Produced by CYP Physiotherapy
Version 4
Date of issue: September 2017
Date of review: December 2024
Next review date: December 2026
If review date has passed, the content will apply until the next version is published
What is Obstetric Brachial Plexus injury (OBPI)?
Obstetric Brachial Plexus injury (OBPI) is usually caused by stretching of the nerves in your baby’s neck during birth. Another term you may hear used for OBPI is Erb’s Palsy.
When a nerve is injured, the muscles that the nerve controls will be weakened, even though the muscles are not injured. OBPI causes weakness of the muscles of your baby’s arm and your baby will have difficulty moving his/ her shoulder, elbow and wrist. Your baby’s arm will tend to lie down at his/her side with the elbow straight, the wrist bent and the hand pointing backwards. Your baby should be able to move his /her fingers. Your baby may not have much feeling in their arm and there may be some swelling or bruising.
How does an OBPI occur?
OBPI usually occurs during a difficult delivery. This may be because the baby is large, a breech presentation, or a prolonged labour. It may also happen when the baby must be delivered quickly to prevent more serious harm to the mother or the baby. Some force may be necessary to move the baby from the birth canal.
The baby's shoulder and neck may be stretched and injury to the nerves that run from the neck down into the arm may result. A brachial plexus birth injury may therefore be a necessary consequence of being born alive after a difficult situation has arisen.
When will the movement of my baby’s arm recover?
In most cases, the injury resolves within the first month to six weeks. Some infants will recover more slowly and will be referred to the National Obstetric Brachial Plexus Injury service.
In the early weeks after birth your baby will be followed up locally to monitor progress.
Caring for your baby with OBPI
- If your baby’s arm is very floppy it should be well supported with the hand, elbow and shoulder in a neutral position. Place a towel under the affected arm during day time naps to help keep your baby’s arm in this position. Adhere to safe sleep guidelines.
- Move your baby’s arm gently during washing and dressing. When putting your baby’s clothes on, dress your baby’s affected arm first. When taking your baby’s clothes off undress your baby’s affected arm last.
- When holding, feeding and cuddling your baby, your baby’s affected arm should be well supported.
- Gently touch your baby’s arm and hand.
- Don’t pull your baby’s arm.
- When lifting your baby, hold around his/her chest, avoid lifting under the armpits.
Moving your baby's arm
- Avoid moving your baby’s shoulder for a few days after birth.
- You can move your baby’s hand, wrist and elbow from birth. Slip your thumb or finger into your baby’s hand and encourage him/her to grasp. Gently turn your baby’s hand, bringing the wrist back. Take your baby’s hand up to his/ her mouth, bending the elbow.
- After a few days, you can begin to move your baby’s shoulder.
- Your baby may be referred for Physiotherapy assessment and treatment as appropriate.
Useful information
Accessible formats
If you require this information in a community language or alternative format such as Braille, audio, large print, BSL, or Easy Read, please contact the Equality and Human Rights Team at: email: fife.EqualityandHumanRights@nhs.scot or phone 01592 729130. For people with a hearing or verbal impairment you can also contact the team through the NHS Fife SMS text service number on 07805800005.
