Will your baby be in danger during birth? Let's learn about birth injury.

Every mother and father is a little scared when they are expecting a baby, right? They wonder if the baby will be healthy, if there will be any problems. Most of the time everything goes well, but sometimes when the baby comes into this world, there can be minor injuries, called 'birth injuries'. But don't worry, these are usually minor things.

What is this birth injury?

Simply put, a birth injury, or as doctors call it, a 'neonatal birth trauma', is any damage that occurs to a baby during birth. These are not very common, and most of the time they are minor injuries. However, very rarely, serious conditions can occur and require further treatment.

The doctors and nurses who treat you and your baby are all trying to prevent these risks or at least minimize their impact. But remember, no one can control exactly how your delivery will go. Also, remember that if something like this happens, it's not your fault at all .

But that doesn't mean you can't do anything. If you have any questions or concerns about childbirth, ask your Ob/Gyn provider. He or she can guide you and perhaps even teach you ways to reduce the risk of a difficult birth.

What are the types of birth injuries?

Birth injuries can be divided into several main types. Let's see what they are:

• Scalp injuries: Injuries to the skin of a baby's head. These are the most common.
• Bone fractures: Sometimes, when the baby comes out, a bone in an arm, leg, or collarbone can break.
• Eye injuries: Minor bruises to the eye and minor internal bleeding can occur.
• Bleeding inside the skull: This is a condition that requires some concern.
• Nerve damage: During childbirth, some nerves can be damaged by compression.
• Brain injuries: This is also rare, but can be serious if it occurs.

Birth injuries are not uncommon in general. A 2021 study found that there were only 29 birth injuries per 1,000 live births. Of those 29, 23 were scalp injuries. So there's not much to worry about, right?

What are the common birth injuries?

Let's now talk about some of the more common birth injuries. You may have heard of some of these.

• Broken collarbones / clavicles: This can usually happen if the baby has difficulty coming out during labor, like if the shoulder gets stuck. But this heals quickly, and sometimes no special treatment is needed.
• 'Caput Succedaneum': This is when the skin on the scalp of a newborn baby swells. It looks like a lump on the head. This will go away on its own in a few days. It is nothing to worry about.
• Cephalohematoma: This is a small collection of blood under the skin of the baby's scalp. It is more localized than a 'caput'. This also usually heals on its own within a few weeks.
• Erb's Palsy: This occurs when the brachial plexus, a network of nerves that runs from the neck to the arm, is damaged. This can cause weakness or paralysis in the baby's arm. This may require treatment such as physical therapy.
• Eyelid swelling: This is also a minor thing and will heal quickly.
• Subcutaneous fat necrosis of the newborn: This is a small area of ​​damage to the fat layer under the baby's skin. It may appear as small bumps on the skin. This usually heals on its own.
• Facial nerve paralysis: In this case, a nerve on one side of the baby's face is compressed, causing that side to droop slightly. For example, the mouth may droop to one side when crying. Most of the time, this is temporary and resolves within a few days.
• Fracture of the upper arm bone (Humerus).
• Femur fractures. These are slightly less common than collarbone fractures.
• Intracranial hemorrhage - for example, subdural bleeds. These are conditions that require some attention.
• Lacerations of the face or scalp.
• Injuries to the nose, for example, a deviated septum.
• Retinal or Subconjunctival Hemorrhages. These usually cause redness in the eye, but heal quickly and do not affect vision.
• Skull fractures. These are rare.

Uncommon and Rare Birth Injuries

Now let's look at some of the less common, or rare, birth injuries. Some of these can be quite serious, so it's good to be aware of these as well.

• Types of bleeding in the brain, such as epidural or subarachnoid bleeding, are conditions that require immediate medical attention.
• Hypoxic-Ischemic Encephalopathy (HIE) is a serious condition that can occur if there is a problem with the baby getting oxygen during labor.
• Damage to internal organs, for example, bleeding into the liver or spleen.
• Rib fractures.
• Spinal cord injuries. This is also a very rare, but very serious condition.
• Subgaleal hemorrhage: This is a large bleed between the skin of the scalp and the membrane covering the scalp. This is also a condition that requires immediate attention.

Some of these rare accidents can be quite serious. Your doctor will explain to you exactly how serious the accident is to your baby. It's important to listen to what they say without panicking.

What are the symptoms of a birth injury?

A birth injury can cause a variety of symptoms, depending on the nature of the injury. Here are a few examples:

• External changes: Bruising (Ecchymosis) , swelling (Edema) , small spots that have changed the color of the skin (Petechiae) . Some parts of the baby may be blue and swollen.
• Inability to move certain body parts: This can be due to a broken bone or nerve damage. For example, if you can't move one arm, it could be a sign of a condition called Erb's Palsy.
• Difficulty in breastfeeding. If the baby is not sucking properly or is vomiting after breastfeeding, that should also be checked.
• Changes in behavior, such as frequent crying and restlessness. If your baby is simply crying frequently or is difficult to comfort, tell your doctor about that as well.
• Hoarseness of voice, wheezing when crying (Stridor).
• Difficulty breathing.
• Seizure-like conditions.

If you notice one or more of these symptoms, it is best to seek medical advice immediately.

What are the causes of birth injuries?

There are several main causes of birth injuries. Let's take a look at what they are:

• If the baby has difficulty coming out of the birth canal: For example, in cases like shoulder dystocia or macrocephaly , the baby's head becomes too large. As the baby grows, it becomes difficult to come out of the mother's birth canal.
• When trying to move the baby around and position it properly during labor, doctors sometimes have to change the baby's position.
• Due to the effects of contractions in the birth canal. These contractions are what push the baby out, but sometimes that pressure can also cause minor injuries.
• When using assistive devices: For example, when removing the baby with a vacuum (Vacuum Extraction Delivery) , when using forceps (Forces Delivery) , or when performing a C-section Surgery, there is sometimes a possibility of minor injuries. These devices are used in urgent cases, for the safety of the mother and the baby.

What are the risk factors for birth injury?

There are several risk factors that can contribute to birth injuries. They are:

• Increased birth weight: This risk is higher for babies weighing more than 4 kilograms (8 pounds and 13 ounces), that is, babies with ' fetal macrosomia '.
• Low birth weight or very early birth: This risk is higher for premature babies or very small babies, because their bodies are very delicate.
• Baby's position: If the baby is not positioned correctly, for example, in a breech position , there is a greater chance of accidents.
• Head size: This can happen to babies who simply have a large head. Also, some medical conditions can cause a large head.
• Difficult childbirth: When childbirth is difficult and takes too long, the chances of accidents are higher.
• Precipitous births: This risk exists even when the baby is born much faster than normal.
• Diabetes: Babies born to mothers with diabetes are at higher risk of birth injuries. This is because diabetes can cause the baby to be larger. Therefore, it is very important to control blood sugar levels during pregnancy.
• Mother's physical characteristics: Sometimes, certain characteristics of the mother's body, for example, the shape of the pelvis , can make childbirth difficult. Also, the size of the baby's head and the mother's pelvis can affect it.

What are the complications of birth injuries?

Research has found that birth injuries can lead to various complications. Some of them are:

• Cerebral Palsy: This is a movement and posture problem caused by damage to the brain.
• Fetal distress: The baby experiences some discomfort while in the womb.
• Newborn jaundice occurs due to increased bilirubin levels (hyperbilirubinemia).
• Meconium Aspiration Syndrome: This occurs when a baby defecates while still in the womb and inhales the fluid. This can lead to lung infections.
• Respiratory Distress Syndrome: Difficulty breathing.
• Need for mechanical ventilation or CPAP (Continuous Positive Airway Pressure) machines.
• Seizures.
• Sepsis: A severe infection that spreads throughout the body.
• Transient Tachypnea: Temporary rapid breathing.

These complications don't occur in every birth accident, but it's important to be aware of them.

How to recognize a birth injury?

Obstetricians and gynecologists (Ob/Gyns), neonatologists, or perinatologists diagnose these birth injuries. They use a combination of methods:

• Physical exam: It is standard procedure for a doctor to examine a baby immediately after birth. This is done to check for congenital conditions and birth injuries. The head, limbs, and chest are all examined carefully.
• Diagnostic imaging: Tests such as brain ultrasound , CT scans , or X-rays can help identify injuries and fractures inside the baby's body. Rarely , MRIs are also used.
• Blood tests: Laboratory tests can help doctors detect certain birth injuries or complications, such as infections and bilirubin levels.

Other tests may be done depending on the situation. Your baby's doctor can tell you more about these tests and why they are helpful.

How is a birth injury treated?

The treatment for a birth injury depends largely on the nature of the injury. Some of the most common treatments include:

• Observation and Watch: Many birth injuries heal on their own. For example, minor collarbone fractures, caput succedaneum, and minor damage to the brachial plexus nerves. Doctors will monitor these for signs of injury.
• Immobilization: If a bone in an arm or leg is broken, the baby will need to be immobilized for several weeks until it heals. This may involve wearing a specially designed splint or harness.
• Physical therapy: Physical therapy is very helpful for brachial plexus nerve injuries. It helps prevent complications like further nerve damage or muscle weakness. Exercises are given to the baby to strengthen the muscles.
• Surgery: In some cases, surgery may be needed to repair things like lacerations. Surgery may also be done to stop blood from pooling inside the baby's skull and causing pressure on the brain. Sometimes, surgery can also help to redirect nerve signals around a nerve injury.

Depending on the situation, your medical team may recommend other treatments. Your baby's doctor can tell you more about this and recommend treatment options.

What happens if my baby has a birth injury?

The outlook for a birth injury depends largely on the type of injury and how serious it is. But in general, the outlook for most birth injuries—especially the more common ones—is very good. Over the past few decades, experts have worked hard to improve the risk of birth injuries and the ways they are treated. Serious birth injuries are much less common now than they were 30 years ago. In 1993, birth injuries were the 11th leading cause of death in newborns. But since 2007, birth injuries have not been on that list. Isn’t that a good thing?

What should I expect if my baby has a birth injury?

If your baby has a birth injury, your medical team will do everything they can to manage the injury and talk to you about what's happening. Most birth injuries are minor and don't require much care. But in some cases, your doctor may recommend that you and your baby stay in the hospital until your baby is well enough to go home.

When you go home, your doctor will talk to you about how to care for your baby, what to watch out for, and other things. It can be easy to forget things with the sleep deprivation that comes with giving birth, so it can be helpful to write down these instructions or ask for a printed copy.

The most important thing is, if you don't understand something, if you have any fears or doubts, never hesitate to tell the doctor. They don't mind explaining things to you and putting your mind at ease. Because they also want to do what's best for you and your baby.

Can Birth Injuries be Prevented?

Birth injuries cannot be completely prevented, but there are some things you can do during pregnancy that can reduce your risk of these injuries.

• Talk to your obstetrician/gynecologist (Ob/Gyn) as soon as possible. He or she can help you prepare before you even get pregnant. If necessary, they can refer you to specialists such as perinatologists.
• Manage any chronic conditions you have. Your obstetrician or fetal medicine specialist can guide you on how to manage these conditions. This can reduce the risk of birth injuries caused by conditions like diabetes.
• Make a birthing plan. Your doctor can advise you on specific procedures or approaches that can reduce the risk of birth injury. They can also tell you about backup plans, such as when a C-section is a better option for you and your baby's safety.

Your medical team will do everything they can to reduce the risk of birth injury. Doctors, nurses, and other clinical staff will all work together to help you and your baby.

What questions should I ask my baby's doctor?

It's a good idea to ask your baby's doctor these questions:

• What kind of birth injury does my baby have?
• How serious is it?
• Does it need treatment?
• What treatment (if any) do you recommend?
• When can my baby go home?
• What should I pay attention to when I take my baby home?
• When should I call your office or bring the baby to the hospital?

When should I take my baby to the doctor?

Your baby's doctor will set up a follow-up schedule, or refer you to a pediatrician who can continue your baby's care. They will have regular visits to monitor your baby's recovery and make sure everything is going well. They can also make changes to the treatment plan if necessary.

When should I take my baby to the hospital?

Your baby's doctor will tell you about things that require emergency treatment. For example (but not limited to):

• If the baby has difficulty breathing .
• If activity has decreased (Lethargy) , that is, if there is a sleepy, lifeless feeling.
• If the skin is cold, pale, or has changed color .
• If the nappy has been dry for 12 hours or more (that is, if there has been no urination).
• If you are unusually restless or sleepy .
• If you don't drink milk.

If you see things like this, seek medical advice immediately and, if necessary, take them to the hospital.

Finally, things to remember

You probably imagined the birth of your baby as a happy, perfect moment. Finding out that your baby had a birth injury is not something any new parent wants to hear. Birth injuries are not uncommon. But even if you and everyone taking care of you and your baby do everything right, sometimes things like this can happen.

But the good news is that most birth injuries are minor and can be treated with little or no help. In more serious cases, your baby's doctors will be there to start treatment as soon as possible.

If you don't understand something, or if you're worried or scared about something, talk to your baby's doctor. They can explain things to you and connect you with other specialists who can help you manage and cope with this experience. Don't worry, you're not alone!

` Birth accidents, birth injuries, newborn, childbirth, baby injuries, skull injuries, nerve damage, medical advice