treatment for Brachial Plexus injuries most likely will include occupational and/or physical therapy to help maximize use of the affected arm while preventing contactures (tightening of the muscles and joints).

It is important to note that even with ongoing therapy treatment and surgical intervention, complete recovery from a Brachial Plexus injury may not occur.

What can be expected with treatment?
Most mild cases of Brachial Plexus injuries recover in 3 to 4 months. The more severe cases improve slowly over 18 to 21 months. By 2 years of age, any recovery that will occur should have occurred, and no further improvement is expected. Treatment consists of Physical Therapy and Surgery.

Therapy for Brachial Plexus Injuries
An occupational or physical therapist will work with your child. The therapist will also help you (the parent) learn to do the exercises. Most parents need to do the range of motion exercises at home with their children two to three times a day for several years.

We recommend daily exercises that help to keep the muscles and joints moving normally. They are called range of motion exercises.

1. Provide tactile stimulation to provide sensory awareness
2. Use exercise to develop strength.
3. Most exercises inclus tasks to increase flexibility, stength and feeling.

If your child is not able to use muscles in the arm and hand, these muscles will stay weak. The arm may not grow normally, and your child may feel tightness in some muscles and joints. A joint that stays in the same position all the time can actually "freeze". Exercises keep the muscles and joints flexible. When the nerves start working better, the muscles and joints will be ready to work.

Surgery for Brachial Plexus Injuries
Surgery may help children who do not recover by the age of 5 months. Nerve surgery is most effective when it is done between the ages of 5 and 12 months and becomes less effective after 1 year. Nevertheless, surgical correction for permanent disability or deformity can be performed in the school-aged child where necessary.

For some children, neurosurgery is not recommended or is not sucessful. In these instances, other procedures can be done to transfer muscles and tendons. This surgery is done by a plastic surgeon when the child is older.

Paying for medical care
The costs for treatment and surgery could overwhelm most families. Families must be able to dedicate long hours to doctor's visits and treatment. Financial support may be available to families in the form of legal compensation.