Birth Injury: Symptoms, Types, Causes and Treatment

Birth injury refers to physical or psychological harm sustained by a newborn or mother during the process of labor and delivery. While many births are uneventful, complications can arise that lead to short-term or even lifelong consequences. Recognizing the symptoms, understanding the types and causes, and knowing the available treatments are vital for both healthcare providers and families. This article offers a comprehensive, evidence-based overview of birth injuries, synthesized from recent research and clinical experience.

Symptoms of Birth Injury

Birth injuries can manifest in a variety of ways, affecting both the baby and the mother. Symptoms may range from obvious physical signs to subtler neurological disturbances or psychological distress. Early identification of these symptoms is crucial for prompt intervention and better outcomes.

Symptom	Description	Who is Affected	Source(s)
Bruising	Discoloration/swelling on skin	Newborn	8 15 16
Limpness/weakness	Reduced movement or tone	Newborn	5 6 8 14
Difficulty feeding	Poor sucking/swallowing	Newborn	5 8
Seizures	Abnormal movements, jerking	Newborn	8 10 15
Pain	Discomfort, crying, guarding	Mother/Newborn	13 16
Loss of reflexes	Absent/weak reflex responses	Newborn	5 8 14
Incontinence	Urinary/fecal leakage	Mother	2 7
PTSD/Anxiety	Flashbacks, nightmares, distress	Mother	1 2 4
Depression	Persistent sadness/loss of interest	Mother	3 4
Sexual dysfunction	Pain or difficulty with intercourse	Mother	2

Table 1: Key Symptoms

Physical Symptoms in Newborns

Newborns may present with visible signs such as bruising, swelling, or abnormal positioning of limbs. More severe injuries can lead to limpness, weak or absent reflexes, or even paralysis. Feeding difficulties, swallowing dysfunction, and unusual crying are also clinical red flags that should prompt further assessment. Neurological symptoms, including seizures, are particularly serious and require urgent attention 5 6 8 10 14 15 16.

Maternal Symptoms

For mothers, physical symptoms after birth injury often include pain, especially related to perineal trauma. Incontinence may develop if pelvic floor muscles or nerves are damaged 2 7. Some women experience persistent pain or sexual dysfunction months after delivery 2.

Psychological and Emotional Symptoms

Birth injuries can be traumatizing, leading to acute trauma symptoms, post-traumatic stress disorder (PTSD), anxiety, and depression in mothers 1 2 3 4. These symptoms may be overlooked or minimized, but they are vital to address for maternal well-being. Partners can also be affected, experiencing distress and feeling helpless 2.

Types of Birth Injury

Birth injuries encompass a wide spectrum, from mild, self-limited conditions to severe, life-altering damage. The type of injury depends on many factors, including the nature of the delivery, fetal position, and medical interventions.

Injury Type	Example/Description	Severity	Source(s)
Soft Tissue	Bruising, swelling (caput, cephalohematoma)	Mild–moderate	8 9 15 16
Nerve	Brachial plexus, facial nerve palsy	Moderate–severe	6 8 14 15
Fracture	Clavicle, long bones	Moderate	6 8 9 16
Intracranial	Subdural, subarachnoid hemorrhage	Severe	9 10 15
Spinal Cord	Paralysis, decreased movement	Severe	5 8 14
Perineal Trauma	Tears, episiotomy, pelvic floor injury	Mild–severe	2 3 4 7
Organ Injury	Liver, spleen, abdominal trauma	Rare, severe	8 15 16
Psychological	PTSD, depression, anxiety	Mild–severe	1 2 3 4

Table 2: Major Types of Birth Injuries

Soft Tissue Injuries

These are the most common and often the least severe. Bruising, caput succedaneum (scalp swelling), and cephalohematoma (blood collection under the scalp) are usual findings after difficult or instrument-assisted deliveries. Most resolve without intervention 8 9 15 16.

Nerve Injuries

Peripheral nerve injuries such as brachial plexus palsy (affecting arm movement) and facial nerve palsies can occur, especially with shoulder dystocia or forceps use. These may recover over weeks to months but can sometimes cause permanent deficits 6 8 14 15.

Fractures

Clavicular fractures are relatively common, particularly in larger infants or with difficult deliveries. Long bone fractures may also occur but are less frequent. These generally heal with conservative management 6 8 9 16.

Intracranial and Spinal Cord Injuries

Bleeding within or around the brain (intracranial hemorrhages) and spinal cord injuries are among the most serious birth injuries, often leading to seizures, neurological deficits, or death. Spinal cord injuries may present subtly, such as with hoarse voice or limb weakness 5 9 10 14 15.

Perineal and Pelvic Floor Trauma

Mothers may experience perineal tears, episiotomies, or pelvic floor muscle injuries, leading to pain, incontinence, or sexual dysfunction. Severe tears (third- or fourth-degree) may also involve the anal sphincter 2 3 4 7.

Organ Injuries

Though rare, internal organ injuries may occur during traumatic deliveries and require immediate attention 8 15 16.

Psychological Injuries

Emotional trauma, PTSD, and depression are increasingly recognized as significant birth injuries, especially after difficult or poorly managed deliveries 1 2 3 4.

Causes of Birth Injury

The causes of birth injury stem from a complex interplay of maternal, fetal, and intrapartum factors. Understanding these risks is essential for prevention and early intervention.

Cause	Risk Factor/Example	Impact	Source(s)
Mechanical Trauma	Forceps, vacuum, large baby	Fractures, nerve	6 8 9 15 16
Prolonged Labor	>60 minutes 2nd stage	Nerve, soft tissue	6 8 9
Fetal Size	>3500g (macrosomia)	Fractures, nerve	6 8
Preterm Birth	Immature organs, brain	Neurological	11 12
Infection/Inflammation	Chorioamnionitis	Brain injury, CP	11 12
Obstetric Intervention	Episiotomy, C-section	Perineal, pelvic	1 2 3 4 7
Poor Intrapartum Care	Inadequate support	Trauma, PTSD	1 2 4
Unknown/Spontaneous	No obvious risk	Any type	8 16

Table 3: Common Causes of Birth Injury

Mechanical Trauma

Mechanical forces during delivery—especially with the use of forceps, vacuum extraction, or in the context of a very large baby—can cause fractures, nerve injuries, or soft tissue damage 6 8 9 15 16. Shoulder dystocia (when the baby's shoulder gets stuck) is particularly high-risk.

Prolonged or Difficult Labor

A long second stage of labor increases the likelihood of both maternal and neonatal injury. Prolonged pressure on the baby’s head or body can result in nerve injury or bruising 6 8 9.

Fetal Size and Position

Larger babies (macrosomia) are at higher risk for birth injuries, as are those in abnormal presentations (breech, face, or shoulder first) 6 8.

Preterm Birth and Inflammation

Preterm infants have fragile organs, particularly the brain, making them more susceptible to injury from hypoxia (lack of oxygen), inflammation, or infection. Conditions like chorioamnionitis (infection of the fetal membranes) can severely damage the developing brain 11 12.

Obstetric Interventions

While interventions such as episiotomy or emergency cesarean may be necessary, they also carry risks. Perineal tears, pelvic floor trauma, and even psychological distress from feeling unsupported or uninformed are commonly reported 1 2 3 4 7.

Quality of Intrapartum Care

A woman's perception of inadequate support or poor communication during labor has been linked to higher rates of trauma symptoms and psychological injury 1 2 4. Lack of education about potential morbidities also contributes to distress.

Unpredictable Causes

Not all birth injuries can be predicted or prevented. Some occur even in well-managed, low-risk labors 8 16.

Treatment of Birth Injury

Prompt recognition and appropriate treatment of birth injuries are essential for minimizing long-term effects. Management strategies depend on the type and severity of injury, and often require a multidisciplinary approach.

Injury/Treatment	Approach/Intervention	Goal/Outcome	Source(s)
Soft Tissue	Observation, cold packs	Pain relief, healing	13 16
Fractures	Immobilization, monitoring	Bone healing	6 8 9 16
Nerve Injury	Physiotherapy, surgery (rare)	Function recovery	6 8 14 16
Intracranial Injury	NICU, neurosurgery, imaging	Prevent sequelae	8 9 10 15 16
Spinal Cord	Steroids, rehab, ventilation	Maximize recovery	5 8 14
Perineal Trauma	Suturing, pain management	Healing, comfort	13 16
Pelvic Floor	Physiotherapy, counseling	Restore function	2 4
Psychological	Support, therapy, education	Emotional wellbeing	1 2 3 4

Table 4: Main Treatments for Birth Injuries

Newborn Injury Management

• Soft Tissue Injuries: Most require only observation. Cold packs or gel pads can relieve pain and swelling, with some evidence suggesting a preference for gel pads over ice 13 16.
• Fractures: Clavicle and long bone fractures are managed conservatively with immobilization. Most heal without complications 6 8 9 16.
• Nerve Injuries: Early physiotherapy is recommended. Some cases of brachial plexus or facial nerve injuries may require surgical intervention, but most recover with time 6 8 14 16.
• Intracranial and Spinal Cord Injuries: These require specialized care, often in a neonatal intensive care unit (NICU). Imaging, neurosurgical consultation, and sometimes ventilation or steroids are indicated 5 8 9 10 14 15 16.
• Organ Injuries: Immediate pediatric and surgical assessment is necessary 8 15 16.

Maternal Injury Management

• Perineal Trauma: Suturing is performed for moderate to severe tears. Pain relief may include ice packs, cold gel pads, or oral medications. Local cooling treatments offer some pain relief, though evidence is limited 13 16.
• Pelvic Floor Dysfunction: Physiotherapy and pelvic floor exercises are key. In cases of severe injury, surgical repair or further interventions may be needed. Emotional support and counseling are also critical 2 4.

Psychological Support

• Acute Trauma and PTSD: Early support, counseling, and clear communication can help reduce psychological morbidity. Women appreciate being informed and having their concerns taken seriously 1 2 3 4.
• Depression and Anxiety: Screening for postpartum mood disorders and providing prompt intervention—either psychotherapy, medication, or both—are recommended 3 4.

Multidisciplinary and Long-Term Care

• Collaboration between obstetricians, pediatricians, physiotherapists, mental health professionals, and support staff ensures comprehensive care.
• Ongoing follow-up may be needed for both physical and psychological sequelae, especially in severe or complex cases 2 4 5 8 14.

Conclusion

Birth injuries are a significant concern for both newborns and mothers, encompassing a range of physical and psychological symptoms. Early recognition and intervention are crucial for optimal recovery and well-being. Awareness and education for healthcare providers, mothers, and families can help reduce the risk and improve outcomes.

Key Points:

• Birth injuries present with a variety of symptoms, some obvious and some subtle, affecting both infants and mothers.
• Types of injuries include soft tissue, nerve, bone, intracranial, spinal cord, pelvic floor, and psychological trauma.
• Risk factors include mechanical trauma, prolonged labor, fetal size, preterm birth, infection, obstetric interventions, and poor intrapartum care.
• Treatment is multidisciplinary, focusing on prompt recognition, supportive care, physiotherapy, surgical intervention when needed, and psychological support.
• Education, communication, and compassionate care are essential for preventing and managing birth injuries.

By fostering a supportive environment, prioritizing early intervention, and continually updating clinical practices, we can help minimize the impact of birth injuries on families.