Birth Injuries:

Birth injuries are not uncommon injuries. Because the child is being
delivered through a narrow vaginal canal, injuries can occur from the
birth process. Newborns with large weight and advanced gestational
age are most prone to these injuries. Other conditions associated with
birth injuries include underlying medical problems such
as osteogenesis imprefecta or arthrogryposis.
Clavicle Fractures:
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Birth Injuries

Orthopedic Injuries

Pediatric Orthopedics

Sports Injury Specialist

Orthopedic Associates
Clavicle fractures are the most frequently encountered birth injury. The
clavicle, also called the collarbone, connects the chest to the shoulder.
The usual symptom is pain over the fracture site, as seldom do the
injuries cause a noticeable deformity. Simple treatments, usually just
strapping the arm to the chest, will allow these injuries to heal.

Treatment is usually only necessary for a few weeks, as the bone

heals quickly in young babies.
Brachial Plexus Injuries (Erb's Palsy):
The brachial plexus is the group of nerves that travel from the neck
down the arm. It's located just underneath the clavicle (collarbone)
and can be injured during childbirth. The brachial plexus is
stretchedwhen the head is pulled in one direction and the arm in the
opposite. Usually this injury causes weakness seen in one arm.
Treatment is to let the nerves to heal over time, most often this leads
to complete recovery. If nerve injury is still evident after 3 to 6 months,
surgery may be recommended.
Femur Fractures:
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Femur fractures (broken thigh bone) occur as the leg is awkwardly
twisted during delivery. These are rare injuries that are much less
common than clavicle fractures. The usual symptom is pain when the
child is moved or diaper is changed. The treatment of a femur fracture
in a newborn is to use aPavlik harness. Usually, a Pavlik harness is
worn for about four weeks.
Sources:

Birth injury is a serious matter. Rarely during the birth process a baby is hurt, this is
called a birth injury or birth trauma. It occurs in about 6 to 8 out of every 1,000 births.

A birth injury can occur becauseof a premature birth, the size of the baby (small or
large babies), position of the mother at birth, complicated labor, position of the baby,
and other reasons. It is also more likely in moms who are having their first baby,
a mother with gestational diabetes or mothers have pelvic abnormalities.
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Birth Injuries

Prenatal Care

Pregnancy Care

Birthing Information

Postnatal Care
Here are some of the types of birth injury that occur:
Caput Succedaneum
This is severe swelling of the baby's scalp. It happens as the baby during labor and
is more common in babies who were born with a vacuum extraction, though it can
also happen as the baby's head presses against the cervix for long periods of time.
There can also be bruising in the area of the caput. Generally this lasts only a few
days and the swelling goes away on its own. Your baby may need to have an
ultrasound to look for further problems in some cases.

Cephalohematoma
This is bleeding underneath the periostium (outer tissue covering the bone) in your
baby's head. It may not appear right away after the birth but show up several hours
later. Treatment is generally not necessary but it may take a few weeks or even
months for this to completely disappear as the blood reabsorbs. It is estimated to
occur in about 1-2% of spontaneous births but is more common in operative
deliveries (forceps andvacuum extraction).
More on Cephalohematoma
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Bruising
This happens as the baby passes through the birth canal and is more common when
a baby is born with the assistance of forcepsor vacuum extractions. This also goes
away on its own typically in a few days. It is also known as forceps marks when
forceps are used.

Lacerations
A cut on your baby's skin caused usually by the scalpel in a cesarean section or from
a vacuum extractor. Some may be deep enough to require sutures (stitches) or they
may be glued, but the vast majority can be bandaged together. Infection is also a
concern and the wound may be treated with antibiotic ointment. The location
depends on how the cut occur and may depend on your baby's position in the uterus.

Subconjunctival Hemorrhage
This is a very common occurrence in babies. It can effect one or both eyes of your
baby and simply looks like a redness in the eye. The amount of red depends on the
amount of small blood vessels broken. It does not need treatment nor does it effect
your baby's eyes long term. The redness can last upwards of a week.

Fractures
Breaking the clavicle (between the shoulder and the neck), also known as the
collarbone, is another problem when there are issues delivering the baby's shoulder.
Fractures of the humerus can also occur with a breech delivery. This typically heals
with no treatment, though splinting may reduce pain. During the time when your
baby's arm is healing, there is little movement on the side of the fracture.

Brachial Palsy
Damage to the brachial plexus, a group of nerves that aids the hands and arms, can
cause a baby to lose the ability to move his or her arm. This may be temporary or
permanent. Your baby may need x-rays, MRI or other radiographic tests to see the
extent of the injury. Special exercises may be required, like physical therapy during
the recovery. This is more common with a shoulder dystocia, when your baby has
trouble with delivering its arm.

Facial Nerve Paralysis

If pressure is put on the facial nerves paralysis can occur. More common in forceps
births, but can occur without it. The paralysis is usually seen when the baby cries.
The damage may clear up on its own in a few weeks.

Intracranial Hemorrhage
This is when blood vessels are broken inside your baby's skull. This bleeding can
occur in many locations depending on what caused the bleeding. It is much more
common in premature infants. Signs are poor feeding and seizures to name two. If
your baby is at high risk for bleeding, screenings will be done to check for an
intracranial hemorr

The words shoulder dystocia bring fear to the heart of every doctor
and midwife. This means that the one, less frequently both,
shoulder(s) of the baby are not entering the pelvis during the birth as
they should. Shoulder dystocia occurs in less than 1% of all births
according to some studies. This can lead to increased complications
for the baby and the mother.
Warning Signs for Shoulder Dystocia
Contrary to popular belief there isn't one exact method to predict who
will have a shoulder dystocia.
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Shoulder Dystocia

Birth Center

Birth Class

Natural Birth

Pregnancy Symptoms
Many different theories have been tested, each with varying results.
We've looked at babies who are big, moms who are small,
complicated pregnancies, particularly in regards to complications like
gestational diabetes, inductions, gestational age, previous babies with
shoulder dystocia, and many others. For example using the weight of
the baby alone as a factor, nearly a quarter of the cases of shoulder
dystocia happen to babies under the considered "danger weight." The
best predictor may be a combination of the factors involved.
What do you do if you and your practitioner feel you're in danger of a
shoulder dystocia? The answer isn't clear on all counts. We do know
that certain positions are more likely to lead to shoulder dystocia, for
example the lithotomy position (laying flat on your back) can prevent
the sacrum from properly moving during birth and therefore narrowing
the amount of room in your pelvis for the shoulders. Episiotomy, a
surgical cut in the area of skin between the vagina and rectum, is
often debated with one side saying that doing a generous
episiotomy allows room for the practitioner to do maneuvers, the other
side argues that the perineum is not what is holding the baby back
and should be left intact.
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Nor is routine cesarean section or induction the answer for all.

Maneuvers to Help Alleviate the Dystocia

There are several things that can be done to help solve the problem of
the shoulder dystocia. Since each birth is different not everyone of
these will work every time, so multiple maneuvers are likely to be tried
in very rapid succession to help resolve the situation in a positive
manner. Here are some of the suggested techniques:

Suprapubic Pressure: This pressure is at the pubic bone, not

at the top of the uterus. This might allow the shoulder enough room to
move under the pubis symphysis.

Gaskin Maneuver: Get the woman into a hands and knees

position. This will also change the diameters of her pelvis, though is
not always possible with epidural anesthesia.

McRobert's Maneuver: Flex the mother's legs toward her

shoulders as she lays on her back, thus expanding the pelvic outlet.
One study showed that this alleviated 42% of all cases of shoulder
dystocia.

Woods Maneuver: This is also known as the corkscrew, the

attendant tries to turn the shoulder of the baby by placing fingers
behind the shoulder and pushing in 180 degrees.

Rubin Maneuver: Like the Woods maneuver, two fingers are

placed behind the baby's shoulder, this time they are pushing in the
directions of the baby's eyes, to line up the shoulders.

Zavanelli Maneuver: Pushing the baby's head back inside the

vagina and doing a cesarean. This is the mostly frequently asked
about method, but also one of the most dangerous.

After the Birth

After a hectic birth that includes a shoulder dystocia, there may be
additional things your doctor or midwife will want to watch for in you
and your baby, including:

A baby that is slow to start and may require assistance with

breathing.

Fractures of the baby's collar bone (clavicle) or humerus.

Fetal Brachial Plexus injury.

Repairs for episiotomy or tearing done during the birth.

Maternal hemorrhage.

Uterine rupture.
While a shoulder dystocia isn't a very common occurrence, knowing
what potential risk factors are for you and your baby can help you
make wise choices for your labor and birth.

References:
Cohen B, Penning S, Major C, Ansley D, Porto M, Garite T (1996).
'Sonographic Prediction of Shoulder Dystocia in Infants of Diabetic

Mothers', Obstetrics and Gynecology, 88, 10-13.

Gaskin I M, Meenan A L, Hunt P and Ball C A (2001.) 'A New/old
Maneuver for the Management of Shoulder Dystocia'
Gherman RB, Goodwin TM, Souter I, Neumann K, Ouzounian JG,
Paul RH (1997). 'The McRoberts' maneuver for the alleviation of
shoulder dystocia: How successful is it?', American Journal of
Obstetrics and Gynecology, 176, 656-661.
Lee C Y (1987). 'Shoulder dystocia', Clinics in Obstetrics and
Gynecology, 30, 77.
Mashburn J (1988). 'Identification and management of shoulder
dystocia', Journal of Nurse Midwifery, 33, 5.
Resnick R (1980). 'Management of shoulder girdle dystocia', Clinics in
Obstetrics and Gynecology, 23, 559.