Birth Trauma

Birth trauma generally refers to those otherwise avoidable injuries suffered by a baby during with the process of vaginal delivery.

Larger infants, those weighing in excess of 4,500 grams, or approximately 10 pounds, are particularly susceptible to birth trauma injuries. Frequently, babies who are delivered by operative vaginal delivery, which may involve the use of forceps or a vacuum extractor, may suffer birth trauma related injuries.

It has been estimated that nearly 50% of all birth trauma injuries are avoidable with the recognition and anticipation of the relevant obstetrical risk factors by the safe and careful medical practitioner. Indeed, the rates of fetal death due to birth trauma have fallen dramatically, as unsafe practices such as midforceps rotation have been discouraged and diagnostic modalities such as ultrasound have permitted safe and careful obstetricians to identify, anticipate and adapt to factors associate with an increased risk of birth trauma.

In general, the potential risk of birth trauma related injuries is associated with the presence of cephalopelvic disproportion, maternal pelvic anomalies, fetal macrosomia, breech or transverse presentation, oligohydramnios or precipitous labor. The injudicious use of forceps or a vacuum extractor by a careless practitioner may also increase the risk of birth trauma related injuries.

More severe forms of birth trauma include cranial and intracranial hemorrhage, such as cephalohematoma and subgaleal hemorrhage. Cephalohematoma results when bleeding occurs in the head near the skull; subgaleal hemorrhage describes bleeding between the skull and the scalp. Either form of hemorrhage can be severe, and may result in neonatal anemia, hypotension, or hypovolemic shock. One of the most commonly recognized causes of subgaleal hemorrhage in the newborn is the improper use of a vacuum extractor during delivery.

Other forms of avoidable birth trauma may include obstetrical brachial plexus palsy, spinal cord injuries, and facial nerve palsies which are frequently caused by forceps compression.

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