Birth injury is damage that occurs as a result of physical pressure during the birthing process, usually during transit through the birth canal.
Many newborns have minor injuries during birth. Most injuries resolve without treatment.
CAUSES: A difficult delivery, with the risk of injury to the baby, may occur with extremely large fetuses. Doctors recommend cesarean delivery (C-section) when they estimate the baby weighs more than 11 pounds (more than 10 pounds when the mother has diabetes). Injury is also more likely when the fetus is lying in an abnormal position in the uterus before birth.
Birth injuries are most commonly due to the natural forces of labor and delivery. In the past, when risks of cesarean delivery were high, doctors did difficult deliveries by pulling the fetus out using forceps (a surgical instrument with rounded edges that fit around the fetus's head). However, bringing the fetus down from high in the birth canal with forceps had a high risk of causing birth injury. Today, forceps are used only in the final stages of delivery and rarely cause injury. Overall, the rate of birth injuries is much lower now than in previous decades because of improved prenatal assessment with ultra-sonography, the limited use of forceps, and because doctors often do cesarean delivery if they foresee an increased risk of birth injury.
TYPES OF INJURIES:
Head injury is the most common birth-related injury.
- Head molding is not an injury. Molding refers to the normal change in shape of the baby's head that results from pressure on the head during delivery. In most births, the head is the first part to enter the birth canal. Because a fetus's skull bones are not rigidly fixed in position, the head elongates as it is pushed through the birth canal, which allows the fetus to pass through more easily. Molding does not affect the brain and does not cause problems or require treatment. The head shape gradually becomes more rounded over several days.
- Swelling and bruising of the scalp is common but not serious and generally resolves within a few days.
- Scalp scratches can occur when instruments (such as monitor leads attached to the scalp, forceps, or vacuum extractors) are used during a vaginal delivery.
- Bleeding outside of the skull bones can lead to an accumulation of blood either above or below the thick fibrous covering (periosteum) of one of the skull bones.
- A cephalohematoma is blood accumulation below the periosteum. Cephalohematomas feel soft and can increase in size after birth. Cephalohematomas disappear on their own over weeks to months and almost never require any treatment. However, they should be evaluated by the pediatrician if they become red or start to drain liquid. Sometimes some of the blood calcifies and leaves a hard lump in the scalp. The lump is not dangerous, is usually hidden by hair, and requires no treatment.
- A subgaleal hemorrhage is bleeding directly under the scalp above the periosteum covering the skull bones. Blood in this area can spread and is not confined to one area like a cephalohematoma. It can cause significant blood loss and shock, which may even require a blood transfusion. A subgaleal hemorrhage may result from the use of forceps or a vacuum extractor, or may result from a blood clotting problem.
- Fracture of one of the bones of the skull may occur before or during the birth process. Unless the skull fracture forms an indentation (depressed fracture), it generally heals rapidly without treatment.
- Most birth injuries are caused by the natural forces of labor and delivery.
Bleeding in and around the brain
Bleeding in and around the brain (intracranial hemorrhage) is caused by the rupture of blood vessels and may be caused by
- Birth injury
- Significant illness in the newborn that decreases delivery of blood or oxygen to the brain
- A blood clotting problem
- Prematurity increases the risk of intracranial hemorrhage.
- Sometimes, intracranial hemorrhage occurs after a normal delivery in an otherwise well newborn. The cause of bleeding in these cases is unknown.
- Bleeding in the brain is much more common among very preterm infants. Newborns who have bleeding disorders (such as hemophilia) are also at increased risk of bleeding in the brain.
- Most infants with bleeding do not have symptoms, whereas others can be sluggish (lethargic), feed poorly, and/or have seizures.
Bleeding can occur in several places in and around the brain:
- Subarachnoid hemorrhage is bleeding below the innermost of the two membranes that cover the brain. This is the most common type of intracranial hemorrhage in newborns, usually occurring in full-term newborns. Newborns with a subarachnoid hemorrhage may occasionally have apnea (periods when they stop breathing), seizures, or lethargy during the first 2 to 3 days of life but usually ultimately do well.
- Subdural hemorrhage is bleeding between the outer and the inner layers of the brain covering. It is now much less common because of improved childbirth techniques. A subdural hemorrhage can put increased pressure on the surface of the brain. Newborns with a subdural hemorrhage may develop problems such as seizures.
- Epidural hematoma is bleeding between the outer layer (dura mater) of tissue covering the brain (meninges) and the skull. An epidural hematoma may be caused by a skull fracture. If the hematoma increases the pressure in the brain, the soft spots between skull bones (fontanelles) may bulge. Newborns with an epidural hematoma may have apnea or seizures.
- Intraventricular hemorrhage is bleeding into the normal fluid-filled spaces (ventricles) in the brain.
- Intraparenchymal hemorrhage occurs into the brain tissue itself. Intraventricular hemorrhages and intraparenchymal hemorrhages usually occur in very preterm newborns and occur more typically as a result of an underdeveloped brain rather than a birth injury. Most of these hemorrhages do not cause symptoms, but large ones may cause apnea or a bluish gray discoloration to the skin, or the newborn's entire body may suddenly stop functioning normally. Newborns who have large hemorrhages have a poor prognosis, but those with small hemorrhages usually survive and do well.
CALCAREA PHOSPHORIC: This remedy is useful for bone bruises, old or slow-healing fractures, or any injury that leads to soreness in the bones, especially if the area feels cold or numb and improves with warmth. The muscles near the injury may ache or stiffen.
ARNICA MONTANA: This remedy relieves pain, bruising and swelling associated with trauma, surgery or overexertion. After injuries with blunt instruments (Symph.). Compound fractures and their profuse suppuration (Calend.). Concussions and contusions, results of shock or injury; with laceration of soft parts; prevents suppuration and septic conditions and promotes absorption.
BELLIS PERENNIS: This remedy is useful for injuries to the trunk and deeper tissues—as from falls, car accidents, surgery, etc. —especially if a feeling of stiffness or coldness develops in the injured area. If Arnica has been given for an injury—especially a strain or bruise—but has not had much effect, Bellis perennis may be helpful.
MILLEFOLIUM: Contusions or sprains that involve small broken blood-vessels and lead to bruiselike bleeding beneath the skin suggest the use of this remedy. It is often also useful for nosebleeds after injury, and for bleeding in other parts of the body (for instance, after childbirth or surgery).
LEDUM PALUSTRE: This relieves bruises from blunt objects, especially where the skin is thin (around the eyes, fingers and toes), as well as pain and bruising from pointed objects.
SYMPHYTUM: This remedy is best known for its healing effect on broken bones, and is also good for bone-bruises. It is valuable if blunt injury occurs to the eyeball (from a rock, a stick, a flying object, etc.) Any injury to the eye or eyeball should be examined by a doctor.