Birth injury, or birth trauma, refers to any damage an infant sustains during the birthing process due to forces like compression or traction, or factors that restrict blood flow or oxygen intake. Fortunately, advances in technology and medical practices have greatly diminished the occurrence of birth injuries over time. In the U.S., there are an average of six to eight significant birth injuries per 1,000 live births, and these injuries contribute to fewer than two percent of neonatal deaths and stillbirths.
Injury is typically sustained during transit through the birth canal. The likelihood of injury increases when the birth canal is too small, or the fetus is too large (which can occur when the mother is diabetic) or is not ideally positioned before birth, such as with breech (buttocks first) delivery. Often, a cesarean birth is used to avoid complications from these factors, but cesarean sections carry risks, as well.
Prematurity can be problematic, as babies born before 37 weeks of gestation have more fragile bodies that are more easily injured. Prolonged labor can also be a factor.
Minor swelling or bruising of a newborn in some areas after vaginal birth is relatively common. This type of injury does not require treatment and heals on its own. Forceps can leave temporary marks or bruises on the face and head. More pronounced swelling of the soft scalp tissues is known as caput succedaneum. Babies delivered by vacuum extraction are more likely to have this condition, along with bruising and, sometimes, a scalp laceration, and the swelling usually disappears in a few days.
One or both of the eyes may have a bright red band around the iris due to subconjunctival hemorrhage, the breakage of small blood vessels in the eyes of a baby. This is very common and does not cause damage to the eyes. The redness is usually absorbed in a week to ten days.
Other categories of birth injuries include:
In normal births, the head comes through the birth canal first and is subjected to much of the pressure of delivery. Swelling and bruising are not typically serious, and heal within a few days. With cephalohematoma, a soft lump caused by pooled blood forms over the surface of one of the skull plates, but below the thick, fibrous covering. It does not need treatment, and heals in weeks or months. Jaundice may occur if the area of injury is larger, from the breakdown of the red blood cells as the injury heals. Rarely, a skull bone may fracture, but unless it forms an indentation, it needs no treatment and heals quickly.
Pressure to facial nerves can create weakness in the muscles of one side of the face, but recovery without treatment takes just weeks. Nerves to one or both arms can be injured, producing brachial palsy, or weakness or paralysis of the arm or hand. The nerve to the diaphragm can be injured, leading to difficulty breathing. Both types of injuries heal within weeks without treatment, but surgery may be needed to repair any torn nerves. Spinal cord injuries are very rare, but produce paralysis below the injury that is often permanent.
In rare cases, bones may be broken or fractured during delivery, most commonly the collarbone. Healing is almost always rapid and complete.
Permanent brain injury that occurs before, during or shortly after birth is known as cerebral palsy. It is caused by an interruption of normal blood flow (ischemia) and/or oxygen flow (hypoxia or asphyxia) before or during labor, around the time of birth, or during the first hours or days after delivery. It is characterized by a lack of muscle control and movement, and symptoms can include seizures, spasms, visual and hearing problems, hyperactivity, and learning disorders.
Factors that can contribute to developing cerebral palsy include:
diabetes, pregnancy induced hypertension, preeclampsia; preterm labor; chorioamnionitis; maternal infection; group B strep infection; placenta previa; and vasa previa.
There is no cure, but therapies are available for treatment.
Perinatal stroke occurs between the 28th week of gestation and the first month of life. It is likely related to the activation of coagulation agents during this time. The rate of stroke in infants is equal to that of the elderly, according to a University of California, San Francisco (UCSF) study – one in 5,000. This can lead to long-term neurological problems, including cerebral palsy, epilepsy, language problems and hyperactivity.
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