Birth Injury

A birth injury is an injury sustained by a baby due to the birth process. There are minor and severe birth injuries which can be caused by many things, including a disproportion between the size of the infant and the size of the birth canal. It can also be due to the lack of oxygen that can happen prior to the actual birth of the baby.

A birth injury is due to several causes. Some of these include having a large baby of greater than 4000 grams in weight. It can be due to prematurity in infants less than thirty seven weeks gestation. These infants are more sensitive to birth trauma due to immature bones. It can simply be due to cephalopelvic disproportion or a small pelvis. It can be due to difficult labor or childbirth or to prolonged labor. A breach delivery or other abnormal presentation can contribute to having a birth injury.

The most common birth injuries can be one of the following:

• A cephalhematoma is a bleeding area and bruise between the bone and the fibrous covering to the bone. It results from pressure of the skull on the pelvis and is usually circular in nature. It appears as a soft, jelly-like lump on the scalp that is made from blood. It can gradually reduce and disappear over several weeks or months.
• Caput succedaneum is a soft tissue swelling of the head caused by the use of vacuum extraction and pressure of the skull on the pelvis of the mother. The swelling normally disappears within the first few days or weeks of life and looks like a baby with a lopsided head or a lump on its head.
• Subconjuntival hemorrhage involves the breakage of blood vessels within the eyes of the baby. It is caused by damage to the eyes during the delivery. It usually looks just like a red blotch on the white part of the eye and does not affect vision. It takes a few days to resolve this bleeding complication.
• Bruising can be caused by the use of the forceps. Forceps are used rarely in deliveries to help control a difficult delivery. The forceps can be harsh on the face and head of the baby so that the baby receives bruises where the forceps are applied to the head of the infant.
• Facial paralysis occurs when there is pressure on the nerves of the face in a difficult delivery. A forceps delivery can cause facial paralysis. It can result in failure of the eye to close or in paralysis of the side of the face of the infant. These can resolve themselves in just a few days or weeks, depending on the degree of damage to the nerve.
• Brachial plexus palsy is a condition in which the shoulders get stuck in the birth canal and the brachial plexus in the underarm area is pulled on at the time of birth. The baby cannot flex or rotate the arm very well due to nerve injury. It can last permanently or just a few weeks, depending on the damage to the nerve. If the nerve is torn, the result can be permanent. There are exercises that can be done in order to speed up the healing process.
• The infant can fracture his or her collarbone due to a lack of ability of the shoulders to fit through the birth canal. This is known as shoulder dystocia. The collar bone can be broken on purpose by the physician in order to facilitate the passage of the baby's shoulders through the birth canal.

The prevention of birth injuries includes knowing whether or not a delivery is going to be able to manage itself spontaneously or if there is going to be cephalopelvic disproportion or not. If there is a good chance that the head or shoulders will not fit into the birth canal or if there is evidence of an abnormal presentation, a cesarean section should be managed in order to safely deliver the infant.