Birth Injury Overview

Fact Checked

A birth injury is any type of damage caused to a baby before, during, or shortly after labor and delivery. Also known as birth trauma, birth injuries can lead to disorders such as cerebral palsy, but most are minor and resolve over time.[1] Some birth injuries are caused by negligent medical mistakes, which could have otherwise been prevented.

Asphyxia

Perinatal asphyxia is a decrease in blood flow or a drop in oxygen in the baby’s blood during delivery or just before or after delivery.

Asphyxia in a newborn can be caused by multiple factors and birth complications:

• Placental abruption, the separation of the placenta and uterine wall
• Obstructed blood flow in the umbilical cord
• An infection in the fetus
• Severe hemorrhaging or illness in the mother
• Drug use by the mother
• Abnormal fetal development

Consequences of perinatal asphyxia can range from mild to severe and temporary to permanent. The severity depends on factors such as the duration of asphyxia and how it is treated.

Cerebral Palsy

Cerebral palsy, or CP, is a neurological condition caused by a lack of oxygen to the brain. It leads to impairments in motor skills, muscle tone, and movement. Related complications can also include learning disabilities, cognitive impairment, speech difficulties, lung disease, low bone density, and limited vision or hearing.

The effects of CP vary widely by individual and may be mild to debilitating. There are treatments but no cure for CP.

Causes of Cerebral Palsy

Perinatal asphyxia is a common cause of injuries at the time of birth. This is an inadequate flow of oxygen to the newborn during childbirth. It may occur because blood flow to the baby is restricted or because the blood getting to the baby does not have enough oxygen.

The cause of perinatal asphyxia may be a genetic abnormality, loss of blood, pressure on the umbilical cord, or an infection.

Types of Cerebral Palsy

• The most common type of CP is called spastic cerebral palsy. It is characterized by abnormal movements, muscle spasms, stiff muscles, and difficulty controlling movements.
• Dyskinetic cerebral palsy is the next most common type of CP, and it causes repetitive movements, irregular movements that are unpredictable, and awkward posture.
• Ataxic CP is characterized by trouble with coordination and balance and tremors.
• A child may also have a mixed type of CP with characteristics of one or more of the other types.

Treating Cerebral Palsy

While there is no cure for CP, treatments can help improve symptoms, and therapy and educational interventions can help with complications of the condition.

Some types of physical therapy are the most common treatments for CP. It helps children develop better muscle tone, learn to move more comfortably and be better able to walk and speak more easily. Medications also play an essential role in managing cerebral palsy. Some children benefit from surgery.

Brachial Plexus Injuries and Erb’s Palsy

The brachial plexus is a bundle of nerves that controls arm movement and feeling. It runs from the spinal cord, through the neck, and down each arm.

Several birth injuries are included under brachial plexus injuries, and the most common is Erb’s palsy. Erb’s palsy occurs when the damage to the brachial plexus causes weakness or lack of sensation in the arm. 

The arm may even be paralyzed if the damage is severe enough. When brachial plexus damage leads to weakness or paralysis in the lower arm, wrists, or hands, it is often called Klumpke’s palsy.

What Causes Brachial Plexus Injuries?

During childbirth, brachial plexus nerves can be damaged when a doctor or midwife pulls the neck and shoulder apart with too much force. This can lead to stretching of the nerves with damage that ranges from mild to severe. The most severe nerve injury entails nerves wholly torn from the spinal column.

Treating Brachial Plexus Injuries

Damage to the brachial plexus is most often not permanent. Most infants show signs right away of not being able to move one arm as much as the other, but this usually heals within a few months.

If the nerve damage is more severe, physical therapy may help the baby recover movement and heal, or surgery may be necessary to repair damaged nerves. In some cases, a person will live with symptoms of Erb’s palsy into adulthood.

If a baby’s symptoms don’t lessen or disappear by about six months of age, the nerves are not healing. This may mean that surgery is necessary to repair the damaged nerves.

Depending on the severity of the damage, nerves may need to be replaced. Donor nerves can be grafted onto torn nerves to help heal, but can also replace them entirely.

Other Nerve Injuries

Other nerves may get damaged in an infant. Nerves can be overstretched and, in extreme cases, ripped or torn.

The nerves in a bundle originating from the brain stem instead of the spinal cord are called cranial nerves, which can be damaged by stretching during childbirth. Depending on which nerve or nerves are damaged, a child may be born with various weaknesses or paralysis.

Facial Nerve Damage

One possibility is that a facial nerve will be damaged. This can happen when forceps compress the nerve. The facial nerve can also get squeezed in the birth canal.

Symptoms of this type of injury are asymmetrical movements in the face, one side of the mouth being drawn toward the other, smoother skin on the paralyzed side, and a general lack of movement and expression on the affected side of the face.

Laryngeal Nerve Damage

Damage to the laryngeal nerve may affect a child’s ability to breathe and swallow. It may also cause paralysis of the vocal cords. This damage often occurs when an infant’s head turns to the side during childbirth.

A newborn with this type of nerve damage will show respiratory distress and may have a hoarse cry. Most babies born with laryngeal nerve damage will recover within a few months.

Spinal Cord Damage

In very rare cases, the spinal cord may be stretched and damaged. This is a severe injury. The result is typically paralysis below where the damage occurred.

Spinal cord injuries are most often permanent and leave a child with lifelong paralysis of a part of the body. An injury to the upper part of the spinal cord can be fatal. This injury can interfere with the baby’s ability to breathe.

Skull Fracture

The pressure that the baby’s head is under as it exits the womb can be great enough to cause a fracture. Forces from the birth canal and the mother’s pelvic bones can sometimes cause a fracture.[2]

A fracture can also result from the instruments a doctor uses to deliver the baby.

Fortunately, most fractures are not severe and heal with time and without causing any other complications. A fracture may also occur with other types of brain injuries in newborns, such as a cephalohematoma (bleeding under the skull).

With a hematoma, the doctor may need to drain fluid from the baby’s brain to prevent damage from the pressure of the fluid.[3]

Brain Damage

Injuries that occur during childbirth or in the womb before delivery have the potential to cause brain damage. Fractures may cause brain damage, but most often do not.

• Cephalohematoma. Cephalohematoma, bleeding below the periosteum, a layer of tissue over the skull, is usually treatable and doesn’t typically leave the baby with any permanent damage.
• Hemorrhage. A hemorrhage, or bleeding, can occur in and around the brain in several places, causing varying amounts of damage or lasting health issues.
• Hypoxic-Ischemic Encephalopathy. Other types of injury to the brain, however, can cause brain damage. One is hypoxic-ischemic encephalopathy (HIE). A lack of oxygen causes this brain damage to the infant’s brain during childbirth. Inadequate oxygen can cause brain cells to die. This is a common cause of cerebral palsy.
• Periventicular Leukomalacia. Periventricular leukomalacia is the death of white brain matter in the area of the brain where nerves send messages from the brain to the muscles of the body. This type of injury can lead to motor disorders, cognitive delays, coordination issues, and vision and hearing impairments.[4]
• Cerebral Dysgenesis. Cerebral dysgenesis refers to the abnormal development of the brain of an infant. There are many possible causes of abnormal development. It may result from direct damage to the baby’s head during childbirth. An infection can also cause cerebral dysgenesis.

Wrongful Death

Most birth injuries do not lead to the infant’s death, but it is possible. Infants die every year because of injuries caused at the time of birth.

A few types of injuries are more likely to be fatal if severe. For instance, HIE, or lack of oxygen to the infant’s brain, if severe enough, may cause significant brain damage and lead to the child’s death.[5] This may happen during difficult labor if the infant gets stuck in the pelvic area or in the birth canal or gets choked by the umbilical cord.

Other possible infant death causes include hemorrhaging, bleeding in the brain, newborn jaundice that goes untreated, severe damage to the spinal cord, or a severe skull fracture.[6]

In many cases, the death of a newborn is considered a wrongful death. Some actions, or failures to act, on the part of medical caregivers directly or indirectly led to the death of the infant.

If a newborn’s death is deemed preventable, it could be termed a wrongful death.

Preventable Birth Injuries

The death of an infant is always a tragedy, but if it could have been prevented with better medical care, the loss is even more devastating. Even when a child is born with a birth injury that isn’t fatal, that child may have to live with lifelong complications.[7]

There are many examples of infant injuries that could not have been foreseen, or that would have been impossible to prevent, but many more that were the result of negligence or wrongdoing.

Some reasons that birth injuries or fatalities could have been prevented include:

• Failure to detect and treat a mother’s infection while pregnant
• Side effects from prescribed medications
• Failure to detect potential issues with the mother, baby, or difficult labor
• Failure to determine the need for a Cesarean section
• Failure to detect problems with the umbilical cord
• Improper use of forceps and other instruments

Birth injuries range from mild and temporary to fatal, with every possibility in between. Fortunately, most birth injuries are not fatal and do not cause serious, lifelong complications.

If you have a child who now faces birth injuries like cerebral palsy, Erb’s palsy, or brain damage, you may feel as if those injuries could and should have been prevented.

Lawyers experienced in birth injuries and wrongful deaths can help you take the steps needed to seek justice and compensation for your child.