Birth Injury

A birth injury is any type of injury that occurs during labor and delivery, including trauma and oxygen deprivation. Birth injuries can range in severity from harmless to extremely severe. Many birth injuries result in permanent disability, which can have effects on the intellectual, cognitive, and/or physical capacities of an individual. In many cases, physicians can avoid causing birth injuries by following standards of care, properly monitoring the health status of the mother and child, and promptly addressing any suspected issues that may arise during pregnancy, labor, and delivery.

Legal Help for Birth InjuriesSome birth injuries are evident immediately after birth. Typical signs and symptoms that a birth injury may have occurred, include the following:

  • The baby is pale or blue in color
  • Breathing and/or heart rate are slow or resuscitation efforts are required
  • The infant is sluggish or lethargic
  • No interest in or difficulty feeding
  • Odd movements in the face, arms, or legs (seizures) or favoring one side of the body
  • Low APGAR scores at one minute and/or later.

In other cases, the injury is not identified for years, when the child begins to miss key developmental milestones or reaches school age when parents or teachers notice behavioral or learning disabilities, motor disorders like cerebral palsy, or speech-language disorders.

There are several different types of birth injuries, and many of them are inter-related. Sometimes, mothers can have risk factors for birth injury that doctors fail to diagnose, resulting in damage. In other cases, birth injury can result from a mismanaged labor and delivery, an unidentified infection, an event that causes oxygen deprivation, or improper NICU care. Birth injuries often impact the baby’s brain, which can result in motor, cognitive, behavioral, or emotional impairments.

What Does Birth Injury Look Like?

Birth injuries can look different depending on the severity and extent of the underlying brain damage. In some babies, parents notice that something is wrong right away – maybe their baby has seizures and has to go to the NICU, or maybe they had a traumatic birth and are concerned that their child is not meeting appropriate developmental milestones.

In many cases, birth injuries can cause cerebral palsy (CP), but birth injury does not always cause motor impairments. Sometimes disabilities stemming from birth injuries can impair cognitive, behavioral, or emotional function, rather than motor function. Common disabilities stemming from birth injury include learning disabilities and intellectual and developmental disabilities (I/DD).

What are the Most Common Types of Birth Injury?

While there are many different types of birth injuries, some of the most common birth injuries include clavicle and other bone fractures, brachial plexus injuries such as Erb’s or Klumpke’s palsy, bruising, and hypoxic-ischemic encephalopathy (HIE). Brain damage from brain bleeds, trauma or oxygen deprivation are also very common and can present with a wide range of severity. Frequently, the outcomes from birth injury include cerebral palsy, intellectual or developmental disabilities (I/DD), and seizure disorders.

What Diagnoses Might Indicate a Birth Injury?

There are certain diagnoses that may indicate has a birth injury. In situations where a baby has been diagnosed with one of the following, the condition can often be associated with medical malpractice:

Birth Injury Caused by Oxygen Deprivation

Hypoxic-Ischemic Encephalopathy (HIE) (Birth Asphyxia)

Hypoxic-ischemic encephalopathy (HIE) is the official medical name for oxygen deprivation that occurs at or around the time of birth.  If a baby’s oxygen supply is depleted or cut off, their brains (and in some cases other organs) can begin to show signs of dysfunction as oxygen-deprived cells begin to die. HIE is preventable – when medical staff adhere to medical standards of care and properly address signs of fetal distress (such as quickly performing an emergency C-section), a birth injury can be avoided.

fetal brain injury, ischemia; placenta; umbilical cord; neonatal brain damage; fetal hypoxia; hypoxic ischemic encephalopathy, HIE; birth asphyxia; neonatal encephalopathy, intrapartum asphyxia; fetal oxygen deprivation

Obstetric Complications That Can Cause HIE

HIE can be caused by multiple factors, including:

Birth Injury Caused by Trauma

Traumatic birth injuries are injuries caused by forces like pressure and torsion on the baby. Traumatic birth injuries can lead to other diagnoses like HIE or cerebral palsy. These injuries can result from the improper use of certain labor and delivery techniques (such as the use of vacuum extractors or forceps), or due to situations where the baby is stuck, malpositioned, or cannot be delivered vaginally for a number of reasons (such as having a shoulder stuck on the mother’s pelvis). Traumatic birth can be prevented by an adherence to standards of care, including via close monitoring of both mother and baby.

subgaleal hematoma; neonatal brain damage; subarachnoid hemorrhage; intracranial hemorrhage

Obstetric Events That Can Cause Traumatic Birth

Traumatic birth can be caused by multiple factors, including:

  • Face or breech presentation (which can cause trauma to the baby’s head and/or neck, and make the baby harder to deliver)
  • Improper use of vacuum extractors or forceps (which can put pressure on the baby’s delicate skull and brain, collapsing fragile blood vessels and causing hypoxic-ischemia)
  • Situations where the baby is ‘stuck’ in the birth canal due to a size mismatch between the mother’s pelvis and the baby’s head (cephalopelvic disproportion) or situations where the baby is much larger than average for their gestational age (macrosomia).
  • Prolonged or arrested labor, where the baby either moves too slowly down the birth canal or doesn’t progress down the canal. The contractions of labor can place pressure on the baby’s head, causing the head to be compressed, which in turn can compromise blood flow to certain parts of the brain.

Birth Injury Caused by Prematurity

Babies who are born prematurely are not yet fully developed. Their brains, lungs and other organs still have not yet fully matured, which means that they are more susceptible to injury and may require medical interventions for neonatal breathing problems. They often go to the NICU, where they may be placed on breathing machines. It is very important that the breathing machines be properly regulated, because if they are not, they may drive down the amount of carbon dioxide in the baby’s blood to dangerous levels. This overventilation causes hypocarbia, which can cause periventricular leukomalacia (PVL). Babies with PVL may show signs immediately, or it may be silent at first and show up around 8 weeks after birth. Babies with this kind of injury can have seizures, motor problems, vision issues, problems with feeding or breathing, or unusual stiffness in their limbs.

Medical staff should screen for risk factors that can cause or contribute to premature birth in order to provide interventions that can prevent premature birth. These include weakened cervical tissue (insufficient cervix) and infection, among others.

Birth Injury Stemming from Improper NICU Care

In addition to the risk of overventilation in premature babies, improper NICU care can cause other injuries:

  • Babies whose mothers have diabetes or obesity are at higher risk for neonatal hypoglycemia (low blood sugar). It is very important to keep babies in the NICU properly fed. Glucose is the brain’s only source of energy, and if a baby’s blood sugar drops too low, brain cells can begin to starve and die, causing seizures and brain injury.
  • Some babies (especially those born to mothers with diabetes, for example), are at higher risk of jaundice. Jaundice is a medical condition where bilirubin (a byproduct of blood cells) builds up in the tissues, causing the skin and/or eyes to look yellowed. In some cases, jaundice goes away on its own. In other cases, a baby may need help getting rid of the extra bilirubin. In these cases, they should be put under blue phototherapy lights, which help the body get rid of the bilirubin safely. If too much bilirubin builds up in the baby’s body, it can cross through the blood-brain barrier and cause brain damage in a condition called kernicterus. Kernicterus is always preventable.

Birth Injury Caused by Improper Prenatal Care

It is very important that prenatal care be thorough, including proper, frequent ultrasounds and other testing. Medical providers should provide tests to help recognize potential risk factors for birth injury, such as umbilical cord problems (nuchal cord, short cord, or knotted cord) or issues with fetal growth (IUGR). Ultrasound testing can help identify cord abnormalities such as abnormal length or knots and can help evaluate if the baby is growing properly.

Birth Injury Caused by Infection

Chorioamnionitis, Fetal Brain Damage and Cerebral Palsy


During labor and delivery, babies are in contact with the mother’s birth canal, which means they are exposed to all bacteria the mother may be carrying. Most bacteria or viruses are harmless, but others are not. Harmful bacteria or viruses can be passed from the mother to the baby during labor and delivery, which is why medical staff should run tests for certain kinds of maternal infections during prenatal care (and before labor and delivery if it is suspected the mother may have certain infections). If these infections are not properly treated (with proper antibiotics or antivirals), they can travel to and infect the baby’s brain (encephalitis), the membranes surrounding the brain and spinal cord (meningitis), or the lungs (pneumonia). Infections that medical staff often look for include:

Medical staff also should screen women for infections during pregnancy, including chorioamnionitis and villitis, urinary tract infections (UTIs) and bacterial vaginosis (BV). Infections from these conditions can be passed on to the baby.

Birth Injury Caused by Untreated or Mistreated Maternal Medical Conditions (High-Risk Pregnancy)

In addition to infections from chorioamnionitis and villitis, UTIs, BV, and GBS, there are many other health conditions in the mother that can increase the risk of birth injury in the baby.  These conditions can make a pregnancy ‘high-risk,’ which means that the mother and baby may need additional monitoring and interventions to prevent birth injury. These conditions include:

With high-risk pregnancies, prenatal care visits are often more frequent and involve more tests to ensure that both mother and baby are progressing well through the pregnancy. For the baby, tests (such as NSTs and BPPs) may be done to ensure the baby is getting enough blood flow, oxygen, and nutrients. In some circumstances, an early planned delivery may be recommended, especially in cases where certain infections, high-blood pressure issues, or diabetes are a factor in the mother’s pregnancy.

Birth Injury Caused by Mismanaged Obstetric Procedures and Emergencies

Labor and delivery can rapidly change from normal conditions to those that require prompt or emergency intervention. Medical staff should be properly trained and have experience in handling obstetric emergencies.

Situations that can quickly become obstetric emergencies include:

  • Fetal distress (fetal oxygen deprivation, which shows up as non-reassuring tracings on fetal monitoring strips), which can contribute to Meconium Aspiration Syndrome (MAS)
  • Umbilical cord compression or prolapse (where blood flow to the baby through the umbilical cord is either partially or
    Umbilical cord prolapse (prolapsed cord)

    Umbilical cord prolapse

    completely interrupted)

  • Uterine rupture (where the uterus tears, causing massive hemorrhage)
  • Placental abruption (where the placenta separates from the uterine wall, causing bleeding)
  • Labor in the presence of placenta previa (a low-lying placenta, which either completely or fully covers the cervix). If a low-lying placenta tears, this could cause severe bleeding, resulting in HIE in the baby). Planned early C-section is usually safer in the presence of placenta previa.
  • Vaginal Birth after C-Section (VBAC): Women with prior C-section scars have an increased risk of abdominal rupture if they undergo labor after their C-section. C-section scar ruptures can cause hemorrhaging and dangerously low blood pressure.
  • Neonatal Resuscitation: After delivery, babies that aren’t breathing at birth, or are struggling to breathe, need emergency resuscitation. If resuscitation is done incorrectly, this can injure the baby by damaging the lungs.

Other situations and delivery room errors that increase the risk of birth injury include:

  • Delayed Delivery: When medical staff waits too long to induce or deliver a baby it can cause birth injury. Medical staff should be trained to recognize situations in which a prompt delivery is necessary, including fetal distress and other obstetric emergencies. The longer medical staff allow labor to progress on in the presence of these emergencies, the greater the risk of birth injury. No more than 30 minutes should elapse between the decision to have an emergency C-section and incision time.
  • Improper Fetal Monitoring: Babies’ heart rates should be continuously monitored during labor and delivery to ensure they tolerate labor well. If fetal monitoring is done improperly, medical staff may miss critical signs of fetal distress, missing a critical window of time to intervene to prevent a birth injury.
  • Improper Anesthesia Administration: While many individuals choose to use an epidural during labor, it is important to note that epidurals do sometimes carry risks. If improperly administered, they can interfere with the second stage of labor and cause low blood pressure, which can, in turn, impact blood flow to the baby. In some cases, anesthesia may interfere with bearing-down, which increases the chances that drugs like Pitocin or Cytotec may be used to augment labor.
  • Improper Pitocin or Cytotec Administration: Pitocin and Cytotec are often used to augment contractions. However, in some situations, they may make contractions too strong, making the uterus clench too much and reducing blood flow to the baby.

Birth Injury Treatment

Birth injuries can cause permanent brain damage. Once this permanent brain damage occurs, much of the care available is supportive and palliative, with the exception of hypothermia therapy to reduce the severity of injury for hypoxic-ischemic encephalopathy (HIE). Hypothermia therapy is given within the first 6 hours of birth. Babies with birth injuries are often enrolled in Early Intervention (EI) programs and provided with numerous therapies to help them maximize their skills and development. Therapies include physical therapy (to help kids develop gross motor skills), occupational therapy (to help develop fine motor skills), speech therapy (to help kids communicate), and other therapies as needed.

Birth Injury and Medical Malpractice

When delivery complications arise, it is the responsibility of the nurses, doctors or other medical professionals to act quickly and appropriately to minimize the risks to the mother and baby. Medical malpractice occurs when this does not happen. Some examples of medical negligence include:

Trusted Legal Help for Children with HIE, Cerebral Palsy and Other Birth Injuries

Michigan Birth Injury Attorneys with a National Presence

Reiter & Walsh, PC | Birth Trauma AttorneysReiter & Walsh ABC Law Centers is a national law firm that focuses solely on birth injury. The firm has been helping children since its inception in 1997. Our attorneys and in-house medical staff have helped families throughout the country obtain compensation for lifelong care, treatment, therapy, and security. The firm’s attorneys are all members of the Birth Trauma Litigation Group (BTLG), and firm owner Jesse Reiter is a past executive board member and past chair of the group.

While the team is based in Michigan, we handle cases all over the United States. Many of our clients have hailed from Michigan, Ohio, Washington D.C., Arkansas, Mississippi, Pennsylvania, Tennessee, Texas, Wisconsin and other states.

The Reiter & Walsh, P.C. birth trauma team has also handled FTCA cases involving military medical malpractice and federally funded clinics.

Contact Reiter & Walsh ABC Law Centers to begin your free case evaluation. Our award-winning birth trauma lawyers are available 24/7 to speak with you.

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Related Articles and Blogs on Birth Injuries from Reiter & Walsh ABC Law Centers

Video: Birth Injury and Hypoxic-Ischemic Encephalopathy (HIE)

The information presented above is intended only to be a general educational resource. It is not intended to be (and should not be interpreted as) medical advice.