Birth Injuries


Birth injuries are physical injuries that happen during the birth process. It can affect both the mother and the baby. Let’s discuss the main types of birth injuries, causes and treatment options for birth injuries.


What are birth injuries?

Birth injuries are any kind of physical damage that happens just before the baby is born, during the birth process or shortly after labor and delivery. Most birth injuries that happen tend to be minor and resolve over a period of time. Some forms of birth injuries can cause lasting damages like it can affect the nerves, brain, bone and muscles. The sad part is certain forms of birth injuries are unpreventable or foreseeable.

Birth injuries do affect the mother and the extent of it can range from tearing in the vaginal area to damage to the pelvic floor. 

Causes of birth injuries

During a birth injury, things are out of control. The main causes of birth injury are

·         The baby is large (>4 kg)

·         The mother is overweight

·         The position of the baby (the baby is not head first in the birth canal)

·         The baby is born prematurely

·         The duration of the labor is very long (the contractions may not be strong enough to push the baby through the birth canal)

·         Mother having an unusually shaped pelvis, making the birth process difficult for a normal vaginal birth.

·         Severe hypoxia

·         Placental abruption

·         Placenta praevia

·         Infections

·         Assisted delivery devices like vacuum or forceps are used to deliver the baby

·         Sometimes birth injuries can happen due to medical negligence like failure to monitor baby’s heart rate, failure to identify that baby is in distress and not addressing the complications appropriately.

Birth Injuries in mothers

Injuries to the perineal area

Perineal tear: During the process of vaginal birth, 1 in 8 women experience perineal trauma, which is a tear or surgical cut between the vagina and anus.

Nerve damage: During the birth process, sometimes nerves in the perineal area can get damaged leading to a painful condition called pudendal neuralgia.

Injuries to the pelvic floor

Muscle Damage: Due to overstretching or tearing, certain changes can happen in the pelvic floor during the birth process.

Pelvic organ prolapse: When pelvic muscles get damaged or weakened, the organs in the pelvis can drop down towards the vagina, causing bladder and bowel issues. 

Umbilical cord problems

The source of oxygen and nutrients to a baby is through the umbilical cord. Problems in the umbilical cord can lead to birth asphyxia. There are several distinct umbilical cord problems.

·         Compression: The umbilical cord is compressed more than is typical.

·         Nuchal cord: The umbilical cord wraps around the baby’s neck one or more times.

·         True knot: When the umbilical cord forms a true knot, severe cord compression occurs, leading to birth injury.

·         Prolapse: In this case, the cord begins to slip via the birth canal ahead of or alongside the baby.

·         Short chord: When there is a short umbilical cord, the fetal movement can cause excessive pulling on the placenta, causing placental abruption.

·         Vasa previa: In this condition, the blood vessels migrate out of the umbilical cord and into the amniotic sac membranes.

·         Infection: Sometimes infection like chorioamnionitis can happen in the fetal membranes that can spread to the umbilical cord, placenta and fetus.

Certain types of umbilical cord problems can lead to oxygen deprivation and fetal distress.

Birth injuries in babies

Minor birth injuries like bruises and small cuts are common in babies and usually resolve quickly. The chances of serious forms of birth injuries in babies are uncommon.

Types of birth injuries in babies

Brain injuries at birth

These are serious forms of birth injuries and can cause physical and mental symptoms. These babies may find difficulties in reaching the developmental milestones or sometimes may not be able to attain the milestone at all. The most common cause of brain injury at birth is cerebral palsy. It is a neurological condition that affects mobility, development and cognition.

Brain injuries happen due to oxygen deprivation to the brain (anoxia) or when there is decreased flow of oxygen to the brain (hypoxia). Sometimes improper use of assisted devices like forceps or ventouse can cause damages to the baby’s brain.

Shoulder dystocia

This form of birth injury occurs in 1 in every 150 deliveries. In this injury, a baby’s head is born but one shoulder gets stuck behind the mother’s pubic bone. It can damage the nerves in a baby’s neck, leading to transient or permanent loss of movement in the arm.  If the condition is not managed appropriately, it can lead to death.

Obstetric brachial plexus injury

The brachial plexus is a group of nerves that controls movement and feeling in the arms. In this condition, the nerves in the baby’s neck are damaged during delivery. This leads to loss of movement and sensation in the arm. In extreme cases, it can lead to permanent damage to the arm. The most common type of brachial plexus injury is Erb’s palsy.

Broken bones

During labor and delivery, some babies are at risk of broken bones (fractures). The most common types of fractures are the one that happens in the collar bone. The common causes of fractures include improper use of instruments like forceps, shoulder dystocia and excessive twisting or pulling of the baby during delivery.

How to prevent birth injuries?

Birth injuries are often unpredictable and not preventable. Following certain measures during pregnancy may be helpful.

·         Exercise regularly and strengthen the pelvic muscles

·         If the normal vaginal delivery is not possible, a C-section can help prevent birth injuries.

·         Avoid constipation as too much strain in the toilet can weaken the pelvic muscles.

Treating birth injuries

Some birth injuries like a minor perineal tear will resolve on its own. A deep tear may require stitches and pain relieving medications are necessary. If the damage happens to the muscles of the pelvic floor, physiotherapy and exercises are required to strengthen the pelvic floor muscles. Some women may require pessaries in their vagina or a surgery to correct a prolapse.

Neonatal injuries

·         For cerebral palsy, physical therapy is the common treatment which helps children attain better muscle tone, walk, move and speak easily. Medications include muscle relaxants, anticonvulsants and pain killers.

·         For Erb’s palsy, if physical therapy does not work, surgery may be required to repair the damaged nerves.

·         To treat brain injuries, therapeutic hypothermia is done.

 


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