Complications in the process of labor and delivery can result in a wide variety of problems in the newborn. These problems, known collectively as birth injuries, can be mild or severe. One major cause is oxygen deprivation, which commonly occurs when the umbilical cord is compressed or twisted in the birth process. The other main cause is mechanical trauma, which may occur when the baby assumes an unusual position at the time of birth (buttocks rather than head first, for example) or when the baby is too large to pass through the birth canal easily.
The incidence of birth injuries has declined in recent years because of advances in obstetrics. Many birth injuries, however, are unavoidable, even with the best medical care. The risk of birth injury is greatest in cases of prolonged or premature labor.
WHAT TYPES OF INJURIES CAN BE SUSTAINED DURING BIRTH?
Injuries most commonly involve the skin, head, bones, nerves and brain. Most skin injuries are minor, consisting of bruises, scrapes, petechiae (small, flat, purplish-red spots caused by bleeding under the skin) or lumps. In general, they disappear within a few days of birth.
Birth injuries involving the head include caput succedaneum, which is a swelling over much of the skull that usually subsides within a few days, and cephalhematoma, which is a distinct bump that increases in size within two days of birth and gradually disappears over a few weeks or months. In addition, some infants suffer burst blood vessels in the eyes which may make the eyes extremely red but rarely causes any lasting damage.
The most common bone injury sustained in birth is fracture of the collar bone, which is always a risk when a large baby is delivered. An arm or leg may sometimes be fractured during the birth as well. Less common are fractures of the spine or ribs but skull fractures are quite rare because a baby's skull bones are not yet fused, allowing the head to mold itself to the shape of the birth canal.
Infants are occasionally born with temporary paralysis of a facial nerve, which gives the face a lopsided appearance, especially during crying. This problem usually passes within a few days of birth, although it may last up to six months. A nerve that supplies one of the arms may also be injured during birth, usually leading to temporary (but occasionally permanent) paralysis of the arm.
The most serious birth injuries are those that affect the brain. They are caused by oxygen deprivation or bleeding within the skull or brain. These injuries vary greatly in severity. They may lead to long-term seizure disorders or cause cerebral palsy or mental retardation, but on the other hand, they may have no lasting effects.
HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS HAD A BIRTH INJURY?
During labor, fetal monitoring may indicate oxygen deprivation, in which case the pediatrician will be on the lookout for resulting problems. Otherwise, the pediatrician will examine the child for signs of injury immedately after birth and at least once more before hospital discharge. If the baby was in a breech position (feet or buttocks first) or the labor was long and difficult, the doctor will be particularly alert to signs of birth injuries.
WHAT TREATMENTS ARE AVAILABLE?
Minor birth injuries, including most fractures, require no treatment except for careful handling and close monitoring to make sure the injury resolves as it should. Infants who have suffered oxygen deprivation during birth may need breathing support (mechanical ventilation) for a while. If a brain injury results in seizures, they can be treated and usually controlled with medication.
PREVENTING BIRTH INJURIES
If the following conditions exist in the mother or fetus, the obstetrician will take them into account in planning the delivery. In some cases, caesarean delivery will be planned to reduce the risk of birth injury.
• Protect bruises, scraped skin or swelling from additional trauma until healing is complete.
• Be careful dressing and undressing a baby with a bone fracture. If the collar bone or an arm is broken, do not put the arm on the affected side through the sleeve.
• Support the fractured bone while carrying the infant. When you lift an infant with a broken collar bone, place your arm under the back and shoulders. DO NOT lift the baby up under the arms.
• If temporary facial paralysis keeps one eye open, protect it from injury until it can close.
• If facial paralysis makes nursing difficult, feed the baby with a medicine dropper or a soft rubber nipple with a large hole.
• If one of the infant's arms is paralyzed, support it at shoulder level while you dress her. Move the arm gently, avoiding unnecessary stress.
