Every year, about 1 to 2 out of every 1,000 babies born in the United States suffer a brachial plexus injury during delivery. When a doctor applies excessive force during a difficult birth, the nerves controlling your child’s arm and shoulder can stretch, tear, or rupture — sometimes permanently. Under Missouri Revised Statute § 516.105, families have two years from the date of injury to file a medical malpractice claim for an Erb’s palsy birth injury, though a minor’s claim may be tolled until they reach age 18. Christopher R. Dixon, a Super Lawyers 2024–2025 honoree and lifetime member of the Million Dollar Advocates Forum, has spent his career holding negligent medical providers accountable across St. Louis.
The Dixon Injury Firm has recovered over $60 million for clients throughout St. Louis, Clayton, Florissant, and St. Charles County — including a $12 million wrongful death verdict and a $2.75 million premises liability recovery. If your child suffered a brachial plexus injury during birth, call (314) 208-2808 for a free case review. You don’t pay unless we win.
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Erb’s palsy is a type of brachial plexus injury that occurs when the nerves in a newborn’s upper arm are damaged during birth. The brachial plexus is a network of five nerves (C5–T1) running from the spinal cord through the neck and into the arm, and damage to the upper nerves (C5–C6) is what specifically causes Erb’s palsy. The result is weakness, loss of feeling, or partial to complete paralysis of the affected arm.
Brachial plexus refers to this bundle of nerves that controls movement and sensation in the shoulder, arm, and hand. When these nerves are stretched or torn during delivery, a baby may be born with one arm hanging limp at their side — a condition parents often notice within the first hours of life.
So how does this happen? Most Erb’s palsy injuries trace back to the moment of delivery itself. When a baby’s shoulder gets stuck behind the mother’s pelvic bone — a complication called shoulder dystocia — the delivering physician must act quickly. But “quickly” doesn’t mean recklessly. Pulling too hard on the baby’s head, twisting the neck at an extreme angle, or using excessive lateral traction during a shoulder dystocia event can stretch or tear the brachial plexus nerves.
Here’s what parents often don’t realize: shoulder dystocia isn’t always an emergency that comes out of nowhere. Risk factors are frequently visible on prenatal charts — high birth weight (macrosomia), gestational diabetes, a history of shoulder dystocia in prior deliveries, and prolonged labor. When a physician ignores these warning signs and fails to plan accordingly, that failure can cross the line from an unfortunate outcome into actionable medical negligence.
As a St. Louis birth injury lawyer, Christopher R. Dixon has reviewed hundreds of delivery room records and understands exactly how preventable these injuries often are.
Shoulder dystocia alone isn’t malpractice. But how a physician responds to it — and whether they should have anticipated it — often is. A medical malpractice claim for Erb’s palsy requires proving that the delivering physician deviated from the accepted standard of care, and that this deviation directly caused the nerve injury.
Standard of care means the level of treatment and skill that a reasonably competent medical professional in the same specialty would provide under similar circumstances. In a shoulder dystocia scenario, the standard of care includes recognized maneuvers like the McRoberts maneuver (hyperflexing the mother’s legs), suprapubic pressure, or delivering the posterior arm first. Excessive downward traction on the baby’s head is almost universally considered below the standard.
Two distinct failure points typically define negligence:
Before delivery: Did the physician identify risk factors for shoulder dystocia? A baby estimated at over 9 pounds, a mother with gestational diabetes, or a prior delivery complicated by shoulder dystocia should all trigger a conversation about a planned cesarean section. Ignoring these indicators and proceeding with vaginal delivery without informed consent can constitute negligence.
During delivery: Even when shoulder dystocia is unexpected, physicians are trained in specific emergency maneuvers. Applying excessive force, using fundal pressure (pushing on the top of the uterus, which is generally contraindicated), or panicking and pulling too aggressively on the baby’s head — these actions fall below the standard of care.
Missouri courts evaluate these cases under Mo. Rev. Stat. § 538.210, which governs medical malpractice actions and requires an affidavit from a qualified medical expert. That expert must confirm that the physician’s actions fell below the accepted standard and directly caused the injury. Without this expert affidavit, the case can’t proceed.
If your child’s Erb’s palsy was caused by a delivery complication, a St. Louis medical malpractice lawyer can evaluate the medical records and determine whether negligence occurred.
Not all brachial plexus injuries are the same. The severity depends on which nerves were damaged and how badly. Understanding the type of injury your child suffered is critical to both their treatment plan and the value of your legal claim.
Nerves Affected: C5–C6
Severity: Mild
Recovery Outlook: Most recover within 3–6 months
Common Treatment: Physical therapy, monitoring
Nerves Affected: C5–C7
Severity: Moderate
Recovery Outlook: Partial recovery; some permanent weakness likely
Common Treatment: Physical therapy, possible surgery
Nerves Affected: C5–C7 or broader
Severity: Severe
Recovery Outlook: Won’t heal without surgical intervention
Common Treatment: Nerve graft surgery
Nerves Affected: Nerve root torn from spinal cord
Severity: Most severe
Recovery Outlook: Permanent damage without nerve transfer surgery
Common Treatment: Nerve transfer, muscle transfer
Avulsion injuries, where the nerve root is torn completely from the spinal cord, can’t be repaired by reattaching the nerve. Surgeons must reroute a less critical nerve to restore some function — a complex procedure called a nerve transfer that doesn’t always produce full recovery.
Many parents are told in the hospital that their baby’s arm weakness “will improve on its own.” And for mild neurapraxia injuries, that’s often true. But when a rupture or avulsion is mischaracterized as a simple stretch injury, families lose valuable time. Early surgical intervention — ideally before six months of age — produces significantly better outcomes for severe brachial plexus injuries.
A St. Louis nerve damage lawyer can work with pediatric neurologists to ensure your child’s injury is properly classified and that the full extent of damage is documented for your claim.
Yes — but it requires the right evidence and the right experts. Erb’s palsy malpractice cases are won or lost on medical records, expert testimony, and a clear chain of causation connecting the physician’s actions to the nerve damage.
Here’s what the evidence typically looks like in a successful claim:
Prenatal records: These show whether risk factors for shoulder dystocia were documented. Estimated fetal weight, maternal glucose levels, birth history, and labor progression notes all matter. If the physician knew or should have known that shoulder dystocia was likely, the failure to act on that knowledge is powerful evidence of negligence.
Delivery room records: The nursing notes, physician notes, and electronic fetal monitoring strips tell the story of what happened minute by minute during labor and delivery. Key details include the duration of shoulder dystocia (typically measured in seconds or minutes), which maneuvers were attempted, and whether excessive traction was applied.
The baby’s medical records: An Erb’s palsy diagnosis is usually documented within hours of birth. The specific nerve roots involved, the degree of motor function loss, and the treatment recommendations all help quantify the injury’s severity.
Expert witness testimony: Under Mo. Rev. Stat. § 538.225, Missouri requires expert testimony from a physician in the same specialty as the defendant. For an Erb’s palsy case, that typically means a board-certified obstetrician who can testify that the delivering physician’s actions fell below the accepted standard.
$2.75 million recovered in a premises liability case and $12 million in a wrongful death verdict — these results reflect the caliber of preparation Christopher R. Dixon brings to complex injury claims. Birth injury cases demand the same level of thorough investigation and aggressive advocacy.
At The Dixon Injury Firm, we don’t take a generic approach to Erb’s palsy cases. We developed the 3-Phase Birth Injury Accountability Method specifically because these cases require a combination of medical knowledge, legal precision, and compassion that most firms can’t deliver.
Phase 1: Medical Record Reconstruction (Days 1–30)
We obtain and review every prenatal record, labor and delivery note, nursing log, and fetal monitoring strip from your child’s birth. Christopher R. Dixon, born and raised in St. Louis with deep knowledge of the local medical community, personally reviews these records alongside a consulting pediatric neurologist. We’re looking for the exact moment the standard of care was breached — and we document it in a timeline that becomes the backbone of your case.
Phase 2: Expert Validation and Damage Assessment (Days 30–90)
We retain board-certified experts in obstetrics, pediatric neurology, and life care planning. The obstetrician confirms the negligence. The neurologist grades the injury and projects your child’s long-term prognosis. The life care planner calculates the cost of future surgeries, physical therapy, occupational therapy, and adaptive equipment your child will need throughout their life. This phase is where we build the financial case that supports a full recovery.
Phase 3: Accountability and Resolution (Days 90+)
Armed with expert reports and a damage model, we file the claim and pursue maximum compensation. Because Christopher R. Dixon is recognized by the National Trial Lawyers Association as a Top 100 Trial Lawyer, insurance companies and hospital defense teams know we won’t accept a lowball offer. We prepare every case as if it’s going to trial — and that preparation is what drives better settlements.
Not sure where to start? That’s exactly what a free case evaluation is for. Call (314) 208-2808 and we’ll tell you honestly whether your child’s case has merit.
The damages in an Erb’s palsy case depend on the severity of the injury, the extent of future medical needs, and the impact on your child’s life. Missouri allows families to pursue both economic and non-economic damages.
What It Covers: Hospital bills, surgeries, therapy to date
How It’s Calculated: Itemized from medical billing records
What It Covers: Surgeries, physical/occupational therapy, adaptive equipment
How It’s Calculated: Life care plan prepared by certified planner
What It Covers: Physical pain your child has endured and will endure
How It’s Calculated: Based on injury severity, duration, and impact
What It Covers: Reduced ability to work as an adult
How It’s Calculated: Economist projections based on injury limitations
What It Covers: Inability to participate in activities other children enjoy
How It’s Calculated: Comparative analysis of limitations vs. peers
What It Covers: Mental anguish of watching your child suffer
How It’s Calculated: Testimony and psychological evaluation
Key insight: Many families underestimate future medical costs. A child with a moderate brachial plexus injury may need physical therapy sessions two to three times per week for years, nerve graft surgery costing $50,000 to $100,000 or more, and ongoing occupational therapy into adolescence. A life care plan that fails to account for these costs leaves money on the table.
Medical errors are the third leading cause of death in the United States, responsible for an estimated 250,000 deaths annually (Johns Hopkins University, 2016). While Erb’s palsy is rarely fatal, it represents the same systemic failures in medical care — and families deserve full accountability when those failures harm a child.
A St. Louis childbirth injury lawyer who understands how to build a complete damage model can mean the difference between a settlement that covers this year’s bills and one that protects your child for life.
If your child was born at a St. Louis hospital — Barnes-Jewish Hospital, SSM Health St. Mary’s Hospital, Mercy Hospital St. Louis, or Missouri Baptist Medical Center — your case will likely be filed in the St. Louis City Circuit Court or the St. Louis County Circuit Court in Clayton.
Missouri’s medical malpractice procedures require filing a health care affidavit within 90 days of the lawsuit under Mo. Rev. Stat. § 538.225. This affidavit must come from a legally qualified health care provider who reviewed the facts and believes negligence occurred. Missing this requirement can result in dismissal.
How long do Erb’s palsy cases take in St. Louis? Most birth injury malpractice cases take 18 to 36 months from filing to resolution. Cases that settle during mediation — which the St. Louis Circuit Court often encourages — may resolve faster. Cases that go to trial can take longer, but trial preparation is what produces the strongest settlement offers.
St. Louis juries have historically been receptive to birth injury claims involving clear evidence of physician negligence. The key is presenting the medical evidence in a way that a jury of non-medical professionals can understand. Christopher R. Dixon’s experience trying cases in St. Louis courtrooms — and his deep roots in this community, including co-founding The St. Louis Suit Project, a 501(c)(3) charitable organization — means he understands both the legal system and the people who serve on these juries.
Missouri’s statute of limitations provides an important protection for families: while the general malpractice limitation is two years, claims on behalf of minors may be tolled under Mo. Rev. Stat. § 516.170 until the child approaches adulthood. But waiting years to investigate weakens evidence and makes the case harder to prove. Medical records get archived, nurses change jobs, and memories fade.
Evidence preservation matters from day one. If your child was injured during delivery, the sooner an attorney reviews the records, the stronger your claim will be. Call (314) 208-2808 — we answer around the clock, including weekends and holidays.
We know this isn’t just a legal case. It’s your child. Here are three specific commitments we make to every Erb’s palsy family:
Available 24/7. Five stars across 282 Google reviews. Over $60 million recovered. And a genuine belief that every child who was harmed by medical negligence deserves a lawyer who treats their case like it’s the only one on the desk.
The information on this page is for general informational purposes and doesn’t constitute legal advice. Every case is unique — past results don’t guarantee future outcomes. Contact a qualified attorney to discuss your specific situation.
Your child’s future shouldn’t be defined by a preventable injury. Call The Dixon Injury Firm at (314) 208-2808 for a free, confidential case review. Missouri’s statute of limitations is running — and the evidence your case depends on won’t last forever.
At The Dixon Injury Firm, there’s no upfront cost. We handle Erb’s palsy cases on a contingency fee basis, meaning you pay nothing unless we recover compensation for your family. All investigation, expert, and court costs are advanced by the firm. If your case doesn’t result in a recovery, you owe us zero.
Missouri’s general statute of limitations for medical malpractice is two years from the date of injury (Mo. Rev. Stat. § 516.105). However, because Erb’s palsy involves a minor, the statute may be tolled under Mo. Rev. Stat. § 516.170. Even so, early investigation is critical because medical evidence degrades over time, and waiting weakens your case.
Erb’s palsy settlements vary widely based on severity. Mild cases involving temporary weakness may settle for $100,000 to $300,000. Moderate cases requiring surgery often range from $500,000 to $1.5 million. Severe avulsion injuries with permanent paralysis can exceed $2 million or more. Each case depends on the specific nerve damage, future medical needs, and strength of the negligence evidence.
If your child was born with arm weakness or paralysis following a difficult delivery — especially one involving shoulder dystocia — negligence may have occurred. Warning signs include excessive pulling during delivery, failure to perform a cesarean section despite known risk factors, or improper use of delivery instruments. A qualified medical expert can review your child’s birth records to determine if the standard of care was breached.
Most Erb’s palsy malpractice cases settle before trial. However, preparation for trial is what drives stronger settlement offers. Christopher R. Dixon prepares every case as if it will be tried before a jury, and that preparation gives insurance companies and hospital defense teams a reason to offer fair compensation rather than risk a courtroom verdict.
Possibly. Missouri’s tolling provisions for minors may extend the filing deadline. However, the longer you wait, the harder it becomes to gather evidence, locate witnesses, and build a strong case. If your child was injured during birth, contact an attorney as soon as possible for a case evaluation.
Hospitals and their insurance carriers routinely characterize birth injuries as unavoidable complications. That’s a legal strategy, not a medical fact. An independent review of the delivery records by a board-certified obstetrician can determine whether the physician’s actions fell below the accepted standard of care. Many injuries hospitals call “unavoidable” are anything but.
A strong Erb’s palsy case typically involves three types of experts: a board-certified obstetrician who can testify about the standard of care during delivery, a pediatric neurologist who can grade the nerve injury and project long-term outcomes, and a life care planner who calculates the cost of future medical treatment, therapy, and adaptive equipment.
Long-term effects depend on the type and severity of the nerve injury. Mild neurapraxia injuries often resolve within months. But ruptures and avulsions can cause permanent weakness, limited range of motion, muscle atrophy, and chronic pain. Some children develop a noticeable size difference between their arms. These lifelong effects are factored into the compensation your family pursues.
Yes. Erb’s palsy cases require a lawyer who understands both the medical and legal complexities of birth injuries. These cases hinge on interpreting fetal monitoring strips, understanding obstetric maneuvers, and working with specialized medical experts. A general personal injury attorney may lack the specific knowledge needed to build a winning claim.
Many personal injury law factories get as many clients in the door as possible, hoping one will be the jackpot. Not us. At The Dixon Injury Firm, we’re highly selective about our cases because we devote considerable time and attention to each client.
