Generally, birth injuries are more common after an attempted operative vaginal delivery (which failed), but are the lowest in women undergoing a repeat cesarean section (without attempting a vaginal). The following are a few common birth injuries and their rates of incidence in infants:
Cerebral Palsy (CP) is a motor disorder that affects a person’s 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. 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. Ischemic stroke (clot blocking blood flow to the brain), which can occur during pregnancy or shortly after birth, is also a risk for developing cerebral palsy.
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 nerves of the brachial plexus are stretched or torn during delivery. Brachial plexus injuries can also occur when a doctor uses birthing instruments during delivery. The severity of injury depends on the degree to which the brachial plexus was stretched.
Brain damage occurs in approximately 3 out of every 1000 live births and can be caused by a multitude of factors. Asphyxiation, a lack of oxygen, can occur at around the time of birth and any amount of oxygen deprivation can result in varying degrees of brain damage. A mother can also develop an infection during pregnancy or around the time of birth which, if not properly treated, can lead to brain damage. In 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) which can result in brain damage, fetal seizures, or death. Physical trauma can also also occur during delivery, including pressure to the skull from the mother’s pelvis or birthing instruments.
Cephalohematoma (CH) is a condition where 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 to be a dangerous condition because it does not affect the brain. CH can occur if the baby’s head is larger than the mother’s pelvic area or if birthing tools, such as a forceps or vacuum, are used during delivery.
Caput Succedaneum is a swelling, known as edema, of the scalp of a baby following a 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 very difficult delivery and that the baby’s head was put under a great amount of pressure. This, in turn, could indicate the possibility of a more serious brain injury due to asphyxiation during delivery.
Neonatal intracranial hemorrhage (ICH) can occur when blood vessels rupture and bleed into the brain. ICH is much more common in premature babies, as well as when birthing tools are used during delivery. There are four different types of ICH that 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 who are 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.
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 the use of birthing instruments (the most common cause of head injuries in infants), pressure inside the womb (if the baby is very big or during a prolonged labor), and by medical negligence during delivery. Another common type of orthopedic injury is a clavicle fracture (the clavicle is the collarbone which connects the chest to the shoulder). Infants can also experience a growth plate fracture during delivery as well as femur fractures, if the leg is twisted during delivery (although femur fractures are much 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 large baby size, prolonged labor, use of epidural anesthesia, or use of medication to intensify labor and contractions.