High-Risk Newborns - Birth Injury
Occasionally during the birth process, the baby may suffer a physical injury that is simply the result of being born. This is sometimes called birth trauma or birth injury.
A difficult birth or injury to the baby can occur because of the baby's size or the position of the baby during labor and delivery. Conditions that may be associated with a difficult birth include, but are not limited to, the following:
- Large babies. Birthweight over about 4,000 grams (8 pounds, 13 ounces)
- Prematurity. Babies born before 37 weeks (premature babies have more fragile bodies and may be more easily injured)
- Cephalopelvic disproportion. The size and shape of the mother's pelvis is not adequate for the baby to be born vaginally
- Dystocia. Difficult labor or childbirth
- Prolonged labor
- Abnormal birthing presentation. An example of this is breech (buttocks first) delivery.
The following are common birth injuries:
- Caput succedaneum. Caput is a severe swelling of the soft tissues of the baby's scalp that develops as the baby travels through the birth canal. Some babies have some bruising of the area. The swelling usually disappears in a few days without problems. Babies delivered by vacuum extraction are more likely to have this condition.
- Cephalohematoma. Cephalohematoma is an area of bleeding underneath one of the cranial bones. It often appears several hours after birth as a raised lump on the baby's head. The body resorbs the blood. Depending on the size, most cephalohematomas take two weeks to three months to disappear completely. If the area of bleeding is large, some babies may develop jaundice as the red blood cells break down.
- Bruising or forceps marks. Some babies may show signs of bruising on the face or head simply as a result of the trauma of passing though the birth canal and contact with the mother's pelvic bones and tissues. Forceps used with delivery can leave temporary marks or bruises on the baby's face and head. Babies delivered by vacuum extraction may have some scalp bruising or a scalp laceration (cut).
- Subconjunctival hemorrhage. Subconjunctival hemorrhage is the breakage of small blood vessels in the eyes of a baby. One or both of the eyes may have a bright red band around the iris. This is very common and does not cause damage to the eyes. The redness is usually absorbed in a week to ten days.
- Facial paralysis. During labor or birth, pressure on a baby's face may cause the facial nerve to be injured. This may also occur with the use of forceps for delivery. The injury is often seen when the baby cries. There is no movement on the side of the face with the injury and the eye cannot be closed. If the nerve was only bruised, the paralysis usually improves in a few weeks. If the nerve was torn, surgery may be needed.
- Brachial palsy. Brachial palsy occurs when the brachial plexus (the group of nerves that supplies the arms and hands) is injured. It is most common when there is difficulty delivering the baby's shoulder, called shoulder dystocia. The baby loses the ability to flex and rotate the arm. If the injury caused bruising and swelling around the nerves, movement should return within a few months. Tearing of the nerve may result in permanent nerve damage. Special exercises are used to help maintain the range of motion of the arm while healing occurs.
- Fractures. Fracture of the clavicle or collarbone is the most common fracture during labor and delivery. The clavicle may break when there is difficulty delivering the baby's shoulder or during a breech delivery. The baby with a fractured clavicle rarely moves the arm on the side of the break. However, healing occurs quickly. As new bone forms, a firm lump on the clavicle often develops in the first 10 days. If the fracture is painful, limiting movement of the arm and shoulder with a soft bandage or splint may be helpful.
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