Birth Trauma (Birth Injury)

Birth injuries in babies

Head and scalp

Forceps can also leave temporary marks or bruising on the face.

Collarbone fracture

A clavicle fracture is the most common birth fracture, often after a difficult shoulder delivery. The baby may cry when the arm is moved, move it less, or have a lump as the bone heals. It heals within 2 to 3 weeks; gentle handling and pinning the sleeve to the clothing for comfort are usually enough.

Brachial plexus injury

Stretching of the nerves in the neck during delivery, especially with shoulder dystocia, can weaken an arm. The most common type, Erb's palsy, causes the arm to hang by the side with the wrist bent ("waiter's tip" position). Most babies recover fully within 3 to 6 months with physical therapy. Those without improvement by around 3 to 6 months are assessed for nerve surgery. See brachial plexus injury.

Facial nerve injury

Pressure from forceps or the mother's pelvic bone can bruise the facial nerve. One side of the face does not move when the baby cries, and the eye may not close fully. Most cases recover within weeks. See facial nerve palsy.

Other injuries

• bruising and small bleeds in the whites of the eyes (subconjunctival hemorrhage), which fade within 1 to 2 weeks
• fractures of the upper arm or thigh bone (rare)
• injury to abdominal organs (very rare)

Risk factors

• a large baby (macrosomia), often above 4 to 4.5 kg (8 lb 13 oz to 9 lb 15 oz), especially with maternal diabetes
• shoulder dystocia (the shoulder becoming stuck after the head is born)
• prolonged labor
• forceps or vacuum-assisted delivery
• breech or other unusual positions
• small maternal pelvis
• very premature babies, whose tissues are more fragile

Birth trauma in mothers

Perineal tears

Most first-time vaginal births involve some tearing. Tears are graded:

• First degree: skin only
• Second degree: skin and muscle; repaired with stitches
• Third degree: extend into the anal sphincter
• Fourth degree: extend into the lining of the anus or rectum

Third and fourth degree tears (obstetric anal sphincter injuries) are repaired in an operating room and can cause fecal incontinence if not recognized. Physical therapy and follow-up are important.

Other physical injuries

• pelvic floor muscle injury leading to urinary incontinence or prolapse
• tailbone injury
• postpartum hemorrhage
• uterine rupture (rare)

Psychological birth trauma

A frightening, painful or out-of-control birth can lead to post-traumatic stress disorder, with flashbacks, nightmares, avoidance and anxiety. It affects a minority of women and also some partners. Talking therapies such as trauma-focused CBT and EMDR are effective.

Diagnosis

Newborns are examined from head to toe after birth. Further tests depend on findings: X-rays for suspected fractures, ultrasound or MRI of the head for bleeding, blood count and bilirubin levels for large bleeds and jaundice, and nerve studies for persistent brachial plexus weakness. Mothers are examined after birth to identify and grade tears.

Treatment and recovery

Most newborn birth injuries need only observation and gentle care. Specific treatments include:

• phototherapy for jaundice from a cephalohematoma; see neonatal jaundice
• blood transfusion and intensive care for subgaleal or brain bleeds
• physical therapy for brachial plexus injury, with nerve surgery for some
• eye protection for facial nerve palsy if the eye does not close

For mothers: stitches, pain relief, stool softeners, pelvic floor exercises, pelvic health physical therapy, and mental health support.

Frequently asked questions

What is the most common birth injury?

Scalp swelling (caput succedaneum) and cephalohematoma are the most common birth injuries in babies, and both usually resolve on their own. The most common fracture is a broken collarbone, which heals within weeks. Brachial plexus injury is less common but well known.

What is the difference between caput succedaneum and cephalohematoma?

Caput succedaneum is soft swelling of the scalp skin, present at birth, that crosses the skull suture lines and fades within days. A cephalohematoma is a firm collection of blood under a skull bone, limited to one bone, that may appear hours after birth and takes weeks to months to resolve.

Do babies recover from birth injuries?

Most do, fully. Scalp swelling, bruising, collarbone fractures and facial nerve weakness usually heal within days to weeks. Most brachial plexus injuries recover within months. Serious injuries such as large bleeds in or around the brain are rare and may have lasting effects.

Can birth trauma cause PTSD in mothers?

Yes. A traumatic birth can lead to post-traumatic stress disorder, with flashbacks, nightmares, anxiety and avoidance of reminders. It is treatable with trauma-focused therapies. Speak to your doctor or midwife if symptoms persist beyond a month.

Can birth injuries be prevented?

Some can. Careful monitoring of labor, managing diabetes in pregnancy, planning delivery for very large or breech babies, and skilled use of forceps or vacuum reduce risk. However, many birth injuries happen despite excellent care because labor is unpredictable.