Birth Trauma – Neonatal Brain Hemorrhage, Clavicle Fracture, and Other Injuries
"What is Birth Trauma?"
Birth trauma refers to physical injuries sustained by a newborn during the delivery process.
It can occur in both vaginal and cesarean deliveries and is influenced by factors such as labor difficulty, fetal size, and delivery method.
This article will cover the major types of birth trauma (brain hemorrhage, clavicle fracture, etc.), causes, treatments, and prognosis.
📌 Introduction
Birth trauma occurs in approximately 2–7% of all newborns, making it a relatively common condition.
While most cases are mild and resolve naturally,
some injuries require medical intervention to prevent long-term complications.
💡 In this article, we will explore the causes, types, treatments, and outcomes of neonatal birth trauma.
Causes and Risk Factors of Birth Trauma
Birth trauma can result from mechanical forces during labor and delivery,
such as compression, traction, or excessive pressure applied to the baby.
Several factors increase the likelihood of birth injuries.
1️⃣ Main Causes of Birth Trauma
✔ Difficult or Prolonged Labor (Dystocia)
- Prolonged second stage of labor increases the risk of fetal distress and trauma
- Cephalopelvic disproportion (CPD) → Baby’s head is too large for the mother’s pelvis
- Uterine contractions that are too strong or prolonged
✔ Instrumental Delivery (Forceps or Vacuum Extraction)
- Forceps-assisted delivery → May cause skull fractures, facial nerve injury, or intracranial hemorrhage
- Vacuum extraction → Can lead to scalp hematoma, skull trauma, or subgaleal hemorrhage
✔ Large Birth Weight (Macrosomia, >4,000g)
- Increased risk of clavicle fractures, brachial plexus injury, and shoulder dystocia
✔ Abnormal Fetal Position
- Breech presentation → Head and neck injuries due to difficult extraction
- Face or brow presentation → Increased risk of skull or spinal trauma
✔ Multiple Births (Twins, Triplets, etc.)
- Higher risk of umbilical cord compression, hypoxia, and mechanical trauma
✔ Prematurity (<37 weeks gestation)
- More fragile blood vessels and bones, increasing the risk of brain hemorrhage and fractures
✔ Cesarean Delivery (C-section)
- Although C-section reduces certain risks, it may still cause trauma,
such as lacerations, skull injuries, or brachial plexus damage
2️⃣ Risk Factors for Birth Trauma
✔ Maternal Factors
- Small maternal pelvis (Cephalopelvic disproportion)
- Prolonged or obstructed labor
- Maternal obesity or diabetes (increases fetal size)
✔ Fetal Factors
- Macrosomia (>4,000g birth weight)
- Prematurity (fragile bones and vessels)
- Breech or abnormal presentation
✔ Delivery Factors
- Instrumental delivery (forceps, vacuum-assisted birth)
- Shoulder dystocia (difficulty delivering the baby’s shoulders after the head is born)
💡 Summary of Birth Trauma Causes & Risk Factors
✔ Difficult labor, instrumental delivery, and large birth weight increase the risk of birth trauma
✔ Premature infants are more vulnerable to fractures and brain hemorrhages
✔ Breech presentation and multiple births pose a higher risk of mechanical injuries
✔ Early identification of risk factors can help prevent severe birth trauma
Understanding these causes and risk factors allows for better prevention and management strategies.
Types of Birth Trauma and Symptoms
Birth trauma can affect various parts of the newborn’s body,
ranging from minor soft tissue injuries to severe neurological damage.
1️⃣ Common Types of Birth Trauma
🧠 1. Intracranial Hemorrhage (Brain Bleeding)
✔ Subdural Hemorrhage → Bleeding between the brain and dura mater
- Cause: Forceps delivery, prolonged labor
- Symptoms: Seizures, apnea, poor feeding, bulging fontanelle
✔ Subarachnoid Hemorrhage → Bleeding between the brain and arachnoid membrane
- Cause: Hypoxia, birth asphyxia
- Symptoms: Irritability, tremors, poor muscle tone
✔ Intraventricular Hemorrhage (IVH) → Bleeding inside the brain’s ventricles
- Cause: Prematurity (<32 weeks gestation)
- Symptoms: Lethargy, apnea, bradycardia, weak sucking reflex
🦴 2. Bone Fractures
✔ Clavicle Fracture (Most Common Birth Fracture)
- Cause: Shoulder dystocia, macrosomia
- Symptoms: Reduced arm movement, asymmetric Moro reflex
✔ Humerus or Femur Fracture
- Cause: Forceful traction during delivery
- Symptoms: Swelling, pain, limited limb movement
🏥 3. Nerve Injuries
✔ Brachial Plexus Injury (Erb’s Palsy, Klumpke’s Palsy)
- Cause: Shoulder dystocia, excessive traction
- Symptoms: Arm weakness, paralysis, absent grasp reflex
✔ Facial Nerve Palsy
- Cause: Forceps delivery, prolonged pressure on the facial nerve
- Symptoms: Asymmetric facial movement, difficulty closing one eye
✔ Phrenic Nerve Injury
- Cause: Brachial plexus trauma
- Symptoms: Diaphragmatic paralysis, respiratory distress
🩸 4. Soft Tissue and Scalp Injuries
✔ Caput Succedaneum → Swelling of the scalp
- Cause: Prolonged labor, vacuum extraction
- Symptoms: Soft, puffy scalp swelling, resolves in days
✔ Cephalohematoma → Blood accumulation under the skull
- Cause: Vacuum or forceps delivery
- Symptoms: Firm, non-mobile swelling, may take weeks to resolve
✔ Subgaleal Hemorrhage (Severe Scalp Bleeding)
- Cause: Forceps, vacuum-assisted delivery
- Symptoms: Rapid scalp swelling, potential hypovolemic shock
2️⃣ Signs and Symptoms of Birth Trauma
✔ Neurological Symptoms: Seizures, irritability, lethargy, apnea
✔ Musculoskeletal Symptoms: Weak or absent reflexes, swelling, reduced limb movement
✔ Respiratory Symptoms: Irregular breathing, low oxygen levels
✔ Facial Symptoms: Asymmetric facial movement, difficulty sucking
⚠ Severe birth trauma can lead to long-term developmental issues.
Immediate medical evaluation is required for any suspected injury.
💡 Summary of Birth Trauma Types & Symptoms
✔ Brain hemorrhages occur due to prolonged labor or instrumental delivery
✔ Bone fractures (clavicle, humerus) are common in macrosomic babies
✔ Nerve injuries affect movement and reflexes (Erb’s palsy, facial palsy)
✔ Soft tissue injuries (caput, cephalohematoma) usually resolve on their own
✔ Early recognition and intervention improve outcomes
Identifying symptoms early ensures better management and treatment.
Diagnosis and Treatment of Birth Trauma
Early diagnosis and appropriate treatment of birth trauma
are crucial to prevent long-term complications.
The approach varies based on the type and severity of the injury.
1️⃣ Diagnosis of Birth Trauma
✔ Physical Examination
- Neurological assessment → Reflexes, muscle tone, abnormal movements
- Musculoskeletal check → Fractures, swelling, limited limb movement
- Facial assessment → Asymmetry, difficulty feeding, weak cry
✔ Imaging Tests
- Cranial ultrasound (for preterm infants) → Detects intraventricular hemorrhage
- Head CT/MRI → Evaluates brain hemorrhages, skull fractures
- X-ray → Identifies clavicle, humerus, or femur fractures
- Ultrasound (for brachial plexus injury) → Assesses nerve damage
✔ Laboratory Tests
- Blood tests (Hemoglobin, Hematocrit) → Monitors anemia from hemorrhage
- Coagulation tests → Evaluates bleeding disorders
2️⃣ Treatment Options for Birth Trauma
🧠 1. Treatment for Intracranial Hemorrhage
✔ Supportive Care (For Mild Cases)
- Oxygen therapy, close monitoring
✔ Severe Cases (IVH, Subdural Hemorrhage, Hydrocephalus)
- Diuretics (reduces brain swelling)
- Lumbar puncture or ventricular shunting (for hydrocephalus)
- Seizure control (anticonvulsants)
🦴 2. Treatment for Bone Fractures
✔ Clavicle Fracture
- Usually heals on its own in 7–10 days
- Arm immobilization with a soft bandage
✔ Humerus or Femur Fracture
- Splinting or casting for proper alignment
- Pain management with acetaminophen
🏥 3. Treatment for Nerve Injuries
✔ Brachial Plexus Injury (Erb’s Palsy, Klumpke’s Palsy)
- Physical therapy (ROM exercises) to prevent muscle stiffness
- Most recover within 3–6 months, but severe cases may need surgery
✔ Facial Nerve Palsy
- Resolves spontaneously in 1–3 months
- Severe cases may require eye protection (lubricating drops, taping the eyelid shut)
✔ Phrenic Nerve Injury (Diaphragmatic Paralysis)
- Oxygen support or ventilation for respiratory distress
- Severe cases may need surgical diaphragm plication
🩸 4. Treatment for Soft Tissue & Scalp Injuries
✔ Caput Succedaneum → No treatment needed, resolves within days
✔ Cephalohematoma → Resolves in weeks, but monitor for jaundice
✔ Subgaleal Hemorrhage → Emergency fluid resuscitation and transfusion if severe
💡 Summary of Birth Trauma Diagnosis & Treatment
✔ Physical exams and imaging (X-ray, MRI, ultrasound) help confirm injuries
✔ Brain hemorrhages may need anticonvulsants or surgical drainage
✔ Bone fractures heal with immobilization, while nerve injuries require therapy
✔ Most soft tissue injuries resolve naturally, but subgaleal hemorrhage is an emergency
💡 Early intervention ensures better recovery and prevents complications.
Prevention and Conclusion for Birth Trauma
While birth trauma cannot always be completely avoided,
proper prenatal care and delivery management can significantly reduce the risk.
1️⃣ How to Prevent Birth Trauma
✔ Prenatal Risk Assessment
- Identify large fetal size (macrosomia) through ultrasound
- Monitor for cephalopelvic disproportion (CPD)
- Assess maternal conditions (gestational diabetes, obesity, hypertension)
✔ Optimizing Labor & Delivery
- Avoid excessive traction or force during delivery
- Careful use of forceps and vacuum extraction
- Consider C-section for high-risk cases (breech, macrosomia, prolonged labor)
✔ Proper Fetal Positioning
- Encourage optimal fetal positioning (pelvic exercises, maternal posture adjustments)
- External cephalic version (ECV) for breech babies before labor
✔ Neonatal Monitoring After Birth
- Immediate APGAR scoring and neurological assessment
- Early imaging (X-ray, ultrasound, MRI) if trauma is suspected
- Physical therapy for nerve injuries (Erb’s palsy, facial palsy)
2️⃣ Long-Term Management of Birth Trauma
✔ Follow-up for High-Risk Infants
- Regular neurological check-ups for infants with brain hemorrhage
- Ongoing physical therapy for nerve damage or fractures
✔ Developmental Screening
- Assess motor skills, reflexes, and cognitive milestones
- Early intervention programs for developmental delays
✔ Parental Education & Support
- Guide parents on physical therapy exercises for nerve injuries
- Monitor for long-term complications (hydrocephalus, cerebral palsy)
🔥 Conclusion & Key Takeaways
Birth trauma is a preventable and manageable condition when recognized early.
Proper prenatal care, careful labor management, and neonatal monitoring are essential.
🎯 Key Prevention & Management Strategies
✔ Early prenatal screening to assess fetal size and position
✔ Controlled delivery techniques to prevent excessive force or pressure
✔ Early detection and intervention for fractures, nerve damage, and brain injuries
✔ Physical therapy and developmental monitoring for affected infants
💡 With early diagnosis, treatment, and supportive care, most newborns recover fully from birth trauma.
Ongoing medical follow-ups ensure the best possible developmental outcomes. 🚀
