Birth Injury

Birth injuries, also known as neonatal birth trauma, are injuries that happen to a baby during birth. They’re not common, and they’re usually minor. But in rare cases, they can be serious enough to need further treatment.

The healthcare providers caring for you will do everything they can to prevent birth injuries or minimize how severe they are. You may want to keep in mind that it’s impossible to control exactly how your labor and delivery will go. And you should also remember that birth injuries aren’t your fault.

But that doesn’t mean you’re powerless. If you have questions or concerns about your upcoming delivery, you can ask your Ob/Gyn provider. They can offer guidance on ways you can help yourself and possibly reduce the risk of having a difficult labor and delivery.

Birth injuries tend to fall into the following types:

• Scalp injuries
• Bone fractures
• Eye injuries
• Bleeding inside the skull
• Nerve damage
• Brain injuries

Birth injuries overall are uncommon. A 2021 analysis found that about 29 birth injuries happen for every 1,000 live births. It also found that about 23 of those 29 are scalp injuries.

Common birth injuries

Some of the most common birth injuries include:

• Broken collarbones (clavicles)
• Caput succedaneum (pronounced KAP-ut sux-ud-DAY-nee-um), swelling of a newborn’s scalp
• Cephalohematoma (pooling of blood under a newborn’s scalp)
• Erb’s palsy (arm weakness or paralysis) from a brachial plexus injury
• Eyelid swelling
• Subcutaneous fat necrosis of the newborn
• Facial nerve paralysis
• Fractured upper arm bone (humerus)
• Fractured upper leg bone (femur)
• Intracranial hemorrhage (brain bleeds) like subdural bleeds
• Lacerations of the face or scalp
• Nose injuries like a deviated septum
• Retinal or subconjunctival hemorrhages (eye injuries)
• Skull fractures

Uncommon and rare birth injuries

Some less common or rare birth injuries include:

• Certain types of brain bleeds like epidural or subarachnoid bleeding
• Brain damage from lack of oxygen (hypoxic-ischemic encephalopathy)
• Internal organ injuries like liver or spleen hemorrhage
• Rib fractures
• Spinal cord injuries
• Subgaleal hemorrhage

Some of these uncommon and rare injuries can be more serious. Your healthcare provider can tell you more about injury severity in your particular case.

What are the symptoms of birth injuries?

Birth injuries can cause a wide range of symptoms. The symptoms mainly depend on the specific injury. Some examples of birth injury symptoms include:

• Visible changes like bruising (ecchymosis), swelling (edema) or discolored spots on your skin (petechiae)
• Not moving certain body parts (either because of fractures or nerve injuries)
• Difficulty feeding
• Crying, fussiness or other behavior changes
• Hoarseness or noisy breathing (stridor) while crying

What causes birth injuries?

There are a few main causes of birth injuries:

• If the baby has difficulty moving through the birth canal (like with shoulder dystocia and macrocephaly)
• From attempts to move or reposition the baby during labor or delivery
• From the force of the birth canal’s muscle contractions
• Assistive devices or tools, like vacuum extraction delivery, forceps delivery or C-section surgery

What are the risk factors for birth injuries?

There are several risk factors for birth injuries. They include:

• High birth weight. Babies with fetal macrosomia are more likely to experience birth injuries. Fetal macrosomia means they weigh more than 8 pounds, 13 ounces (4 kilograms).
• Low birth weight or being born very early. Babies born prematurely or who are very small at birth also have a higher risk of birth injuries.
• Positioning. Babies have a higher risk of birth injury if they aren’t oriented the right way, like with breech positioning.
• Head size. This can happen to babies who just happen to have a large head. But certain medical conditions can also cause a larger head size.
• Difficult births. Birth injuries are more likely when labor and delivery are harder or take longer.
• Precipitous births. These are births that happen much faster than usual.
• Diabetes. Babies being delivered by birthing parents with diabetes have a higher risk of birth injuries. Research indicates blood sugar level management may help limit the risk.
• Maternal body characteristics. Birth injuries are more likely when a mother has body traits that contribute to a difficult delivery. One example is pelvis shape. The size comparison between your baby’s head and your pelvis’s shape can also be a factor.

What are the complications of birth injuries?

Research links birth injuries to a wide range of complications. They include:

• Cerebral palsy
• Fetal distress
• High bilirubin levels (hyperbilirubinemia) leading to newborn jaundice
• Meconium aspiration syndrome
• Respiratory distress syndrome
• Needing mechanical ventilation or continuous positive airway pressure (CPAP) ventilation
• Seizures
• Sepsis
• Transient tachypnea (temporary fast breathing)

How are birth injuries diagnosed?

Ob/Gyns, neonatologists or perinatologists can diagnose birth injuries. They’ll use a combination of methods to do that, including:

• A physical exam. It’s standard procedure for a provider to do a physical exam on your baby shortly after birth. They do that to check for congenital conditions and birth injuries.
• Diagnostic imaging. Brain ultrasound, CT scans or X-rays can detect various injuries inside your baby’s body. Less commonly, MRIs may also help.
• Blood tests. Lab analysis can help providers diagnose certain birth injuries or related complications.

Other tests are possible, depending on the situation. Your baby’s healthcare provider can tell you more about the tests and why they might help.

How are birth injuries treated?

The treatment for birth injuries mainly depends on the specific injury. Some examples of common treatments include:

• Monitoring and waiting. Many birth injuries heal on their own. Examples include minor collarbone breaks, caput succedaneum and minor brachial plexus injuries.
• Immobilization. Broken arm or leg bones usually need to be held in place for several weeks until they heal. Your baby may need to wear a specially made splint or harness to help with this.
• Physical therapy. Brachial plexus injuries can benefit from physical therapy. It can help prevent complications from further nerve damage or loss of muscle strength.
• Surgery. In some cases, surgery might be necessary to repair injuries like lacerations. Surgery can also stop blood from accumulating inside your baby’s skull and pressing on their brain. Surgery may also help reroute nerve signals around an injury, restoring function.

Your healthcare team may recommend other treatments, depending on the situation. Your baby’s healthcare provider can tell you more and recommend treatment options.

Can birth injuries be prevented?

Birth injuries aren’t totally preventable. But there are a few things you can do while you’re pregnant that may lower the risk of them happening. They include:

• Talking to your Ob/Gyn as soon as possible. They can help you prepare before you even become pregnant. And they can refer you to specialists like perinatologists, if necessary.
• Managing chronic conditions. Your Ob/Gyn or perinatologist can guide you on how to manage your conditions. That may limit the risk of having birth injuries from conditions like diabetes.
• Having a birthing plan. Your Ob/Gyn or other provider can advise you on specific procedures or approaches that may limit the risk of a birth injury. They can also advise you on backup plans, like when a C-section is a better option for the safety of you and your baby.

Your care team will also do everything they can to help reduce the risk of birth injuries. Everyone, including physicians, nurses and other clinical staff, will work together to prepare and help you and your baby.

What’s the outlook if my baby has a birth injury?

The outlook for birth injuries depends strongly on the type of injury they have and how severe it is. But in general, the outlook for most birth injuries — especially the most common ones — is excellent. Over the past several decades, experts have worked on ways to reduce the risk of birth injuries and improve the ways of treating them. Severe birth injuries are much less common now than they were 30 years ago. In 1993, birth injuries ranked 11th among causes of newborn deaths. But birth injuries haven’t made that list since 2007.

What should I expect if my baby has a birth injury?

If your baby has a birth injury, your healthcare team will do everything they can to manage that injury and talk to you about what’s happening. Most birth injuries are minor and won’t need a lot of care. But in some cases, your provider may recommend you and/or your baby stay in the hospital until your baby recovers enough to go home.

When you do go home, your provider will talk to you about how to care for your baby, things to watch for and more. It may help to write out these instructions or ask for a printed copy. Dealing with sleep deprivation after delivery can make it very easy to forget things.

If you have any questions or aren’t sure you understand, don’t hesitate to tell your provider. Making sure you understand and feel comfortable with their instructions won’t annoy them because they want the best for you and your baby.

What questions should I ask my baby’s provider?

You may want to ask your baby’s provider the following:

• What kind of birth injury does my baby have?
• How severe is it?
• Does it need treatment?
• What treatments (if any) do you recommend?
• When can my baby go home?
• What should I watch for once I take my baby home?
• When should I call your office or bring my baby to the hospital?

When should I take my baby to see their healthcare provider?

Your baby’s provider will set up a follow-up schedule or refer you to a pediatrician who can continue to manage your baby’s care. They’ll schedule regular visits to monitor your baby’s recovery and ensure everything is going well. Those visits will also let them adjust the care plan if necessary.

When should I take my baby to the hospital?

Your baby’s provider will tell you things to watch for that need emergency care. Examples include (but aren’t limited to) your baby being or having the following:

• Short of breath
• Decreased activity (lethargy)
• Skin that’s cold, pale or discolored
• Dry diapers for 12 or more hours
• Unusual irritability or sleepiness
• Not taking feeds