Although most babies in the United States are delivered with few or no physical injuries, there is always a chance that something will go wrong during the birth process. On average, 29 out of every 1,000 babies in the U.S. suffer some kind of birth trauma, often as a result of poor use of instruments or improper handling of a newborn by doctors or other medical staff.
Causes of Birth Trauma
Birth trauma is a general term used to describe any cuts, fractures, or other injuries sustained by a newborn baby during labor or delivery. Birth trauma is more common in developing nations in Africa, Asia, and Latin America, but at least 2% of live births in the U.S. are adversely affected by physical injuries not related to any congenital condition.
Birth trauma occurs more frequently among larger-than-average babies, particularly in cases where the baby’s size may be too large in relation to the mother’s pelvic area. Deliveries of larger, heavier babies often require doctors to use their hands, forceps, or vacuums to ease their passage through the birth canal. In these situations, neonatal injuries can occur if a doctor uses too much physical force while handling the baby or is not careful with birthing instruments.
Per Stanford’s Lucile Packard Children’s Hospital the most common conditions that cause birth trauma include:
- Babies that weigh over 8 pounds, 13 ounces (4,000 grams)
- Babies born before the 37th week of pregnancy
- The mother’s pelvis may have the wrong shape or size for a safe delivery
- Difficult labor or delivery (dystocia)
- Prolonged labor
- Abnormal fetal position at birth (baby is in a head-up, buttocks-first, or breech, position)
Common Birth-Related Traumas
Generally, the most common neonatal injuries affect a baby’s head, neck, and shoulders, although they can cause damage to any other part of the body. These areas of the body are more likely to be injured because most babies are born in a head-first position. According to the Packard Children’s Hospital, the most common traumatic injuries include:
Caput succedaneum is a condition marked by scalp swelling, typically during or shortly after birth. It is usually caused by pressure from the mother’s uterus or vaginal wall during delivery. Bruising of the scalp is more likely to happen during a long and difficult labor, especially in situations when the amniotic sac has broken and the baby’s head is unprotected while passing through the birth canal.
Caput succedaneum can also be caused by the use of vacuum extraction devices during a protracted delivery.
Cephalohematoma is an accumulation of blood below the baby’s periosteum, the protective membrane that covers an infant’s skull. Cephalohematoma shows up as lumps on a baby’s head, usually several hours after delivery. The lumps feel soft and may grow larger during the baby’s first hours postpartum.
Most cephalohematomas do not require medical attention and disappear within a few weeks or months as the body reabsorbs the blood. However, some cephalohematomas may cause jaundice if they are too large and too many red blood cells break down.
Bruising may occur on a baby’s face, head, and/or other body parts due to the physical stresses of the passage through the birth canal or contact with bones and tissue in the mother’s pelvis. The use of forceps during delivery may also leave forceps marks on a newborn’s head or face, especially when doctors use too much force. In addition, vacuum extraction may cause lacerations or bruising on a baby’s scalp.
Similar to bruising, broken bones can occur with improper use of birth-assisting tools or when an infant is tugged too forcefully. In extremely rare instances, a physician or someone on the medical staff may drop a newborn.
Subconjunctival hemorrhage is bleeding that occurs when small blood vessels in the baby’s eyes break. It may be present in one or both of the infant’s eyes and appears as a bright red band surrounding the iris. Subconjunctival hemorrhages do not cause permanent damage to the eyes. The red area vanishes within a matter of days as the body reabsorbs the blood.
Bells’ palsy occurs when a baby’s facial nerve is damaged during labor or birth. In most cases, nerve damage is caused by pressure on the infant’s face during the passage through the birth canal.However, facial paralysis can be also caused by doctors that use forceps during delivery.
Nerve damage is most noticeable when babies cry. The facial muscles on the side where the nerve was injured can’t move, and the eye on that side remains open.
Bell’s palsy eventually improves without treatment if the nerve is only bruised. If the baby’s facial nerve is torn, surgery may be needed to restore muscular function on the affected area.
A brachial plexus injury is the result of an injury to a baby’s brachial plexus. This is a network of nerves that connects the spinal cord to the baby’s arms and hands. Brachial palsy is a common occurrence in difficult births, especially if a baby’s shoulder gets stuck in the birth canal and a doctor tugs hard on one arm to help extract the newborn.
The most common sign of brachial palsy is when a baby can’t flex or rotate the affected arm. The severity of the injury depends on how badly damaged the nerves are. If the nerves are only bruised or stretched, the injury heals over a period of weeks or months and arm movement is restored with the aid of physical therapy.
More serious injuries, in which the nerves are torn, often result in permanent nerve damage.
Oxygen deprivation, or anoxia, before or during birth can cause serious health problems to a newborn. This type of birth of trauma can occur if the placenta separates prematurely or if the umbilical cord becomes entangled around the baby’s neck and reduces oxygen flow to the brain.
Inadequate oxygen supply often causes damage to a baby’s cerebellum, the part of the brain that controls the body motor functions. This results in the onset of cerebral palsy (CP), a group of neuromuscular disabilities that affect a child’s ability to control movement, posture, and muscle tone.
Oxygen deprivation can also occur if a baby doesn’t start breathing independently after birth. Delays in breathing that last for 3 minutes or more are a high risk factor of serious brain damage. This category of birth injury destroys brain cells within a matter of minutes and causes seizures, coma, and, if a baby is not placed in life support in time, death.
Oxygen deprivation causes permanent disabilities like cerebral palsy, and is also a major cause of hearing impairment, partial or total blindness, learning disabilities, and other complications.
Hypoxia is a slightly less severe form of oxygen-related birth trauma. Unlike anoxia, which is used to describe total oxygen deprivation, hypoxia refers to low levels of oxygen in a baby’s circulatory system.
Fractures are the most common injuries associated with birth trauma. Fractures generally affect a baby’s clavicle (collarbone) and are frequently caused by shoulder dystocia or during breech deliveries. This type of injury prevents a baby from moving the arm on the affected side. If the infant feels pain as a result of the fracture, a splint or soft bandage is needed to prevent jostling of the arm until the injury heals.
Most birth traumas are conditions that usually heal on their own without any medical treatment. Babies often recover with few or no complications, although individual outcomes depend on a wide range of factors, such as the severity and cause of the injuries.
In many instances, birth trauma can be avoided if doctors recognize and foresee medical risk factors. Proactive measures, such as monitoring the mother’s health or using ultrasound images to check the fetus’ position in the weeks and days before labor, often prevent help birth trauma and injuries.