en Peripheral nervous system Research <strong>Background and Aim:</strong> Newborns with brachial plexus birth paralysis (BPBP) impose a heavy burden on their families. Given the importance of awareness of its incidence, our main goal was to assess changes in its trend. Also, this study aimed to evaluate the correlation between BPBP trends and the policy aiming at increasing rates of vaginal delivery (VD) (2018).<br> <strong>Methods and Materials/Patients:</strong> This analytic cross-sectional study was conducted among patients with BPBP born at Al-Zahra Hospital, the Main Center of Obstetrics in Rasht City, Iran, between 2013 and 2023. Descriptive statistics were used to examine the patients&rsquo; demographic and clinical characteristics. The results were analyzed using SPSS software, version 26.<br> <strong>Results:</strong> Over 11 years, 41617 live births occurred. Our study revealed a BPBP incidence of 1.54 cases per 1000 live births during this period. Of these, 33 newborns (51.6%) were male. In our study, the Joinpoint regression analysis showed that the incidence of BPBP increased throughout the study period (P<0.05). Also, there was no significant change in the rising trend of BPBP at the time the established policy aimed at increasing VD rates. In fact, the policy had no significant impact on the trend of BPBP. Moreover, there were no instrumental deliveries among the patients, despite the increasing trend of this injury. Only 10.9% of the patients with BPBP had a clavicle fracture after birth. There was no humerus fracture among all the patients. Also, only 11.5% of the cases had shoulder dystocia in our study.<br> <strong>Conclusion:</strong> The findings indicate that the incidence of BPBP increased over the 11 years. Our study highlighted that the policy aimed at increasing VD rates did not significantly affect BPBP rate. Therefore, enhanced training for early-career obstetricians and improved preventive strategies are recommended.<br> &nbsp; Neural injury, Neonates, Brachial plexus, Vaginal delivery 0 0 http://irjns.org/browse.php?a_code=A-10-1401-1&slc_lang=en&sid=1 Fatemeh Hosseinzadeh 100319475328460012872 100319475328460012872 Yes Department of Obstetrics and Gynecology, Reproductive Health Research Center, School of Medicine, Al-Zahra Hospital, Guilan University of Medical Sciences, Rasht, Iran. Sahel Rezaee 100319475328460012873 0009-0000-9447-9531 No Student Research Committee, Guilan University of Medical Sciences, Rasht, Iran. Maryam Ghalandari 100319475328460012874 100319475328460012874 No Vice-Chancellorship of Research and Technology, Guilan University of Medical Sciences, Rasht, Iran. Roya faraji Darkhane 100319475328460012875 100319475328460012875 No Department of Obstetrics and Gynecology, Reproductive Health Research Center, School of Medicine, Al-Zahra Hospital, Guilan University of Medical Sciences, Rasht, Iran. Mohammadreza Emamhadi 100319475328460012876 100319475328460012876 No Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran. Shahrokh Yousefzadeh-Chabok 100319475328460012877 100319475328460012877 No Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.