Traumatic Birth Injuries: Risk Factors and Classification

Probably the most frequently asked question among our prospective clients is “What exactly is a ‘traumatic birth injury‘ and how do I know if my child has one?” Traumatic birth injury is a term used to identify a large group of injuries that a baby may suffer as a result of being born. Mild physical birth injuries generally resolve on their own with no permanent damage. However, more severe traumatic birth injuries can result in permanent physical and mental harm.

Recent statistics reveal that significant traumatic birth injuries occur in about 6-8 of 1,000 live births and are responsible for about 2% of neonatal deaths. Surprisingly, nearly half of birth injuries are potentially avoidable through simple identification and planning for obstetrical risk factors.

The typical risk factors for traumatic birth injury include:

    • Infants whose size is large for their date (macrosomia), especially those who weigh more than 4000 grams (about 8 lbs, 13 ozs.)
    • Cephalopelvic disproportion (the size and shape of the mother’s pelvis is smaller than the baby’s head)
    • Prolonged labor
    • Premature babies born before 37 weeks
    • Abnormal delivery positions such as breech delivery or face presentation
  • Abnormal or excessive traction (pulling) during delivery

Types of traumatic birth injuries

Birth injuries fall into 5 main categories:  1) brain injury, hemorrhages (bleeds) and soft tissue injury, 2) peripheral nerve injury, 3) cranial nerve/spinal cord injury, 4) bone injury, and 5) intra-abdominal injury. Below are examples of traumatic injuries in each category:

Brain injury, intracranial hemorrhages (bleeds), soft tissue injury

  • Intracranial hemorrhage is bleeding that occurs inside the skull. There are several types of intracranial hemorrhages in infants including:
  • Cerebral hemorrhage – A form of stroke where bleeding occurs within the brain itself.
  • Intraventricular hemorrhage –this is a bleeding into the brain’s ventricular system, where spinal fluid is produced. It is the most serious type of intracranial bleeding and occurs most often in premature infants and infants with low birth weight.
  • Subarachnoid hemorrhage – bleeding in the subarachnoid space – the area between the arachnoid membrane and the protective covering that surrounds the brain.
  • Subdural hemorrhage or subdural hematoma– bleeding that is due to a rupture of one or more blood vessels that are in the subdural space – the area between the surface of the brain and the thin layer of tissue that separates the brain from the skull.
  • Cephalohematoma. This is bleeding between the skull and its covering and it usually presents as a raised bump on the baby’s head. It occurs a few hours after birth and lasts anywhere from 2 weeks to a few months after birth.
  • Hypoxic ischemic encephalopathy (HIE) or birth asphyxia. This is brain injury in newborns due to a lack of oxygen (a.k.a. hypoxia or apoxia) or blood flow during labor and/or delivery. Mental and physical impairments can vary from mild to severe and permanent, depending on the length of time the baby was deprived of oxygen or blood flow.

Peripheral nerve birth injury

    • Brachial plexus injury/ Erb’s Palsy. This occurs when the brachial plexus (group of nerves to the arms and hands) is injured. It frequently occurs in births involving shoulder dystocia (difficulty delivering the baby’s shoulders). As a result of this type of injury, the baby cannot flex and rotate its arms. Sometimes the injury resolves itself. However, if the nerve is torn, there may be permanent damage.

Cranial nerve and spinal cord birth injury.  These types of injuries are mostly associated with improper hyperextension, traction (pulling), overstretching and rotation of the baby during the delivery process.

  • Facial nerve paralysis. Pressure on the baby’s face during labor or delivery or improper forceps use can cause injury to the facial nerve. This results in no movement on the side of the face where the injury occurred, and oftentimes the eye cannot close. In mild cases, it resolves on its own. In more serious cases where the nerve is torn, surgical intervention is required.
  • Spinal cord injury. A very serious injury marked by hemorrhages, respiratory failure and overall weakness.

Bone birth injury. Fractures are often seen in breech deliveries, shoulder dystocia births or large infants. This includes long-bone fractures, bone-cartilage separations and clavicle or collarbone fractures. Fractures can generally be avoided via C-Sections.

Intra-abdominal birth injury. These types of birth injuries are fairly uncommon. Hemorrhage is probably the most serious and the internal organ most often damaged is the liver.

The outcome of newborns diagnosed with traumatic birth injury depends on the type of injury and the severity. Almost half of all traumatic birth injuries are avoidable with simple identification and planning by medical personnel. If your child experienced these or other birth injuries and has physical or mental limitations as a result, call the birth injury attorneys at Reiter & Walsh ABC Law Centers in Detroit, Michigan. We can evaluate your child’s case and determine if negligence played a role in the birth injury.  Contact us today for a free consultation.

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