Many babies are born each year with injuries which may be attributable to some type of trauma during the labor and delivery process. Some of the types of trauma a newborn may sustain during the birthing process are apparent at birth. Other types of trauma are not apparent until the baby ages and mature and it becomes noticeable to parents or physicians that certain milestones are not being reached by the child as would ordinarily be expected.

It is frequently difficult to identify a cause of a birth-related trauma simply from looking at the child. Indeed, often it is difficult to determine a cause even from a review of the medical records. Usually, a review of the records and an examination and testing of the baby by a physician will be required to fully evaluate whether the infant sustained a birth-related injury and to identify the exact injury sustained.

To prepare for such an evaluation, you should provide the physician with any photographs or videotape which demonstrate signs of injury or delays. In addition, you should maintain a log of milestones reached and any delays or difficulties in reaching milestones. You should compile all records of the prenatal care, including duplicates of any of the ultrasounds performed during the pregnancy. In addition, the physician will need to review the labor and delivery records, including fetal heart monitoring strips, and the baby’s newborn nursery records and subsequent health care records.

We do not always have success in identifying a specific injury or the cause of an injury in a newborn; however, with the input of world-class physicians with special education, training and experience in the evaluation and care of children, we are able to gather critical information to help us understand what may have caused the baby’s problems.

The birthing process is a stressful one for the unborn baby, as it blends compression, contractions, torque and traction, often over an extended period of time. For babies who are large for gestational age, the process of delivery may be even more difficult. The baby’s presentation and position in the womb as well as the gestational age are also important to take into account when trying to determine the safest method and time of delivery.

While birth-related deaths are estimated to account for less than 2% of neonatal deaths, careful planning and consideration of risk factors may further decrease the number of neonatal deaths and injuries. The use of ultrasound technology and fetal monitoring prior to attempting a vaginal birth may reveal useful information to the physician and patient. Trauma arises in the context of a planned vaginal delivery that gets interrupted by unexpected difficulties. When those difficulties can be anticipated and either avoided or managed, the baby has a better chance of a healthy delivery.

Various professional organizations have issued position statements and published information to help reduce birth trauma. These organizations have given guidelines for the use of instrumentation during delivery. In the hands of experienced practitioners, an instrumentation-aided delivery may result in a successful and safe delivery. For practitioners with little or no experience with the use of midforceps and vacuum extractors, the baby may have a greater risk of birth trauma and serious injury.

Certain factors have been associated with birth trauma, including:

  • Prima gravida
  • Cephalopelvic disproportion, small maternal stature, maternal pelvic anomalies
  • Prolonged or rapid labor
  • Deep transverse arrest of descent of presenting part of the fetus
  • Oligohydramnios
  • Abnormal presentation (breech)
  • Use of midcavity forceps or vacuum extraction
  • Versions and extractions
  • Very low birth weight infant or extreme prematurity
  • Fetal macrosomia
  • Large fetal head
  • Fetal anomalies

Thankfully, most deliveries are smooth and uncomplicated and with no apparent or actual lasting trauma to the baby or Mom. If any of the above risk factors exist in your pregnancy or from a past pregnancy, you should talk to your physicians about how best to manage your delivery.

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