What is birth injury?

Having a baby in Australia is very safe, although it’s estimated that more than 1,000 babies are injured during childbirth each year. It can be very upsetting if your baby has been injured, but most birth injuries are only temporary.

Also called 'neonatal birth trauma', birth injury to a newborn baby can include many things, from bruising to nerve damage to 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. Here are some of the types of birth injury affecting babies.

Bruises and swelling of the scalp

Sometimes a baby can be born with minor, temporary injuries to their head or face. These include bruises, swelling (sometimes called a chignon), lumps caused by fluid under the skin (caput succedaneum) or bleeding under the skin (cephalohematomas), and blood inside the eye (subconjunctival haemorrhage).

Fractures

Fractures (breaks) can occur when there is difficulty getting a baby through the birth canal. The bone that most often breaks is the collarbone (clavicle), and this can happen when the baby's shoulder gets stuck (shoulder dystocia), or if the baby is born breech (bottom first).

Nerve damage

Nerves can be damaged during childbirth, particularly in the baby's face (which can lead to facial paralysis) and the shoulder (which can lead to brachial palsy — loss of arm movement). Usually, nerve damage in a newborn is only temporary.

Brain injury

In very rare cases, a baby can suffer a brain injury during childbirth. If the baby doesn’t get enough oxygen for a long time during labour (perinatal asphyxia), they can experience brain damage. Cerebral palsy is a type of brain damage, but only a very small percentage of cerebral palsy cases is due to complications at birth.

Bleeding on the brain

In rare cases, a baby can suffer bleeding in or around the brain during childbirth. This is more common among very premature babies, and most infants with bleeding don't have symptoms. Others may be lethargic, have difficulty feeding and/or have seizures.

What causes birth injury?

Birth injuries can occur simply because of the pressure and resistance involved in giving birth vaginally. When the baby moves through the birth canal, there's pressure on its skull and body from the mother's pelvic bones.

Large birth weight (more than 4kg) can increase the risk of injury during childbirth. There is also a greater risk if the baby is in a difficult position for labour and birth (such as the breech position). Premature babies born before 37 weeks are typically more fragile and may be injured more easily.

Other causes of birth injury to a baby include a difficult or prolonged labour, the shoulder becoming stuck in the birth canal and cephalopelvic disproportion (if the mother's pelvis isn't large enough or shaped in a way that allows for a vaginal birth).

Babies born with the assistance of forceps or ventouse (vacuum) are at higher risk of bruising, marks or swelling on the baby's head or face.

Lack of oxygen to the baby during birth could be caused by a number of things, such as problems with the umbilical cord, serious events in the mother such as haemorrhage or fever during labour, uterine rupture or abruption of the placenta (when it comes away from the uterus prematurely).

How are 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 run tests to check for other injuries.

If there has been a fracture, your baby may need an x-ray or other imaging. The limb may need to be immobilised and some babies may need surgery.

If your baby has damaged nerves, the medical team will monitor them closely and recovery can take a few weeks. For more serious nerve damage, your baby may need special care.

Resources and support

• Talk to your doctor, midwife or obstetrician/gynaecologist.
• You can call Pregnancy, Birth and Baby on 1800 882 436 to speak with a maternal child health nurse (7 days a week, 7am to midnight AEST).
• Call the healthdirect helpline on 1800 022 222.
• Contact the Australian Birth Trauma Association for support and resources.