The mildest form of nerve injury, caused by compression or stretching without a break in the nerve fiber itself. Function typically returns on its own within days to a few weeks.
Understanding Nerve Injury From Forceps Delivery
A forceps-assisted delivery is usually safe, but when forceps are misapplied or used with too much force, they can injure the delicate nerves in a newborn’s face or neck. This page is here to help you understand what a nerve injury from forceps looks like, what may have caused it, and what options your family may have.
What is nerve injury from forceps?
Forceps are curved metal instruments a physician may use to help guide a baby’s head through the birth canal during a difficult delivery. When positioned and applied correctly, forceps are generally considered a safe delivery tool. But a newborn’s facial nerve sits very close to the surface of the skin near the ear, so even modest pressure from a misplaced blade can compress, stretch, or, in rare cases, tear the nerve.
Facial nerve palsy, weakness or paralysis in the muscles on one side of a baby’s face, is the nerve injury most commonly linked to forceps use. Forceps can also contribute to injuries affecting other nerves in the head, neck, and shoulder area, including the brachial plexus. Many nerve injuries from forceps are mild and resolve on their own within weeks to months, though some are more severe and require ongoing medical care.
Signs and symptoms of nerve injury from forceps
Doctors often describe forceps-related nerve injuries based on how they appear immediately after birth and how they may affect a child over time. Some injuries are apparent right away, while others become noticeable as a baby grows and misses developmental milestones. In the first hours and days after delivery, parents and healthcare providers may notice signs such as:
- One side of the face does not move when the baby cries or startles, known as asymmetric crying facies
- The eyelid on one side does not close fully or blink normally
- The mouth appears to droop or pull toward one side
- The crease between the nose and mouth (nasolabial fold) is flattened on the affected side
- Difficulty nursing, sucking, or forming a seal around a bottle or nipple
- Excessive drooling on the affected side
- Eye irritation, dryness, or redness caused by an eyelid that will not fully close
What causes nerve injury from forceps?
- Forceps blades placed too close to, or directly over, the path of a nerve
- Excessive force, pulling, or rotation during forceps application
- A difficult or prolonged labor that requires repeated forceps attempts
- Use of forceps after a failed vacuum extraction attempt
- Prolonged pressure on the baby’s face against the birth canal or the mother’s pelvis
When nerve injury from forceps may be medical malpractice
- Forceps blades were placed incorrectly or without adequate visualization of the baby’s position
- Excessive force or repeated traction was used despite signs the delivery was not progressing safely
- The physician continued attempting a forceps delivery after a failed vacuum extraction without reassessing the risks
- Forceps were used despite indications the baby was not appropriately positioned for the procedure
- The medical team failed to recognize or respond to signs of nerve injury after delivery
- Parents were not informed of the risks associated with a forceps-assisted delivery
If you are concerned that your child’s nerve injury may have resulted from improper use of forceps, Wais, Vogelstein, Forman, Koch & Norman, LLC can review your delivery records alongside independent medical experts to help you understand what happened and what options may be available to your family.
Treatment and long-term outlook
Most infants with a mild nerve injury from forceps are closely monitored by their pediatrician, and many recover full function within weeks to a few months as the nerve heals on its own. More significant injuries may call for ongoing care, such as:
- Physical or occupational therapy to support muscle function and movement
- Eye protection, such as lubricating drops or a protective patch, when the eyelid cannot fully close
- Corticosteroid treatment in some cases
- Surgical options, such as nerve grafting or muscle transfer procedures, for injuries that do not improve over time
Every child’s recovery is different. A pediatric neurologist or specialist can offer the clearest picture of what to expect for your baby.
Injury Forms: Nerve Injury from Forceps
Recognizing the degrees of nerve injury from forceps.
Nerve injuries fall along a spectrum of severity. Understanding where your child’s injury falls can help your family know what to expect for recovery and what kind of care may be needed.
Neurapraxia (mild)
Neurotmesis (severe)
The most severe form of nerve injury, involving a complete or near-complete tear of the nerve. Recovery is usually incomplete without surgical repair.
Axonotmesis (moderate)
A more significant injury in which the nerve fibers are damaged but the surrounding protective sheath stays intact. Recovery is often possible, but it can take several months as the nerve regenerates.
Brachial plexus-related nerve injury
Forceps and other delivery complications can also affect the network of nerves running from the neck into the arm, leading to conditions such as Erb’s palsy. Visit our dedicated Erb’s Palsy (Brachial Palsy) page to learn more about this related injury.
Frequently Asked Questions
Common questions about nerve injury from forceps.
We know a new diagnosis can bring up a lot of questions, so we’ve answered a few of the ones we hear most often.
How is nerve injury from forceps different from Erb’s palsy?
Nerve injury from forceps most often refers to facial nerve palsy, which affects the muscles of the face. Erb’s palsy, by contrast, involves the brachial plexus, the network of nerves that controls movement and feeling in the arm and shoulder. Both can result from a difficult or improperly managed delivery, but they affect different nerves and different parts of the body.
Is nerve injury from forceps always caused by medical malpractice?
No. Some nerve injuries occur even when a physician uses forceps correctly and follows the accepted standard of care. Whether malpractice played a role depends on the specific circumstances of the delivery, including how the forceps were applied and whether the medical team recognized and responded to any warning signs.
What treatment options are available for a baby with a nerve injury from forceps?
Treatment depends on the severity of the injury. Many babies recover with monitoring alone, while others benefit from physical therapy, eye protection, or corticosteroids. In more severe or persistent cases, a pediatric specialist may recommend surgical options such as nerve grafting.
How long do we have to file a claim for our child’s birth injury?
Every state sets its own time limit, known as a statute of limitations, for filing a birth injury claim, and these limits often work differently for claims involving a minor child. Because deadlines vary and can significantly affect your family’s options, it’s best to speak with an attorney as soon as possible to understand the timeline that applies to your situation.
