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Types of Birth Injuries

Nov 23, 2021

Generally, birth injuries are more common after an attempted vaginal delivery (which failed) but are the lowest in women undergoing a repeat cesarean section (without risking a vaginal). The following are a few common birth injuries and their rates of incidence in infants:

Cerebral Palsy

Cerebral Palsy (CP) is a motor disorder that affects balance, posture, and general ability to move.

CP is the most common motor disability among children. Low birthweight and premature birth are significant risks for developing cerebral palsy at birth.

Ischemic stroke (clot blocking blood flow to the brain), which can occur during pregnancy or shortly after birth, is also a risk of cerebral palsy. One study showed that among children weighing less than 1500 grams at birth, 59.5 babies per 1000 live births had cerebral palsy. Among babies weighing between 1500 and 2499 grams, 6.2 per 1000 live births had cerebral palsy, and 1.1 babies per 1000 live births had cerebral palsy among children born weighing more than 2500 grams.

Brachial Plexus

A brachial plexus birth injury, also known as Erb’s Palsy, is an injury to the brachial plexus nerve network that controls different muscle functions in the chest, shoulder, arms, and hands. This injury occurs at a rate of 1 to 3 per 1000 live births and can happen when the brachial plexus nerves are stretched or torn during delivery.

Brachial plexus injuries can also occur when a doctor uses birthing instruments during delivery. The injury severity depends on the degree to which the brachial plexus was stretched.

Brain Damage

Brain damage occurs in approximately 3 out of every 1000 live births and can be caused by many factors. Asphyxiation, a lack of oxygen, can occur at around the time of delivery, and any amount of oxygen deprivation can result in varying degrees of brain damage.

Adequate 5-8% of pregnancies, women develop a condition known as preeclampsia (the mother has high blood pressure) which can cause brain damage to the baby. In some cases, preeclampsia can lead to eclampsia (maternal seizures), resulting in brain damage, fetal seizures, or death. A mother can also develop an infection during pregnancy or around the time of birth which, if not adequately treated, can lead to brain damage.

Physical trauma can also occur during delivery, including pressure to the skull from the mother’s pelvis or birthing instruments.

Cephalohematoma

Cephalohematoma (CH) is when blood collects between the scalp and the skull of a baby and occurs when damaged blood vessels release the blood. CH occurs in 1-2% of live births, either during or after birth, but is not considered a dangerous condition because it does not affect the brain. CH can arise if the baby’s head is larger than the mother’s pelvic area or birthing tools, such as forceps or vacuum, are used during delivery.

Caput Succedaneum

Caput Succedaneum is a swelling, known as edema, of a baby’s scalp following vaginal birth. This happens when pressure is applied to the baby’s head as it passes through the birth canal. Although usually harmless, caput succedaneum can lead to other medical conditions, such as jaundice.

Caput succedaneum can indicate that the baby went through a complicated delivery and that the baby’s head was put under an incredible amount of pressure. This, in turn, could indicate the possibility of a more severe brain injury due to asphyxiation during delivery.

Intracranial Hemorrhage

Neonatal intracranial hemorrhage (ICH) can occur when blood vessels rupture and bleed into the brain. ICH is much more common in premature babies and when birthing tools are used during delivery.

Four different types of ICH can occur in infants: subgaleal hemorrhage (0.15 to 3 per 1000 live births), subdural hemorrhage, the most common type of ICH (0.29 per 1000 live births), subarachnoid hemorrhage (SAH) (0.13 per 1000 live births), and intraventricular hemorrhage (IVH), which is particularly common in preterm babies (17.5% of premature babies weighing less than 1500 grams).

In all of these cases, babies delivered using birth-assisted tools have higher rates of developing ICH. This is significant because a 2009 article in Obstetrics & Gynecology found that approximately 5% of all deliveries in the United States are birth instrument-assisted vaginal deliveries.

Bone Injuries

During a vaginal delivery, a baby can sustain orthopedic injuries due to the narrow nature of the birth canal. Infants can experience head injuries, including skull fractures, which can lead to traumatic brain injury, a cause of infant death. This type of injury can occur with birthing instruments (the most common cause of head injuries in infants), the pressure inside the womb (if the baby is very big or prolonged labor), and medical negligence during the delivery.

Another common type of orthopedic injury is a clavicle fracture (the clavicle is the collarbone that connects the chest to the shoulder). Infants can also experience a growth plate fracture during delivery and femur fractures if the leg is twisted during delivery (although femur fractures are rarer).

Facial Nerve Palsy

Facial nerve palsy can occur during birth and result in the loss of voluntary muscle movement in the face. This happens when pressure is applied to the facial nerve (the seventh cranial nerve) during labor and delivery. Causes of facial nerve birth trauma include a large baby size, prolonged labor, epidural anesthesia, or medication use to intensify labor and contractions. 

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