Birth Injuries Caused During Delivery
Birth injuries that occur during delivery are not uncommon. Improper use of vacuum extractors or forceps, administering the wrong medication, or mishandling the infant can result in serious injuries to newborns. Depending on how the physician handles the delivery, an infant may also experience injuries related to stress, decreased oxygen, high or low blood pressure.
Caput succedaneum is a condition marked by scalp swelling, typically during or shortly after birth. It is usually caused by pressure from the mother’s uterus or vaginal wall during delivery. Bruising of the scalp is more likely to happen during a long and difficult labor, especially in situations when the amniotic sac has broken and the baby’s head is unprotected while passing through the birth canal. Caput succedaneum can also be caused by the use of vacuum extraction devices during a protracted delivery.
Cephalohematoma is an accumulation of blood below the protective membrane that covers an infant’s skull. Cephalohematoma shows up as lumps on a baby’s head, usually several hours after delivery. The lumps feel soft and may grow larger during the baby’s first hours postpartum. Most cephalohematomas do not require medical attention and disappear within a few weeks or months as the body reabsorbs the blood. However, some cephalohematomas may cause jaundice if they are too large and too many red blood cells break down.
BRUISING & BROKEN BONES
Bruising may occur on a baby’s face, head, and/or other body parts due to the physical stresses of the passage through the birth canal or contact with bones and tissue in the mother’s pelvis. The use of forceps during delivery may also leave forceps marks on a newborn’s head or face, especially when doctors use too much force. In addition, vacuum extraction may cause lacerations or bruising on a baby’s scalp. Similar to bruising, broken bones can occur with improper use of birth-assisting tools or when an infant is tugged too forcefully. In extremely rare instances, a physician or someone on the medical staff may drop a newborn.
Subconjunctival hemorrhage is bleeding that occurs when small blood vessels in the baby’s eyes break. It may be present in one or both of the infant’s eyes and appears as a bright red band surrounding the iris. Subconjunctival hemorrhages do not cause permanent damage to the eyes. The red area vanishes within a matter of days as the body reabsorbs the blood.
Bells’ palsy occurs when a baby’s facial nerve is damaged during labor or birth. In most cases, nerve damage is caused by pressure on the infant’s face during the passage through the birth canal. However, facial paralysis can be also caused by doctors that use forceps during delivery. Nerve damage is most noticeable when babies cry. The facial muscles on the side where the nerve was injured can’t move, and the eye on that side remains open. Bell’s palsy eventually improves without treatment if the nerve is only bruised. If the baby’s facial nerve is torn, surgery may be needed to restore muscular function on the affected area.
BRACHIAL PLEXUS INJURY
A brachial plexus injury is the result of an injury to a baby’s brachial plexus. This is a network of nerves that connects the spinal cord to the baby’s arms and hands. Brachial plexus injuries are more common when there is a difficult birth, especially if a baby’s shoulder gets stuck in the birth canal and a doctor tugs hard on one arm to help extract the newborn.
The most common sign of brachial plexus injury is when a baby can’t flex or rotate the affected arm. The severity of the injury depends on how badly damaged the nerves are. If the nerves are only bruised or stretched, the injury heals over a period of weeks or months and arm movement is restored with the aid of physical therapy. More serious injuries, in which the nerves are torn, often result in permanent nerve damage.
Oxygen deprivation before or during birth can cause serious health problems to a newborn. This type of birth trauma can occur if the placenta separates prematurely or if the umbilical cord becomes entangled around the baby’s neck and reduces oxygen flow to the brain.
Inadequate oxygen supply often causes damage to a baby’s cerebellum, the part of the brain that controls the body motor functions. This results in the onset of cerebral palsy (CP), a group of neuromuscular disabilities that affect a child’s ability to control movement, posture, and muscle tone.
Oxygen deprivation can also occur if a baby doesn’t start breathing independently after birth. Delays in breathing that last for 3 minutes or more are associated with a high risk of brain cell death, and can cause seizures, coma, and, if a baby is not placed on life support in time, death.
Oxygen deprivation causes permanent disabilities like cerebral palsy, and is also a major cause of hearing impairment, partial or total blindness, learning disabilities, and other complications.
Fractures are the most common injuries associated with birth trauma. Fractures generally affect a baby’s clavicle (collarbone) and are frequently caused by shoulder dystocia or during breech deliveries. This type of injury prevents a baby from moving the arm on the affected side. If the infant feels pain as a result of the fracture, a splint or soft bandage is needed to prevent jostling of the arm until the injury heals. Most birth traumas are conditions that usually heal on their own without any medical treatment. Babies often recover with few or no complications, although individual outcomes depend on a wide range of factors, such as the severity and cause of the injuries.
In many instances, birth trauma can be avoided if doctors recognize and foresee medical risk factors. Proactive measures, such as monitoring the mother’s health or using ultrasound images to check the fetus’ position in the weeks and days before labor, often prevent birth trauma and injuries.
EPIDURAL BIRTH INJURIES
An epidural is a popular pain-management method used by millions of women each year while going through labor and delivery. Despite its popularity and common use, there are a variety of risks associated with epidurals which can lead to epidural birth injuries as well as long-term maternal injuries.
You should always give permission before an epidural is administered. It is the healthcare provider’s obligation to inform you of all the risks associated with the procedure. Be certain to request information on the type of medicine to be used, the risks, the complications, and any other pertinent information before consenting to an epidural. Although an epidural provides significant pain relief during labor, it’s important to understand the risks as well as the benefits. It’s always a good idea to research beforehand and weigh out the pros and cons. Maternal risks associated with epidurals include: Seizures and dizziness / Infections / Spinal membrane injuries / Breathing problems Nerve damage / Long-term back pain / Epidural Headache Increased risk of vacuum extraction or forceps use during delivery / Lower blood pressure
Infant risks include: Lack of oxygen leading to cognitive disorders and cerebral palsy / Brain injuries Infant stroke / Coma / Poor muscle tone
Administering an epidural must always be done by a professional anesthesiologist or nurse-anesthetist with proper education, experience, and training. Since the area involved is so close to the spinal cord, even a small mistake can lead to devastating consequences. Some of the more common mistakes associated with epidural negligence are:
Administering too much medication / Administering the wrong medication / Injecting the needle into the wrong area / Failing to monitor maternal and fetal distress/ Giving the epidural too soon / Giving the epidural to a mother who uses blood thinners
Fetal lacerations (cuts) usually occur during a caesarian-section delivery as a result of improper procedures performed by medical personnel during childbirth. The injuries are caused by nicks and cuts from scalpels, forceps, and other instruments used by physicians while performing a surgically-assisted delivery. These lacerations are mostly minor and easily treated in the delivery room, but in some cases they can be deep and require stitches or reconstructive surgery.
A pair of forceps is a tool used by doctors to assist with a difficult delivery. The tool closely resembles large salad tongs. The open end of forceps are typically placed around infant’s head to help guide the baby out during the mother’s contractions.
There are risks of injury to both mother and baby when forceps are used. Mothers are at risk for tears and lacerations in the vaginal and perianal area that can lead to fecal and/or urinary continence. Babies are at risk for cuts and bruises to the head and face. Babies can also suffer facial nerve injuries or even brain damage. You have a choice regarding use of forceps during delivery. Doctors are obligated to inform you of their use, and the risks associated with it.
Horner’s syndrome refers to damage to the nerve pathway that leads from the brain to the eye and face on the affected side of the body. 65% of Horner’s Syndrome cases are from trauma suffered during the birth process. The trauma is usually associated with Improper use of forceps during delivery, or pulling too hard on the baby while the baby’s shoulder is impacted, or the baby is breech. The most common symptoms of Horner’s Syndrome are pupils (the black spots in the center of the eye) that are different sizes, or that open and close at different speeds. The eyelid of the affected eye may droop, or the affected eye may appear “sunken”.
Hydrocephalus is an unusual buildup of cerebrospinal fluid in the baby’s brain. This may or may not cause problems for the infant. Because their skulls are still able to expand, some babies don’t experience any negative effects from the excess fluid buildup inside their brain. However, some babies can suffer devastating brain injuries from the increased pressure inside their heads.
The most obvious signs of hydrocephalus in babies are an abnormally large head or an unusually fast increase of the head’s circumference. Hydrocephalus may also cause headaches, irritability, vomiting, seizures, and sleepiness. In severe cases, hydrocephalus may also cause comas. Babies with hydrocephalus present at birth are said to have “congenital hydrocephalus”. Genetic abnormalities or developmental disorders linked to conditions such as spina bifida sometimes cause the congenital forms of hydrocephalus.
Babies who develop hydrocephalus after birth are said to have “acquired hydrocephalus”. External factors, including other diseases or head trauma, usually cause acquired hydrocephalus. Treatment for hydrocephalus is usually surgical. Doctors will place tubes (shunts) into the brain that allow the fluid to drain and flow normally. However, shunt systems need constant monitoring and regular medical follow-ups.
Because hydrocephalus often causes neurological damage, it can have a negative effect on a child’s intellectual and physical development. If left untreated, progressive hydrocephalus can be fatal.
A brain hemorrhage is the medical term for bleeding within the brain. This bleeding can be caused by trauma, high blood pressure, blood vessel abnormalities, blood disorders, liver disease, or brain tumors. The use of birth-assisted tools during delivery can, in rare instances, lead to hemorrhaging. Bleeding inside the brain can cause brain cells to die, leaving the baby with permanent brain damage.
It is often difficult to diagnose a brain hemorrhage in a baby. Usually, doctors will look for difficulty swallowing, lethargy, loss of consciousness, nausea or vomiting, weakness in an arm or leg, or seizures. Testing for brain bleeding includes head CT scan and head MRI. Surgery is usually the treatment for a brain hemorrhage. Surgery is important to stop the bleeding, and to keep other brain cells from dying.
The term “ischemia” refers to a process that occurs when parts of the body do not receive enough blood because of a blocked or ruptured blood vessel(s). When this happens, the cells that depend on the affected blood supply “starve” to death. When ischemia occurs in the brain, the parts of the body controlled by the affected area stop working properly. Patients with brain ischemia may notice blindness in one eye, dizziness or vertigo, loss of coordination, weakness or paralysis in one arm or leg, on one whole side of the body, or on both sides of the body.
In babies, brain ischemia is harder to diagnose because of the baby’s inability to communicate. Often, symptoms such as lethargy, loss of consciousness, decreased movement, or seizures lead doctors to perform brain imaging studies on the baby. These imaging studies can show doctors whether there has been ischemic injury to the brain, and help them decide how best to treat it.
There are many causes of infant brain ischemia. These include infection, placental disorders, dehydration, oxygen deprivation, and birth asphyxia. Some types of infant brain ischemia are preventable, but only if the doctor recognizes the cause and provides the proper treatment.
Chorioamnionitis is an inflammation of the membranes (the fluid-filled sack) surrounding the baby in her mother’s uterus. It is caused by a bacterial infection. It typically results from bacteria ascending into the uterus from the vagina and is most often associated with prolonged labor. The risk of developing chorioamnionitis increases with each vaginal examination that is performed in the final month of pregnancy, including during labor. Failure of the doctor to recognize the onset of chorioamnionitis and timely deliver the baby can result in permanent and serious injury or even death.
HYPOXIC ISCHEMIC ENCEPHALOPATHY
Hypoxic Ischemic Encephalopathy (HIE) is a brain injury that occurs from too little oxygen reaching the baby’s brain. Hypoxia is a medical term for too little oxygen in the blood stream. Ischemia is the medical term for cell and tissue damage caused by too little oxygen. Encephalopathy is the medical term used to describe disease, damage or malfunction of the brain. Often, babies who suffer HIE are later diagnosed with Cerebral Palsy.
There are a number of medical conditions that can cause HIE during pregnancy. These include the mother having diabetes, poor circulation to the placenta, high blood pressure, infection, drug and alcohol abuse, and fetal anemia.
HIE can also be caused during the labor and delivery period. During the labor process, excessive bleeding from the placenta, low maternal blood pressure, umbilical cord accidents, prolonged late stages of labor, abnormal fetal position, or rupture of the uterus can lead to decreased amounts of oxygen in the baby’s brain leading to HIE.
Babies can also suffer HIE after birth. If the baby is born too early, her lungs may not have developed enough to provide adequate oxygen to her brain. If the baby is born with severe heart or lung disease, has an infection, or suffers from chronic apnea (periods of time where the baby stops breathing), HIE may result. In infants, the symptoms of HIE are usually a slow heart rate, poor muscle tone, weak breathing or no breathing at all, bluish or pale skin color, or excessive acid in the blood.
Babies who suffer a period of HIE may go on to suffer developmental delays, epilepsy, cognitive issues, motor skill development delays, and neurodevelopment delays. Children who suffer a prolonged period of HIE may be diagnosed with Cerebral Palsy.
Jaundice is an abnormal buildup of a substance called bilirubin. When red blood cells break down, bilirubin is formed. Usually, the liver filters out excess bilirubin from the blood. In newborn babies, however, the liver may not be ready to process the bilirubin quickly enough. This can allow bilirubin to build up in the blood and other tissues and fluids of the baby’s body. Because bilirubin has a yellowish color, it causes a yellowing of the baby’s skin, eyes, and other tissues. This is called jaundice. If the excess bilirubin is left untreated, it can lead to serious medical complications. One of the most serious of these complications is called Kernicterus.
Kernicterus is a rare form of brain damage that occurs due to high levels of bilirubin. The symptoms associated with the early stages of Kernicterus include poor feeding, jaundice, poor muscle tone, and lethargy. As the disease progresses, the baby may start to make high-pitched shrieks, and have seizures. The soft spot on top of the baby’s head may start to bulge.
Left untreated, kernicterus can lead to permanent and serious brain damage. The baby may be left with learning disabilities, cerebral palsy, hearing loss, and may even die.
Treatment for jaundice can be as simple as placing the baby under ultraviolet lights. However, if the baby has had high levels of bilirubin for a while, the doctor may order blood transfusions. The blood transfusions are designed to get more healthy blood into the baby’s system as quickly as possible.
MECONIUM ASPIRATION SYNDROME
Meconium aspiration syndrome (MAS) occurs when a newborn breathes in a mixture of meconium (solid waste) and amniotic fluid. After birth, this mixture can get into the baby’s lungs and prevent the lungs from delivering the right amount of oxygen into the baby’s blood.
Babies can release meconium (which is sort of like poop) in response to the stress of labor. The baby can then suck in the meconium while still in the uterus. The baby can also breathe in the meconium just after delivery, while trying to take his/her first gulps of air. This can block the baby’s airway just after delivery. Babies with MAS can have a bluish appearance shortly after birth. Doctors will check to see if the baby is making crackling noises while breathing, and insert a tube into the infant’s airways to clear out the meconium and amniotic fluid. If MAS is not treated in time, the lack of oxygen in the baby’s blood can cause a stroke, brain damage or cerebral palsy.
PERSISTENT PULMONARY HYPERTENSION (PPHN)
Persistent pulmonary hypertension occurs when the baby’s blood circulation bypasses the lungs, preventing the baby from breathing. With PPHN, the baby does not change over from fetal to normal newborn circulation. Blood is forced away from the lungs due to high blood pressure in the arteries that go to the lungs. This decreases the baby’s supply of oxygen.
Babies with PPHN will often exhibit rapid breathing (more than 60 times a minute), grunting or moaning when the baby breathes out, chest retractions, a blue color of the lips or around the mouth, cool or blue hands and feet, low blood oxygen levels, low blood pressure, decreased urine output, and swelling.
A cardiac ultrasound test is used to check the pathway of blood circulation. If the diagnosis is confirmed, the baby is given oxygen and medicines and is kept quiet and warm. Treatment for severe, life-threatening PPHN may involve treating with nitrous oxide or a procedure called ECMO.
If PPHN is not properly and timely treated the baby’s brain can be damaged. This can cause long-term thinking and learning difficulties, cerebral palsy, or even death.