Birth Injuries Due to Physical Trauma vs. Neurological Injuries
Any birth injury has the potential to cause great harm. Certain birth injuries, however, are more likely to require long-term treatment than others. The main factor that determines the longevity of a birth injury is how it was acquired.
The two main causes of birth injuries are physical damage—such as the fetus being trapped in the pelvis during delivery—and oxygen deprivation that occurs during labor and delivery.
Below, our Philadelphia birth injury attorneys explain the differences between injuries caused by physical trauma and injuries to the newborn’s neurological system, as well as the prognoses for each.
What Causes Birth Injuries?
Birth injuries are damages that occur to a mother or a child as a result of physical pressure or oxygen deprivation during the birthing process. The way the injury is caused will greatly affect its severity and permanence.
Sadly, birth injuries are startlingly common, with approximately 28,000 babies in the U.S. suffering from one every year. Sadly, such events are largely preventable when doctors and nurses provide adequate care in the delivery room.
Injuries caused by the labor and delivery team (doctors, midwives, or nurses) that may result in birth injuries include, but are not limited to, the following:
- Failure to assess the mother and fetus to detect potential risks for the fetus becoming stuck, such as fetal orientation, fetal size, maternal pelvic outlet size, and shape, prior birthing history and experiences
- Failing to properly monitor the mother and child for signs of compromise or entrapment
- Failing to take the appropriate actions to mitigate any signs of distress, including assisting in maneuvering the fetus, appropriate pressures, and maternal repositioning
- Failing to order a C-section when necessary
- Failing to use birth assistance tools properly
Such mistakes may leave a mother or a baby with a temporary or permanent birth injury. Certain birth injuries require life-long treatment and forever prevent a child from experiencing a “normal” life.
Different Types of Birth Injuries
The permanence of a birth injury is greatly impacted by how the injury occurred. Below, we discuss the differences between the two main types of birth injuries: those caused by physical damage and those caused by oxygen deprivation.
Physical Birth Injuries
Physical birth injuries result from physical damage that occurs during the labor and delivery process. One of the most common causes of this is the failure for the delivering team to recognize the real risk for the fetus becoming entrapped and manage it before it becomes critical. Other times, the delivering obstetrician can cause damage while performing what is known as an “operative delivery” with improper use of tools such as forceps or a vacuum extractor.
Such negligence can cause several temporary or permanent physical birth injuries, including broken bones, or nerve damage to the arms, shoulders, or neck:
Shoulder Dystocia Leading to Erb’s Palsy or Clavicular Fracture
Shoulder dystocia is a term that references the fact of the fetal shoulder being stuck behind the mother’s pubic bone. If not properly reduced, it can lead to nerve damage, commonly known as Erb’s Palsy, or physical damage, usually a broken collar bone. A shoulder dystocia can rapidly develop into an emergency with grave consequences for the fetus or mother.
These birth injuries most commonly happen when a child gets stuck in the mother’s birth canal, usually behind the pelvic bone. This causes the child not to be delivered, and the attending physician or midwife has to take alternative measures to help the birth proceed.
Once a shoulder dystocia is recognized, the attending physician can take several measures to resolve the situation, including:
- Reposition the mother's legs to help widen the birth canal.
- Apply pressure to the mother's lower stomach area.
- Attempt to use birth assistance devices.
- Order a C-section.
The failure to take any of the aforementioned measures, or the failure to use birth assistance devices correctly, may result in damage to the child’s brachial plexus nerves, as well as permanent damage to the mother, such as perineal tears or vaginal tears which can extend to the rectum and cause incontinence.
Such damage may result in the following birth injuries:
- Erb's palsy: The infant’s arm may not move from below the elbow.
- Klumpke's palsy: The infant’s fingers and hands may be paralyzed.
- Horner's syndrome: The infant may have droopy eyelids and uneven pupil size.
- Complete brachial plexus injury: Total paralysis to the arm may occur.
Neurological Birth Injuries
The other main type of birth injury affects the brain or nervous system. Such injuries often result from oxygen deprivation during the birthing process.
The brain requires a constant flow of oxygen in order to develop and function properly. Even a short cessation of this oxygen flow can cause brain cells to die. This is why it’s vital that doctors and nurses keep a close eye on the mother and child during labor and delivery, and mitigate any signs of fetal distress as soon as possible.
The failure to act quickly enough may result in the following neurological birth injuries:
One of the most serious birth injuries that can result from oxygen deprivation is cerebral palsy. Cerebral palsy is a group of neurological disorders with similar symptoms rather than a single medical condition.
These disorders affect a child’s motor skills, muscle coordination, and movement.
The main warning signs of oxygen deprivation during labor and delivery include the following, as visible to the delivery team via the fetal monitor, uterine monitor, and maternal vital signs monitoring:
- Decreased fetal heart rate variability
- Fetal heart rate decelerations, known as “variable” or “late” decelerations. When these become repetitive, or when consistently linked to maternal contractions, that is a significant sign that there is fetal distress.
- Fetal tachycardia, usually above 160 or 180 beats per minute
- Slow fetal heartbeat, known as bradycardia
- Infections, such as chorioamnionitis, group B strep infections, and other virulent organisms
If the delivery team either does not monitor the baby’s heart rate during the birth or does not respond to one of the aforementioned issues correctly, the baby may suffer oxygen deprivation and develop cerebral palsy as a result.
Hypoxic Ischemic Encephalopathy
Hypoxic Ischemic Encephalopathy (HIE) is a mechanism of brain injury caused by hypoxia (lack of oxygen to the brain) or anoxia (no oxygen to the brain).
HIE is extremely dangerous. Sadly, 15-20% of infants who develop HIE will die during childbirth or in the newborn period. Children who survive will usually have low APGAR scores. Additionally, at least 25% of them will have significant or catastrophic neurological damage, including the following:
- Spasticity affecting some or all limbs; if all four limbs are involved, it is called “spastic quadriparesis.”
- Aspiration pneumonias from an inability to properly swallow and control secretions
- Cognitive disorders, including learning disabilities and/or the following:
- Seizure disorders
- Inability to speak
- Inability to sit unassisted
- Vegetative state
How to Treat a Birth Injury
The treatment for a birth injury will differ greatly depending on whether it was caused by physical damage, oxygen deprivation, or an infectious process. While many physical birth injuries can be cured or improved with treatment, most neurologically based birth injuries are permanent. However, there have been recent advances that can offer hope.
With that in mind, the following are common treatments for birth injuries:
Total Body Cooling
Newborns fortunate enough to be delivered close to a specialized hospital that can provide high level neonatal care can potentially receive total body cooling. The idea is simple: cool the body to a sufficiently low temperature that the newborn’s metabolic rate is reduced, and the body’s immediate response to the birth related insult is minimized. Miraculous recoveries have occurred in newborns who were severely compromised at birth due to a hypoxic or anoxic insult.
Milder birth injuries that are physical in nature may be treated with physical therapy. Severe birth injuries, on the other hand, may require surgery.
The most common physical birth injuries that require surgery include:
- Severe cases of shoulder dystocia/Erb’s palsy
- Contractures due to stiffness caused by the neurologic damage due to the hypoxia or anoxia
- Shunt placement to drain off excess fluid from the newborn’s brain if there has been, for example, a cerebral hemorrhage
- Feeding tube placements for children unable to feed themselves
There are several different types of therapy that may benefit children who suffered physical or brain-related birth injuries, including the following:
- Physical therapy
- Occupational therapy
- Speech therapy
While many brain-related birth injuries have no cure, most children respond positively to consistent therapy sessions.
Not all birth injuries require medication. However, certain medications can improve or manage symptoms for children who have suffered from physical or brain-related birth injuries. These medications may include:
- Pain management and anti-inflammatory medications
- Anti-seizure medications
- Anticholinergic medications
- Stool softeners
Did Your Child Suffer a Birth Injury? Contact Us Today
Physical and brain-related birth injuries require different treatments. They also require a team of attorneys that understands the differences between these two types of birth injuries and the damage they can cause.
At The Beasley Firm, LLC, our managing partner, Jim Beasley, Jr., graduated from Temple University with a major in the Honors molecular biology program and obtained a medical degree from the University of Pennsylvania to study medicine. Marsha Santangelo, M.D. is also a physician and attorney at The Beasley Firm, LLC.
All of The Beasley Firm, LLC’s attorneys have extensive experience in litigating highly complex birth injury cases, and have recovered hundreds of millions of dollars that have secured their clients’ future care, education, and comfort needs.
We want to help you and your family through this difficult time. Contact The Beasley Firm, LLC today at (215) 866-2424 to schedule a free consultation.