What is birth injury?

Having a baby in Australia is very safe, although it's thought that more than 1,000 babies are injured during childbirth each year. It can be very upsetting if your baby has a birth injury, but most 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 1 in every 200 babies born in Australian hospitals experience a birth injury.

What causes birth injury?

Birth injuries can happen as a result of different causes and risk factors including when there is:

• fetal distress (not enough oxygen getting to the baby's brain during labour)
• vacuum or forceps used in an assisted birth
• malpresentation during birth
• difficulty due to the baby's shoulders getting stuck inside your pelvis during birth (shoulder dystocia), especially if your baby is large

Having a baby with a birth injury is never due to anything you did or didn’t do.

Making decisions in labour and birth should be a shared decision making process, between you and your doctor or midwife. Your health team should explain any intervention they recommend and why, 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

The most common form of birth injury involves minor, temporary injuries to a newborn’s 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 by itself.

Bleeding can sometimes happen between the skull bone and its fibrous covering. This may appear a few hours after birth and looks like a raised lump on the baby's head (known as 'cephalohematomas'). Depending on the size, this can take from 2 weeks to 3 months to disappear completely.

Fractures

Fractures (broken bones) can occur if 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 break. These fractures are more likely if the baby's shoulder gets stuck behind the mother’s pelvic bone (shoulder dystocia), and the risk may be higher with a large baby.

Nerve damage

Nerves can be damaged during childbirth. For example, forceps may occasionally press on 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. A routine check will usually identify this problem while you and your baby are still in hospital after birth. 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, babies 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 that can occur, but only a very small percentage of cerebral palsy cases are due to complications at birth.

Brain bleeds

In rare cases, babies can suffer bleeding in or around the brain in the first few days of life, caused by events during pregnancy or birth. This is more common if your baby is very premature. Babies with brain bleeds may not have any symptoms, or they 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 monitor the baby and may carefully check for other injuries.

If there is a bone fracture, your baby may need an x-ray or other imaging. The limb (arm or leg) 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.

Having a baby with a birth injury is never due to anything you did or didn’t do.

Psychological wellbeing of parents

It can be very distressing to watch your baby experience and recover from a birth injury.

Some people, including birth parents and non-birthing parents, may find the experience of childbirth emotionally traumatic.

'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. If your birth experience felt traumatic to you, then it was. Your experience is valid and worthy of acknowledgement, treatment and recovery.

You may notice symptoms of postnatal depression and/or anxiety, postpartum post-traumatic stress disorder or obsessive compulsive disorder. Sometimes the effects of birth trauma might first appear sometime after you've given birth. Birth trauma can continue long after the birth and some people may not recognise the signs for months or even years.

If you are concerned, it’s important to seek help from your doctor, midwife or child health nurse. Getting early care and support can help. It’s never too late to ask for help — some people seek help months or years after a traumatic birth.

There are many resources and professionals who can support your treatment and recovery from both physical birth injury and birth trauma.

Who can I speak to if I'm not satisfied with my healthcare?

If you aren’t satisfied with your healthcare, there are many people you can speak to, including:

• your doctor or midwife
• the health complaints agency or health department in your local state or territory
• the Australian Health Practitioner Regulation Agency (AHPRA), if you have a concern about the unsafe behaviour or practice of a registered health practitioner
• the National Health Practitioner Ombudsman

If you aren’t sure about something that happened to you, especially during labour, birth or in an emergency, it’s a good idea to ask your doctor or midwife for a debrief. This is an opportunity to ask questions after an event, so that you better understand what happened.

Some hospitals offer this as a formal service — ask your midwife or doctor about what is available.

You can also view your medical records on your own or with another health professional. Find out more about requesting access to your medical records from the Health Information Office of the Australian Information Commissioner.

Resources and support

• If you have questions or concerns about your baby's injury speak to your doctor, midwife, obstetrician or gynaecologist.
• The Australian Birth Trauma Association offers support and resources for parents.
• 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.
• 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.