Overview of Common Birth Injuries and their Causes
In the small number of legitimate medical malpractice claims, certain types of birth injuries may be attributed to medical negligence. Negligence during prenatal care can include failure to detect birth defects or failure to diagnose dangerous health conditions of the mother. Malpractice cases associated with birth injuries could involve a failure to order a timely cesarean delivery or the negligent use of forceps or vacuum.
What Causes Birth Injuries?
During labor and delivery, a newborn could suffer a number of physical injuries, including damage to the cranial nerve, brain, spinal cord, bones, muscles, ligaments or intra-abdominal injuries. Some common causes of birth injuries can include:
- Excessive force used during delivery
- A failure to timely recognize fetal distress
- A failure to prepare/plan for a likely cesarean birth
- Untreated post-birth seizures resulting in brain damage and subsequent cerebral palsy
This blog provides an overview of a few common types of birth injuries that can result from medical errors in the delivery room. While each condition is a unique injury with different effects, subsequent (specific) conditions may result from that injury. In most cases, either oxygen deprivation and/or excessive physical force used to deliver a baby may result in a number of different birth injuries and conditions.
Many birth injuries stem from a hypoxic brain injury (hypoxia) or anoxic brain injury (anoxia). Hypoxic brain injury refers to partial oxygen deprivation, while an anoxic brain refers to total oxygen deprivation. More specifically, Hypoxic Ischemic Encephalopathy (HIE), is a damaging condition in the brain often caused by a hypoxic injury event during birth. A severe hypoxic brain injury or HIE (oxygen deprivation) often leads to Cerebral Palsy or Mental Retardation.
Cerebral Palsy, (CP) is a physical disorder resulting from brain damage or brain malformation. CP impairs muscle function, speech, and motor skills. The term “cerebral” refers to the cerebellum, the part of the brain responsible for sending signals to muscles throughout the body. The word “palsy” means “disorder of movement” as well as muscle weakness. Most Cerebral Palsy cases are congenital, meaning that the disorder is present from birth.
CP can manifest as a result of brain damage produced by environmental conditions occurring during the time period from the last trimester of pregnancy to immediately before or during delivery. Brain injuries suffered during childbirth is a leading accidental cause of Cerebral Palsy.
Mental retardation or intellectual disability (MR/ID) exists in children whose brains do not develop properly or function within the normal range. There are four levels of retardation: mild, moderate, severe, and profound. Sometimes, MR/ID cases may be classified as unspecified. Mental retardation involves both a low IQ and problems adjusting to the various stages of everyday life.
MR/ID can result in learning, speech, physical, and social disabilities. Severe cases are typically diagnosed at birth. However, milder forms might not be detected until a child fails to meet a common developmental goal. When a birth injury is the specific cause of MR/ID, the condition is usually a result of trauma before or during birth, oxygen deprivation, infection, complications of premature birth.
Symptoms of MR/ID can vary widely based on the level of the disability. Permanent deficits may include:
- Failure to meet educational milestones
- Sitting, crawling, or walking later than other children
- Difficulty learning to talk or trouble speaking clearly
- Memory impairment
- Inability to understand or learn the consequences of actions
- Cognitive impairments, reduced mental processing capacity
- Childish behavior beyond a normal age
- Lack of curiosity
- Learning difficulties
- IQ below 70
- Inability to lead an independent adult life
Brachial Plexus Palsy
The brachial plexus is a network of nerves near the neck that give rise to all the nerves of the arm. These nerves provide movement and feeling to the arms, hands, and fingers. Weakness and/or a disorder of movement related to these nerves are deemed brachial plexus palsy. This condition causes arm weakness and a loss of motion. Nerves of the brachial plexus can be physically strained, broken, or pinched during a difficult delivery from:
- A newborn’s head and neck pulling toward the side as the shoulders pass through the birth canal
- Excessive pulling on the baby’s shoulders during a head-first delivery
- Excessive pressure on the baby’s raised arms during a breech (feet-first) delivery
Brachial plexus injuries usually affect only the upper arm. There are different, specific forms of brachial plexus injury an infant might experience. The specific type is classified by the amount of arm paralysis the baby exhibits:
Erb’s Palsy – Erb’s paralysis affects the upper and lower arm. The nerves extending from the C5-C6-C7 vertebrae may be injured in some way. This represents roughly 60 to 70 percent of Brachial Plexus Palsy injuries. The baby will demonstrate weakness involving the muscles of the shoulder and biceps.
Klumpke Palsy – Klumpke paralysis (formerly palsy) affects the hand. It involves injury to the lower roots of the nerves in the C8-T1 vertebrae. The injury typically affects the muscles of the hand, limiting wrist flexion and finger movement. The infant may also have an eyelid droop on the opposite side of the injury. This injury is the rarest form of brachial plexus palsy – seldom seen in babies or children.
Prognosis for Brachial Plexus Birth Injuries
The prognosis for each particular injury is largely dependent on the extent of the injury and varies from patient to patient. Most children achieve normal or near-normal arm function without surgery, but not all children recover fully. If a baby does not recover fully, surgery may improve the baby’s strength and/or motion and help to optimize shoulder joint development.
One of the common problems with brachial plexus birth palsies can be the abnormal development of the child’s shoulder joint, which may progress over time. In addition to physical examinations, a child may require follow-up ultrasounds, magnetic resonance imaging (MRI) and/or computed tomography (CT) scans to monitor shoulder development.