Birth injury & birth trauma
"Why Won't My Baby Move Their Arm?" Shoulder Dystocia, Erb's Palsy and the Questions You're Allowed to Ask
In this article
If your baby was born with a weak or floppy arm after a frightening birth, you may be living with guilt, confusion and a lot of unanswered questions. I'll explain what shoulder dystocia and Erb's palsy are, what the hospital was expected to do, and how a lawyer actually works out whether something went wrong. Mostly, I want you to know that wanting answers is not the same as being ungrateful.
You're not imagining it.
You noticed it in the first hours.
Your baby's arm hung by their side. It didn't move like the other one.
Maybe a nurse said it would "come good". Maybe a doctor used the word Erb's in passing, and you nodded because you were too exhausted to ask what it meant.
And maybe you don't really remember the birth itself. Just that it suddenly became urgent. More people in the room. Someone pushing on your belly. Your legs being pulled back towards your chest. A doctor pulling, hard. A silence that felt like it went on forever.
Now you're doing physio exercises with a newborn. Or you're sitting in a specialist's waiting room, or reading about nerve surgery at 2am. And underneath all of it is a question you might be afraid to say out loud:
Did this have to happen?
Please hear me on this. You are allowed to ask that question. It doesn't make you ungrateful that your baby survived. It doesn't mean you're looking for someone to blame. It means you're a parent who wants to understand what happened to your child. That is one of the most natural things in the world.
What actually happened at the birth
Let's start with the medical words, because so often they're thrown at parents in the moment and never properly explained.
Shoulder dystocia
After your baby's head was born, one of their shoulders became stuck behind your pubic bone. It's an obstetric emergency, and maternity staff are trained to manage it with a specific sequence of manoeuvres.
In plain terms: your baby's shoulder got caught on the way out, and the team had minutes to free it safely. You can read more on Pregnancy, Birth and Baby's shoulder dystocia page.
Brachial plexus injury and Erb's palsy
The brachial plexus is a bundle of nerves running from the neck into the shoulder, arm and hand. When those nerves are stretched or torn during birth, the arm can become weak or paralysed. An injury to the upper nerves is called Erb's palsy.
In plain terms: the nerves that make your baby's arm work were damaged. The Royal Children's Hospital Melbourne has a clear fact sheet on brachial plexus palsy.
Many babies recover well over the first months. Some don't, and some need specialist surgery. The RCH explains how specialist brachial plexus teams care for these babies.
And it's worth saying: shoulder dystocia can hurt mothers too. If you were left with a severe tear or heavy bleeding after the birth, those injuries matter as well. They're yours.
What the hospital was expected to do
This is the part most parents never get told. Shoulder dystocia is frightening, but it isn't mysterious. It's one of the most rehearsed emergencies in maternity care, and there are known steps before, during and after.
Before the birth: knowing your risk.
Shoulder dystocia is more likely when a baby is large, when the mother has diabetes in pregnancy, or when there's been a shoulder dystocia before. If those risks were present in your pregnancy, someone should have talked with you about them, including whether a planned caesarean might be safer.
Let's say you were told at 36 weeks that your baby was "measuring big", and you had gestational diabetes. Was anything said about what that might mean for the birth? Were you given a choice, or just a date for induction?
Material risk
Since the High Court's decision in Rogers v Whitaker, Australian doctors must tell patients about the material risks of a treatment. That means the risks a reasonable person in your position would want to know about, or that this doctor knew you would care about.
In plain terms: you were entitled to the information you needed to make a real choice about how your baby was born.
If forceps or a vacuum were used.
Assisted births can increase the risk when a baby is large or labour has stalled. RANZCOG's patient information on assisted birth acknowledges that, rarely, babies can suffer nerve injuries. Whether that decision was right, and whether you were told, are fair questions.
During the emergency: the manoeuvres, and what not to do.
When a shoulder is stuck, staff are trained to call for help and move through a set of manoeuvres. These include bringing your legs back towards your chest and pressing just above your pubic bone. Sydney's Royal Hospital for Women sets this out in its shoulder dystocia procedure, which tells staff to avoid sideways and downward pulling on the baby's head.
That matters, because excessive pulling on the head and neck is one of the main ways a baby's nerves are damaged.
If what you remember is someone pulling hard on your baby's head, hold onto that memory. It may be important.
After the birth: the notes, and the follow-up.
Staff are expected to record what happened: which manoeuvres, in what order, how long it took, which shoulder was stuck. Gaps or vagueness in those notes can tell their own story. A baby with a weak arm should also be referred early to a specialist team, because timing can affect recovery.
If this is landing for you, and you're realising that parts of your story were never explained, you don't have to work it out alone. I'm happy to listen, with no pressure to do anything next.
What "negligence" really means
I want to demystify this word, because it carries so much weight and it's rarely explained.
When I look at a birth injury, I'm not asking "was this a bad outcome?" Bad outcomes happen in medicine even when everyone does everything right. I'm asking two quite specific questions.
Standard of care
Did the care you and your baby received fall below what was reasonably expected of a competent clinician at the time? That's assessed with the help of independent medical experts who review your records.
In plain terms: did they do what a careful doctor or midwife should have done?
Causation
If the care did fall short, did that failure actually cause the injury? Or would it have happened anyway?
In plain terms: would your baby's arm be okay if things had been done properly?
Both have to be shown. That's why I'm careful never to promise anyone an answer before the evidence is in. But it's also why the question is worth asking properly, rather than being waved away with "these things happen".
Questions worth sitting with
You don't need to know the medical answers. That's not your job. But as you think back, you might gently notice whether any of these feel true.
Were you told your baby was big, but no one really talked about what that meant for the birth? Did you have diabetes in pregnancy and never hear the word "caesarean" as an option? Do you remember the pulling? Did your baby also have a broken collarbone or arm? Has their arm still not come right after several months, or have they needed surgery?
None of these, on their own, proves anything. But if one of them made your stomach drop a little, that's worth paying attention to.
And an honest word.
Shoulder dystocia can't always be predicted, and not every brachial plexus injury means someone did something wrong. I'd rather tell you that now than have you hear it later. What I can tell you is that an independent review of the records is the only way to know. And you deserve to know.
You're also far from alone in asking. When the NSW Parliament inquired into birth trauma, its 2024 Birth Trauma report drew on thousands of families' experiences of frightening, disempowering births.
What a claim can and can't do
A claim can't turn back time. I wish it could.
What it can do, if your child has a lasting injury, is help pay for the therapy, surgery and equipment they'll need. It can support them at school and at home, and recognise how the injury may shape their working life one day. It can also recognise what this has cost you as a parent: the appointments, the lost work, the worry.
For a lot of families, though, the most valuable thing is simply an honest answer.
There are other routes to answers too, and they can sit alongside a claim. NSW public hospitals have an open disclosure process for talking with families when something goes wrong. You can make a complaint to the Health Care Complaints Commission, which explains what you can complain about. Or you can raise a concern about an individual practitioner with Ahpra. I can talk you through how these fit together.
Looking after yourself in the meantime.
Caring for a baby with an injury, while processing a traumatic birth, is a lot to carry. Birth Trauma Australia offers peer support from people who've been there. PANDA runs a national perinatal mental health helpline on 1300 726 306. Please reach for them if you need to.
Frequently asked questions
My baby's arm is getting better. Should I still talk to someone?
It's worth a conversation. Some babies recover fully, but for others, weakness becomes clearer as they grow. Getting advice early means nothing is lost if recovery stalls.
Is there a time limit?
Yes. In NSW, time limits are set by the Limitation Act 1969, and the rules for children's claims can be complicated. Please don't assume you have plenty of time.
I keep thinking I should have pushed harder, or done something differently.
I hear this so often, and I want to be really clear: shoulder dystocia is never the mother's fault. Managing it safely is the job of the people caring for you.
Do I need to know exactly what went wrong before I get in touch?
No. Most people who contact me don't know. Working that out, with the help of independent experts, is my job.
A closing thought
You may have spent months being told to focus on the positives: your baby is here, the arm might improve, you should be grateful.
You can be grateful and want the truth. Both can be true at once.
So I'll leave you with a gentle question. If you gave yourself permission to want answers, without guilt, what would you want to know?
Keep reading: Birth injury and birth trauma · When a stillbirth may have been preventable · "They said it was just a headache": missed pre-eclampsia
This article is general information only. It is not legal or medical advice, and reading it does not create a lawyer–client relationship. Every situation is different. If you are in crisis, please call Lifeline on 13 11 14 or 000 in an emergency.
