Birth Injuries Explained
Babies are fragile creatures, especially in those first, tender days. Unfortunately, many parents have taken their precious new child home only to find out a few days later that their baby is displaying symptoms of a birth injury. This terrifying discovery can lead to a rash of questions, including whether the doctor, hospital or nurses are to blame, how life raising a child injured at birth will be, and what treatments are available for birth injuries.
The following guide will attempt to help answer many basic questions and point towards further information that can be learned in consultation with a medical professional. Nothing in this guide will be construed as legal advice. This is simply a general purpose guide concerning birth injuries. Some of the most common injuries sustained by children at birth include:
Medical experts and doctors use a great deal of advanced terminology, much of it derived from Greek, to describe illnesses and other medical conditions. Hypoxia refers to the lack of oxygen. The term intrauterine hypoxia refers to an extremely serious condition where the baby is denied sufficient oxygen for a period of time. While much scientific research and study continues, intrauterine hypoxia is implicated as a serious risk factor for several neurological and psychiatric illnesses, including epilepsy, ADHD, cerebral palsy and eating disorders.
Scientific experts agree that there are a number of primary causes of intrauterine hypoxia. Some indirect causes include the mother smoking during pregnancy. It has been shown that when the mother smokes, carbon monoxide is introduced into the umbilical cord, which causes a severe reduction in blood flow to the placenta, and therefore to the baby. When this happens, the baby can suffer injuries to the central nervous system, meaning both the brain and spinal cord are at risk.
Intrauterine growth restriction, commonly referred to as IUGR, refers to a situation where the fetus fails to thrive during the pregnancy, a condition that can be caused by an inadequate oxygen supply to the fetus. IUGR is a key factor responsible for more than half of low birth weight neonatal deaths around the world, as well as surviving premature and low birth weight babies.
Birth asphyxia is a special term that refers to hypoxia occurring during the delivery process. This can be brought on by a myriad of causes, including:
- The baby has anemia
- The baby’s airways are malformed or blocked
- The mother is suffering from either high or low blood pressure
- The umbilical cord chokes the baby
- The delivery was extremely long or complicated
- The mother’s blood was under-oxygenated before or during delivery
- The mother and/or baby have a serious infection
Today, modern medicine is beginning to treat hypoxia by lowering the core body temperature of newborn babies within six hours of birth. While many doctors previously used high concentrations of oxygen to revive hypoxic babies, the current medical guidelines recommend using normal air to avoid an overabundance of free radicals being introduced into the system.
In the United States, intrauterine hypoxia and birth asphyxia combined are ranked as the tenth leading cause of neonatal deaths.
While it may often be obvious when a baby has suffered from asphyxia, and treatment applied, parents should be aware that asphyxia comes in two stages. The first is when the cells are deprived of oxygen, and begin to build up toxic levels of waste products. The second stage of damage can be far more insidious, as it can last for days or even weeks. Called a “reperfusion injury”, it refers to damage that happens to cells after normal oxygen has been restored because damaged cells flood the body with their accumulated toxins.
Precisely to avoid secondary damage from reperfusion injuries, medical professionals should never use pure oxygen to treat a baby born with injuries sustained from birth asphyxia. Concentrated oxygen can introduce free radicals into the body, further damaging the injuries caused by the original hypoxic event.
Brachial Plexus Injuries (BPI)
A brachial plexus injury can be somewhat difficult to describe without resorting to complex medical terms, but generally refers to injuries sustained in a particularly important bundle of nerves on the spinal cord. These special nerves run across a particular part of the spine, and allow people to control the muscles in their chest, shoulder, arm and hand. When these nerves are injured, including during childbirth, they will form a lesion that may cause partial or complete paralysis.
It may be difficult to detect signs of BPI immediately after birth. Symptoms include babies with paralyzed or “floppy” arms, no flexing or control of the hand, no turning or manipulation of the wrist, an inability to move the arm, and numbness throughout or entirely through the hand and arm. At best, BPI can lead to total and irreversible paralysis, currently untreatable by modern medicine. At best, BPI can lead to impairment to the arm, hand, or wrist while simultaneously causing a great deal of pain for the baby.
The good news is that many babies can completely or partially heal within six months. Unfortunately, babies who show no marked improvement in that time may require surgery to repair their nerve damage. As a rule of thumb, if a baby can bend his or her elbow at three months old, it is likely to recover normally in conjunction with physical therapy exercises.
In extremely simple terms, BPI are often caused by excessive stretching of the spine during delivery. During some difficult deliveries, the baby’s shoulder can become blocked in the birth canal after the head has already passed through. Referred to in medical terms as shoulder dystocia, a medical professional attempting to clear a baby with a blocked shoulder can inadvertently twist and over-stretch critical parts of the spine, causing BPI. Although BPI are generally a result of difficult vaginal deliveries, they can occasionally be sustained during Caesarean section births.
Cerebral palsy, often shortened to CP, is a group of different nerve disorders that first start manifesting in early childhood. Young children who have trouble coordinating their muscles, including shaking, trembling, difficult swallowing, and poor coordination, may be suffering from CP. Many babies born with CP are have difficulty in performing normal physical activities like sitting up, crawling, rolling over or walking. The word “cerebral” refers to the brain, because it is believed that brain damage leads to muscle control issues, known as “shakes” or “palsy”, but scientists are not completely sure what causes CP.
It is believed that babies are at a higher risk for developing CP if they experience trauma in intrauterine development, including hypoxia, or birth trauma during delivery, or exposure to chemicals, radiation or infection.
What is known is that the nerve damage in the brain that leads to CP most often occurs during gestation, childbirth or shortly after birth. Babies born with more severe cases of CP may have either very floppy or very stiff bodies, a curved spine, a smaller jawbone and/or a smaller head, while other babies born with CP exhibit no exterior signs at first. It is often only when the baby achieves 6-9 months old that muscle control issues and shaking may be first identified. CP can then degenerate into seizures, epilepsy, urinary and fecal incontinence, intellectual disabilities and behavioral problems.
As CP expresses itself on a sliding scale of magnitude, there are different therapies and treatments available to help young children survive CP into adulthood. As breakthroughs are always on the horizon for preventing and curing this persistent neonatal injury, it is best to consult with a doctor or medical expert if you believe your child may be exhibiting symptoms of Cerebral Palsy.
Erb’s Palsy, sometimes called Erb-Duchenne Palsy, is when a specific group of nerves on the spine are injured and thus cause partial or complete paralysis to the arm. The group of nerves responsible for controlling the arm are a subset of the brachial plexus, meaning that Erb’s Palsey is a subset of other BPI. Erb’s Palsey is almost always caused by shoulder dystocia – extracting a child whose head is out but shoulders are not – during a difficult birth. Erb’s Palsy can also be caused by excessively hard pulling on the arms during a breech – feet exit the birth canal first – delivery.
Depending on the severity of the damage to the nerves, some babies can see the paralysis resolve itself over a period of months without any rehabilitative therapy or surgery necessary. Other babies will see paralysis of the arm lead to atrophy of the muscles and a loss of ability to bend the elbow. Sometimes, physical therapy including massage and the application of electrical current to the muscles can reverse atrophy and help strengthen muscles in the arm. It should be noted that many babies and young children with Erb’s Palsy suffer a great deal of pain and discomfort. A variety of surgical techniques now exist to help provide relief from Erb’s Palsy.
Much like Erb’s Palsy, Klumpke’s Paralysis refers to a subset of the nerves in the brachial plexus. Because these two conditions are so similar, sometimes Klumpke’s Paralysis is referred to as Klumpke’s Palsy. Klumpke’s refers to nerves that originate in the back of the neck and control muscles of the hand and forearm. Unfortunately, because the back of the neck is such a fragile area, damage to the cluster of nerves is often much more extensive, leading to lifelong permanent paralysis.
Even doctors refer to it as a “claw hand”, when babies suffering from Klumpke’s have rigid muscle paralysis in the hand, leading it to make a “claw” shape. Klumpke’s is almost always the result of complications during the delivery process, especially when the infant is very large and/or the mother is very small. To put it extremely simply, many babies who are too large to easily exit the birth canal get one arm stuck, and when they are pulled out during the delivery process, it “yanks” the delicate bones and thus causes nerve damage.
The delivery process can easily expose a baby to dozens of powerful infectious microscopic agents. As newborns have weak and undeveloped immune systems, they are often particularly vulnerable to these infections. Powerful viruses such as HIV, rubella, syphilis, herpes simplex, CMV, and hepatitis B can be particularly devastating to newborn babies. Harmful bacteria can also attack the vulnerable immune system of babies, including E-Coli, listeria, gonococci, and even chlamydia.
Babies can become vulnerable to infections in one of three ways: from mother and transmitted via the placenta, exposure to infectious agents during delivery, or from coming into contact with external sources after birth.
Whether from the tension, torque or traction of the birthing process, it is possible for babies to sustain bone injuries. The most common bone fracture during delivery is the clavicle, however any other bone can potentially be broken or bruised during a traumatic delivery.
The Difference Between Birth Injury and Birth Trauma
Doctors and medical experts have been studying birth injuries since the beginnings of modern medicine. To be extremely precise, birth injuries are any systemic injury incurred during the delivery process, while birth trauma refers to what is objectively referred to as mechanical damage to the baby.
To put it in more human terms, birth trauma is when a physical force, usually from a medical instrument, is applied during the delivery process and damages a child.
Birth injuries are more “natural” injuries, when the baby is injured during some form of maladjustment during the delivery process. Any baby whose throat or “windpipe” becomes entangled in the umbilical cord can quickly lose vital access to oxygen. Together, these and other injuries are referred to as birth injuries while applied force injuries, usually from medical instruments, are classified as birth trauma.