Birth Trauma – Causes, Symptoms and Treatment

What Is Birth Trauma?

Birth trauma refers to physical injuries that occur in a newborn or the birthing mother during the process of labor and delivery. These injuries may be mechanical, hypoxic (caused by oxygen deprivation), or related to obstetric interventions. The majority of birth injuries are mild and resolve without lasting effects. However, in rare cases they can be severe and require specialized medical care.

In a broader sense, the term can also encompass psychological trauma experienced by the mother or child as a result of a distressing birth experience. This entry focuses on physical birth trauma in the newborn.

Causes and Risk Factors

Birth trauma most commonly results from mechanical forces during passage through the birth canal. Several factors can increase the risk:

• Macrosomia: An abnormally large or heavy newborn (birth weight above 4,000 g)
• Cephalopelvic disproportion: The mother's pelvis is too narrow for the baby to pass through safely
• Abnormal fetal presentation: Such as breech, transverse lie, or shoulder dystocia
• Prolonged labor: Extended labor increases mechanical stress on the newborn
• Assisted delivery: Use of vacuum extraction or forceps delivery
• Prematurity: Premature infants are more vulnerable due to immature tissues and bones
• Inadequate obstetric monitoring or inexperienced delivery personnel

Types of Birth Trauma in Newborns

Soft Tissue Injuries

These include abrasions, bruising (hematomas), and swelling of the skin. A common example is caput succedaneum, a swelling of the scalp caused by fluid accumulation during delivery, which typically resolves within a few days.

Cephalohematoma

A cephalohematoma is a collection of blood between the skull bone and the periosteum (the membrane covering the bone), caused by friction during birth. It does not cross suture lines and usually resolves within weeks to months without treatment.

Fractures

The most common fracture in newborns is a clavicle fracture (broken collarbone), which occurs most often during shoulder dystocia. Humerus (upper arm) fractures are also possible. These fractures generally heal rapidly and without complications.

Nerve Injuries

Brachial plexus palsy (also known as Erb's palsy) is one of the most well-known nerve injuries in newborns. It results from traction or compression on the brachial plexus nerve network and manifests as weakness or paralysis of the affected arm. Milder cases resolve spontaneously, while severe cases may require physiotherapy or surgical intervention.

Intracranial Injuries

Bleeding within the skull (e.g., subdural or subarachnoid hemorrhage) is a rare but serious complication that can result from instrumental delivery or excessive pressure on the skull. These injuries require immediate intensive medical care.

Hypoxic-Ischemic Encephalopathy (HIE)

Hypoxic-ischemic encephalopathy occurs when the newborn's brain is deprived of adequate oxygen during delivery, often due to umbilical cord complications or placental abruption. It can lead to permanent neurological damage and requires intensive treatment, including whole-body cooling (therapeutic hypothermia).

Symptoms

The symptoms of birth trauma depend on the type and severity of the injury. Common signs include:

• Visible swelling, bruising, or asymmetry on the newborn's body
• Guarding posture or restricted movement of an arm or leg
• Unusual crying or irritability
• Abnormal sleepiness or difficulty waking
• Seizures (in cases of intracranial injury)
• Breathing difficulties or changes in skin color (pallor, cyanosis)
• Poor feeding

Diagnosis

Birth trauma is diagnosed through a clinical examination of the newborn immediately after delivery. Depending on the clinical suspicion, the following investigations may be used:

• Physical examination: Assessment of skin, reflexes, muscle tone, and range of motion
• Imaging: X-rays to detect fractures; cranial ultrasound to assess intracranial structures; MRI if brain injury is suspected
• Neurological assessment: Evaluation of reflexes and motor function
• Blood tests: Such as blood gas analysis to detect oxygen deprivation

Treatment

Treatment is guided by the type and severity of the injury:

• Minor injuries (e.g., caput succedaneum, mild hematomas): Observation and regular monitoring; no specific intervention needed
• Fractures: Immobilization using splints or bandages; clavicle fractures usually heal without intervention
• Brachial plexus palsy: Physiotherapy; microsurgical procedures in severe cases
• HIE: Therapeutic hypothermia (whole-body cooling to 33-34 degrees Celsius for 72 hours) to reduce brain damage; intensive care monitoring
• Intracranial hemorrhage: Neurosurgical intervention and intensive care

Prognosis and Prevention

The prognosis depends strongly on the nature and extent of the injury. Many minor birth injuries heal completely. However, severe injuries such as HIE can lead to permanent impairments. Good prenatal care, careful monitoring during labor, and the timely identification of risk factors are essential to preventing birth trauma or minimizing its consequences.

References

1. Volpe, J. J. - Neurology of the Newborn. 6th Edition. Elsevier Saunders, 2018.
2. World Health Organization (WHO) - Recommendations for intrapartum care for a positive childbirth experience. Geneva: WHO, 2018. Available at: https://www.who.int/publications/i/item/9789241550215
3. Doumouchtsis, S. K. and Arulkumaran, S. - Head injuries after instrumental vaginal deliveries. Current Opinion in Obstetrics and Gynecology, 2006.