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Birth Injury – Definition, Types and Treatment

A birth injury is physical damage that occurs to the mother or newborn during the process of childbirth. It ranges from minor perineal tears to serious tissue or nerve damage.

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Things worth knowing about "Birth Injury"

A birth injury is physical damage that occurs to the mother or newborn during the process of childbirth. It ranges from minor perineal tears to serious tissue or nerve damage.

What Is a Birth Injury?

A birth injury refers to any physical harm that occurs to the birthing person or the newborn during labor and delivery. Such injuries are relatively common and affect a significant proportion of all births. They may arise spontaneously or in connection with obstetric interventions such as vacuum extraction (ventouse) or forceps delivery. While most birth injuries heal well with appropriate care, some require medical treatment or surgical repair.

Causes and Risk Factors

Birth injuries result from the mechanical forces involved in the birthing process. Several factors can increase the risk:

Fetal macrosomia: A larger or heavier than average baby
Prolonged labor: An unusually long delivery process
Instrumental delivery: Use of vacuum extractor or forceps
Shoulder dystocia: Difficulty delivering the baby's shoulders after the head
First-time mothers (primiparae): Higher risk of perineal injury during a first birth
Abnormal fetal presentation: Such as breech or transverse lie
Precipitate labor: Rapid delivery leaving insufficient time for tissue stretching

Types of Birth Injuries in the Mother

Perineal Tear

A perineal tear is the most common birth injury in the mother. It occurs when the pressure of the baby's head stretches and tears the perineum — the area between the vaginal opening and the anus. Perineal tears are classified into four degrees of severity:

Degree I: Superficial injury involving only the skin and mucosa
Degree II: Extends into the perineal muscles
Degree III: Involves the external anal sphincter
Degree IV: Complete disruption of the anal sphincter complex and rectal mucosa

Episiotomy

An episiotomy is a deliberate surgical incision made in the perineum during delivery to facilitate the birth or to prevent uncontrolled tearing. Current medical guidelines recommend its use only when there is a specific clinical indication.

Other Maternal Injuries

Vaginal lacerations and labial tears
Cervical lacerations: Tears involving the cervix
Uterine rupture: A rare but life-threatening tear of the uterine wall
Symphysis pubis disruption: Injury to the pubic joint
Bladder or urethral injuries

Types of Birth Injuries in the Newborn

The newborn can also sustain injuries during delivery:

Clavicle fracture: Fracture of the collarbone — the most common bony birth injury in the newborn
Brachial plexus injury: Damage to the nerve network supplying the shoulder and arm, often associated with shoulder dystocia
Cephalohematoma: A collection of blood beneath the periosteum of the skull bones
Caput succedaneum: A harmless soft-tissue swelling of the scalp
Intracranial hemorrhage: Rare but serious bleeding within the skull
Facial nerve palsy: Weakness of the facial nerve due to pressure during delivery

Diagnosis

Maternal birth injuries are assessed immediately after delivery through a thorough clinical examination by the midwife or obstetrician. Perineal injuries are graded and treated accordingly. The newborn is evaluated at birth as part of the standard neonatal examination (Apgar score and physical assessment). When deeper injuries or organ damage are suspected, imaging techniques such as ultrasound, X-ray, or MRI may be used.

Treatment

Treatment for the Mother

Minor perineal tears (degree I) often heal without suturing. More significant tears and episiotomies are repaired surgically under local or regional anesthesia. Supportive measures include:

Pain management with appropriate analgesics
Local ice packs and sitz baths
Pelvic floor physiotherapy to restore muscle function
Close postpartum follow-up for higher-degree injuries

Treatment for the Newborn

Most birth injuries in newborns resolve spontaneously. A clavicle fracture is managed with gentle positioning and supportive care. Brachial plexus injuries may require physiotherapy and, in severe cases, neurosurgical intervention. Intracranial hemorrhages require intensive monitoring and medical management.

Prognosis and Prevention

The majority of birth injuries heal without long-term complications. However, severe injuries such as third- or fourth-degree perineal tears can lead to lasting problems including fecal incontinence or chronic pelvic floor pain. The risk of serious injury can be significantly reduced through experienced obstetric care, controlled perineal protection techniques, selective use of episiotomy, and thorough postnatal follow-up.

References

World Health Organization (WHO): WHO Recommendations for Intrapartum Care for a Positive Childbirth Experience, 2018. Available at: https://www.who.int
Royal College of Obstetricians and Gynaecologists (RCOG): Management of Third- and Fourth-Degree Perineal Tears, Green-top Guideline No. 29, 2015.
Cunningham F. G. et al.: Williams Obstetrics. 25th Edition. McGraw-Hill Education, New York, 2018.

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