What is birth injury?

Having a baby in Australia is very safe, although it's estimated that more than 1,000 babies are injured in childbirth each year. It can be very upsetting if your baby has been injured, but most birth injuries are temporary and will get better on their own.

Also called 'neonatal birth trauma', birth injury to a newborn baby can include many things, from bruising to nerve damage, or a broken bone. Sometimes an injury occurs as a result of life-saving procedures.

About 49 in every 10,000 babies born in Australian hospitals suffer a birth injury.

What causes birth injury?

Birth injuries can have many different causes and risk factors including when there is:

• pressure in the birth canal
• not enough oxygen getting to the baby's brain during labour
• vacuum assisted or forceps used in birth, especially if your baby has already not received enough oxygen in labour
• breech presentation in labour (bottom/feet first)
• difficulty due to the baby's shoulders getting stuck inside your pelvis during birth (shoulder dystocia), especially if your baby is large

Making decisions in labour should be a shared decision making process, between you and your doctor or midwife. Unless it is an emergency, someone in your health team will explain any intervention they recommend, as well as the risks and benefits to you and your baby. You need this explanation before you can give your informed consent.

Types of birth injuries

Bruises and swelling of the scalp

Your baby may be born with minor, temporary injuries to their head or face. These include swelling of the soft tissues of the baby's scalp, which can happen as the baby travels through the birth canal (known as 'caput succedaneum') or from a vacuum assisted delivery (known as 'chignon').

The swelling usually goes away in a few days without problems. Bleeding can sometimes happen between the skull bone and its fibrous covering. This may appear a few hours after birth, as a raised lump on the baby's head (known as 'cephalohematomas'). Depending on the size, this can take 2 weeks to 3 months to disappear completely.

Fractures

Fractures (broken bones) can occur when your baby has difficulty coming through the birth canal. The bone that most often breaks during birth is the collarbone (clavicle). The upper arm bone (humerus) may also brake. These fractures can happen when the baby's shoulder gets stuck (shoulder dystocia), and the risk may be increased with a large baby.

Nerve damage

Nerves can be damaged during childbirth, for example, forceps can sometimes injure your baby's facial nerve, which can lead to facial paralysis.

The brachial plexus is a network of nerves that start in the neck and continue down the arm. These nerves can be stretched in the uterus or during birth and cause weakness or paralysis to your baby's arm. Erb's palsy is the most common brachial plexus injury. This will usually be noticed during routine checks in hospital after your baby is born. Your health team will monitor your baby, and check for improvement in movement and function over time.

It's important to remember that nerve damage in a newborn baby is usually temporary.

Brain injury

In very rare cases, your baby may suffer a brain injury during childbirth. If your baby doesn't get enough oxygen during labour, they can experience brain damage. Hypoxic-ischaemic encephalopathy (HIE) is an injury to the brain caused by a lack of blood and oxygen. The brain is especially vulnerable to this because it needs more oxygen and blood than any other organ in the body.

Cerebral palsy is a type of brain damage, but only a very small percentage of cerebral palsy cases are due to complications at birth.

Brain bleeds

In rare cases, your baby can suffer bleeding in or around the brain in the first few days of life. This can originate from pregnancy or birth events. This is more common if your baby is very premature. Your baby may not have symptoms or may be pale, limp or have seizures.

How is birth injury in babies treated?

Most birth injuries in babies are temporary. If the injury was to the soft tissue, then no treatment is normally needed — the medical team will just monitor the baby and may do tests to check for other injuries.

If there is a bone fracture, your baby may need an x-ray or other imaging. The limb may need to be immobilised (held still with supports or splints) and some babies may need further treatment.

If your baby has damaged nerves, the medical team will assess them and physiotherapy may be required. If recovery takes longer than expected your baby may need further treatments.

How are birth injuries prevented?

Australia is a very safe country to give birth in, but complications can still occur, including birth injuries.

You can take steps to reduce the risk, including doing pregnancy safe and pelvic floor exercises, getting regular antenatal health checks, managing health issues and working with an experienced medical team during pregnancy and labour.

Nonetheless, some risk factors cannot be controlled, such as the size or your baby or labour complications.

Psychological wellbeing of parents

It can be very distressing to watch your baby experience and recover from a birth injury. 'Birth trauma' is distress experienced by a parent during or after childbirth. While trauma can be physical, it can also be emotional or psychological, and can continue for some time after you've given birth. It's important to seek help as early as possible, and this can help you, your newborn, and your whole family.

Read about emotional aspects of birth trauma.

Resources and support

• If you have questions or concerns about your baby's injury speak to your doctor, midwife or obstetrician / gynaecologist.
• The Australian Birth Trauma Association offers support and resources for parents.
• Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available from 7 am to midnight (AET), 7 days a week (including public holidays).
• The Centre of Perinatal Excellence (COPE) provides information and a list of support services — from planning, through birth and new parenting.
• Perinatal Anxiety & Depression Australia (PANDA) — call 1300 726 306 to speak with a counsellor (Mon to Sat, 9am to 7.30pm AEST).
• You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.