Birth Injury Causes

Infant Formula Contamination

Umbilical Cord Prolapse

An umbilical cord prolapse occurs when the umbilical cord drops through the mother’s cervix during labor and delivery. When this happens, the cord is delivered before the infant’s head, which increases the risk of the cord becoming trapped or wrapped around the infant’s neck or body. Umbilical cord prolapse most often occurs during breech delivery, premature delivery, or in cases where the umbilical cord is unusually long. It can also occur when there is an excessive amount of amniotic fluid.

An umbilical cord prolapse is dangerous, and the healthcare team must act quickly to prevent birth injuries. Infant’s who experience an umbilical cord prolapse are at risk for:

• Oxygen Deprivation
• Infant Brain Damage
• Cerebral Palsy
• Cognitive Problems
• Death

Anoxia and Hypoxia at Birth

Anoxia occurs when there is a complete lack of oxygen. Hypoxia occurs when there is a partial lack of oxygen. Both of these forms of oxygen deprivation are serious and can lead to a variety of birth injuries. Anoxia and hypoxia starve the brain and vital organs of oxygen, which can lead to:

• Infant Brain Damage
• Hypoxic Ischemic Encephalopathy (HIE)
• Cerebral Palsy

Birth Asphyxia

Birth asphyxia means that an infant’s brain has experienced oxygen deprivation. Similar to anoxia and hypoxia, birth asphyxia involves oxygen deprivation, but can occur before or during labor, and after delivery. This is sometimes called neonatal asphyxia or perinatal asphyxia. Without immediate treatment, birth asphyxia can progress into anoxia, and can lead to:

• Infant Brain Damage
• Hypoxic Ischemic Encephalopathy (HIE)
• Cerebral Palsy

Birth Trauma

Birth trauma is a general term used to describe any sort of traumatic injury an infant suffers during labor and delivery. This umbrella term includes injuries like cuts, fractures or traumatic head injuries. It also includes injuries caused by a doctor or nurse improperly using medical instruments or handling the infant. Birth trauma can cause a wide assortment of birth injuries, including:

• Cerebral Palsy
• Erb’s Palsy
• Fetal Lacerations
• Facial Nerve Palsy
• Hypoxic Ischemic Encephalopathy (HIE)
• Horner’s Syndrome
• Hydrocephalus
• Infant Brain Damage
• Infant Broken Bones
• Infant Cervical Dystonia
• Infant Fractures
• Infant Seizures
• Infant Skull Fractures
• Infant Spinal Cord Damage
• Intracranial Hemorrhage
• Klumpke’s Palsy
• Neonatal Stroke
• Ocular Injuries
• Subgaleal Hemorrhage

For more details on specific types of birth trauma: (See “Forceps Delivery Injury”, “Vacuum Extraction Injury” and “Extreme Traction During Delivery”).

C-Section Injuries

A Cesarean section, or C-section, is the surgical delivery of an infant. A C-section often occurs when there are difficulties with labor or delivery, or there are complications affecting the mother or infant. Like any surgical procedure, there are some risks to having a C-section. In terms of birth injuries, a C-section can cause:

• Fetal Lacerations
• Infant Breathing Problems
• Oxygen Deprivation

Drug-Related Negligence

Drug-related negligence is a tragic and unfortunate cause of birth injuries and birth defects. Drug-related negligence involves a healthcare provider improperly or negligently prescribing, administering, or monitoring medication to pregnant women or infants. These acts of negligence can lead to:

• Brain damage
• Seizures
• Heart defects
• Cleft palate

As a form of medical negligence, drug-related negligence should never happen. Parents and their children have legal rights, and may be eligible for compensation if the child’s injury is the result of medical negligence.

Epidural Birth Injuries

An epidural is a type of anesthesia used during vaginal and C-section deliveries. During a vaginal delivery, an epidural administers pain relieving medication to the mother that helps block pain. During a C-section delivery, an epidural administers medication that causes a total loss of feeling and sensation to the lower part of the body. Epidurals allow the mother to be awake during delivery.

Administering an epidural requires training and skill. It also requires continuous maternal and fetal monitoring. Mistakes or complications can cause epidural birth injuries, such as:

• Oxygen Deprivation
• Infant Brain Damage
• Infant Stroke
• Cerebral Palsy

Failure to Diagnose

One of the primary roles of a doctor is to assess symptoms and medical history, run tests, and make a proper diagnosis. Sadly, sometimes doctors fail to diagnose medical conditions, or they diagnose a condition as something else. While mistakes can happen to anyone, failure to diagnose is often the result of doctor negligence.

A failure to diagnose a medical condition or complication of pregnancy can be extremely risky for the mother and infant. Failure to diagnose an infection, gestational diabetes, abnormal fetal presentation, or preeclampsia can all result in injuries to the infant. Such birth injuries may include:

• Oxygen Deprivation
• Nerve Damage
• Infant Stroke
• Brachial Plexus Injury
• Cerebral Palsy
• Erb’s Palsy

Doctor negligence is discussed in more detail separately. (See “Negligent Doctor” and “Negligent Hospital”).

Failure to Diagnose Gestational Diabetes

Gestational diabetes is fairly common during pregnancy. Unlike other types of diabetes, gestational diabetes develops during pregnancy and then generally resolves after delivery. In many cases, women do not have symptoms related to gestational diabetes. Doctors generally screen women during pregnancy just to make sure they do not have it. Unfortunately, sometimes doctors fail to diagnose gestational diabetes or fail to treat it properly.

When gestational diabetes is not diagnosed and treated properly, the infant’s health is put at risk. Gestational diabetes can cause fetal macrosomia, which increases the risk of birth injuries, such as:

• Brachial Plexus Injury
• Shoulder Dystocia

Infants born to mothers with uncontrolled gestational diabetes are also at risk for health problems later in life, including obesity and diabetes

Fetal Macrosomia

Fetal macrosomia is a medical condition where an infant is unusually large for their gestational age. Doctors diagnose fetal macrosomia when the infant’s birth weight is more than 8 pounds, 13 ounces. It is important that doctors monitor fetal size throughout pregnancy, and especially as the due-date approaches. Fetal macrosomia makes a vaginal birth incredibly difficult, and most often requires a C-section or early labor induction.

Fetal macrosomia puts infants at risk for certain complications or birth injuries. It also increases the likelihood that forceps or other instruments will be necessary during delivery. Birth injuries that develop as a result of fetal macrosomia include:

• Abdominal Injuries
• Brachial Plexus Injury
• Oxygen Deprivation
• Shoulder Dystocia
• Infant Broken Bones
• Infant Fractures
• Infant Skull Fractures
• Subcutaneous Fat Necrosis

Forceps Delivery Injury

Forceps is a birth-assisting tool that doctors use to help guide the infant’s head down the birth canal. This tool resembles salad tongs that cradle the infant’s head. Forceps are often used during difficult deliveries when the mother is unable to push, or the infant needs more help moving down the birth canal.

There are risks to using forceps during delivery. Primarily, the infant can suffer injury if the tool is used improperly or with too much force. This can result in a forceps delivery injury, such as:

• Abdominal Birth Injuries
• Brachial Plexus Injury
• Bruising and Petechiae
• Caput Succedaneum
• Cerebral Palsy
• Fetal Lacerations
• Facial Nerve Palsy
• Infant Skull Fractures
• Infant Spinal Cord Damage
• Ocular Injuries
• Subgaleal Hemorrhage

Infant Resuscitation Errors

The best case scenario during labor and delivery is that the newborn enters the world with little assistance and no complications. Unfortunately, sometimes newborns cannot breathe on their own right after birth. In such cases, the healthcare team may need to resuscitate the infant using CPR, airway suctioning, or positive pressure ventilation.

If a doctor or nurse makes a resuscitation error, the newborn is at risk for potentially serious or life-threatening birth injuries, such as:

• Infant Brain Damage
• Cerebral Palsy
• Autism
• Cognitive Disabilities
• Attention Deficit-Hyperactivity Disorder (ADHD)

These are just some of the possible birth injuries caused by resuscitation errors including failure to detect the need for resuscitation, using improper resuscitation techniques or failure to have a qualified healthcare provider on-hand.

Intrauterine Growth Restriction (IUGR)

Intrauterine growth restriction, or IUGR, is a medical condition where an infant doesn’t grow as much as is expected during pregnancy. Infants with IUGR generally weigh less than the 10^th percentile for normal fetal weight. This condition occurs for several reasons, including:

• Placental Insufficiency
• Preeclampsia
• Chromosomal Defects
• Maternal Infections
• Multiples (twins, triplets)
• Gestational Diabetes

IUGR increases the risk of difficulties with labor and delivery, and often requires the infant be born via C-section. Due to their small size and possible lack of development, these infants are also vulnerable to birth injuries, including:

• Jaundice
• Meconium Aspiration Syndrome
• Cerebral Palsy

Large or Small Head Circumference

If an infant’s head circumference is large or small for their age, it can be a sign of complications or brain injuries. A large head circumference is called macrocephaly, and a small head circumference is called microcephaly.

• Macrocephaly – Head circumference is more than two standard deviations above the mean average for their age and gender.
• Microcephaly –  Head circumference at least two standard deviations below the mean average for the infant’s age and gender.

Large or small head circumference can be a sign that the infant has suffered birth injuries, such as:

• Hypoxic Ischemic Encephalopathy (HIE)
• Birth Asphyxia
• Bleeding in the Brain
• Traumatic Brain Injury
• Maternal Infections
• Placental Insufficiency
• Infant Stroke

Maternal Infections

Part of an appropriate prenatal plan is assessing any pre-existing maternal infections and taking steps to reduce the risk of infections passing to the infant. Also, doctors should screen pregnant women for certain infections prior to birth in order to prevent possible transmission during delivery. Not all infections are dangerous to an unborn child, but some do have risks. Maternal infections that carry a risk of birth injuries to the infant include:

• Rubella
• Chickenpox
• Group B Strep
• Syphilis
• Toxoplasmosis
• Urinary Tract Infection
• Hepatitis B Virus
• Herpes Simplex Virus

These infections can all cause complications during labor and delivery. They also carry a risk that the infant could suffer birth injuries, such as:

• Infant Brain Damage
• Ocular Injuries
• Cerebral Palsy
• Meningitis
• Neonatal Sepsis

Meconium Aspiration Syndrome

Meconium is, essentially, an infant’s first bowel movement. It is a thick substance composed of intestinal secretions, fat, cells and proteins. Generally, the infant passes meconium in the first few days of life. Sometimes, however, the infant passes it while still in the womb. This can lead to meconium aspiration syndrome, which occurs when the infant breathes in meconium and amniotic fluid together.

Because of the consistency of meconium, breathing it in can cause oxygen deprivation. As a result, the infant can suffer from:

• Infant Brain Damage
• Hypoxic Ischemic Encephalopathy (HIE)
• Cerebral Palsy
• Infant Stroke

Possible risk factors for meconium aspiration syndrome are discussed separately. (See “Gestational Diabetes”, “Preeclampsia”, “Oligohydramnios”, “Chorioamnionitis” and “Placental Insufficiency”).

Medication Birth Defects

Doctors have a responsibility to use caution when prescribing medications during pregnancy. There are many medications that are considered safe, but doctors should always weigh the benefits with any possible risks. There are many medications linked to birth injuries and birth defects. Some examples include:

• Accutane
• Celexa
• Depakote
• Effexor
• Lexapro
• Paxil
• Provigil
• Prozac
• Topamax
• Yaz
• Zofran
• Zoloft

Taking these medications while pregnant can impact the health and development of the fetus.

Negligent Doctor and Birth Injuries

A negligent doctor can have an extreme impact on how a pregnancy, labor and delivery progress. It can lead to acts or omissions that are careless, or it can lead to intentional acts that are malicious or simply wrong. Examples of doctor negligence include:

• Failure to diagnose pregnancy, ectopic pregnancy or molar pregnancy.
• Failure to inform parents of a fetal abnormality or illness.
• A botched hysterectomy or birth control procedure.
• Failure to diagnose a complication of pregnancy.
• Failure to diagnose or treat a maternal infection.
• Failure to order a C-section in a timely manner.
• Errors in prescribing medication.
• Excessive force used during delivery.
• Improper use of birth-assisting tools.
• Improper fetal monitoring.

These are just a few examples of how a negligent doctor can cause a birth injury. A more detailed discussion of individual examples of doctor negligence is found in separate articles. (See “Forceps Delivery Injury”, “Vacuum Extraction Injury”, “Maternal Infections”, “Birth Trauma”, “Medication Birth Injuries”, “Prolonged Labor”, “Extreme Traction During Delivery”, “Resuscitation Errors”, “Failure to Diagnose” and “Misdiagnosis”).

Negligent Hospital Staff

It is not just doctors whose negligence can lead to birth injuries, negligent hospital staff can also lead to injuries. For example, if a staff member picks up a newborn by the arms without proper support of the infant’s neck, the newborn can suffer from Erb’s palsy. Infant’s can also be injured due to improper vaccinations, mistakes during tests, or improper cleaning of the hospital.

(See “Negligent Doctor”, “Negligent Nurse”, “Hospital-Acquired Infections” and “Erb’s Palsy”).

Oxygen Deprivation at Birth

Oxygen deprivation is a broad term used to describe any type of oxygen deprivation at birth. This may include anoxia, hypoxia and birth asphyxia. A lack of oxygen can occur for a variety of reasons, such as:

• Preeclampsia
• Birth Trauma
• Placental Insufficiency
• Umbilical Cord Prolapse
• Shoulder Dystocia
• Medications

Any type of reduced or obstructed oxygen is dangerous and creates a risk for birth injuries, including:

• Infant Brain Damage
• Hypoxic Ischemic Encephalopathy (HIE)
• Cerebral Palsy
• IUGR
• Subcutaneous Fat Necrosis
• Folic Acid Deficiency Anemia
• Infant Cervical Dystonia
• Seizures
• Neonatal Stroke

To learn more about individual types of oxygen deprivation, see: (“Anoxia and Hypoxia” and “Birth Asphyxia”).

Perinatal Hypoxia

Perinatal refers to the period immediately before and after an infant is born. Perinatal hypoxia refers to a lack of oxygen during the perinatal period. This can happen if there are complications, such as the mother being anemic, umbilical cord collapse or compression, or the infant suffering a traumatic brain injury during the perinatal period. Perinatal hypoxia can further lead to birth injuries, such as:

• Cerebral Palsy
• Seizures
• Cognitive Disabilities
• Behavioral Disorders

More information about hypoxia is discussed separately. (See “Anoxia and Hypoxia”).

Placental Abruption

Placental abruption is a rare but serious complication of pregnancy. It occurs when the placenta separates from the inner wall of the uterus. This can interrupt the flow of blood, oxygen and nutrients from the placenta to the infant. It can also cause extreme bleeding in the mother. Because it happens quickly and with little warning, it is important that women who suspect placental abruption get medical attention immediately. The interruption of blood flow and oxygen to the infant can cause:

• Infant Brain Damage
• Hypoxic Ischemic Encephalopathy (HIE)
• Cerebral Palsy
• Preterm Birth
• Stillbirth

Placental Insufficiency

Placental insufficiency is a serious complication that can be dangerous to mother and infant. The disorder occurs when there is inadequate blood flow to the placenta during pregnancy. This restricts oxygen and nutrients from the infant, which can impact development and lead to a host of medical conditions, such as:

• Oxygen Deprivation
• Infant Brain Damage
• Cerebral Palsy
• Hypothermia
• IUGR
• Infections
• Premature Birth

More information about the risk factors for placental insufficiency are discussed separately. (See “Preeclampsia”, “Placental Abruption”, “Maternal Infections” and “Post-Term Birth Injuries”).

Placenta Previa

Placenta previa is a rare but serious complication affecting the placenta. It occurs when the placenta moves to the bottom of the womb and covers the cervix. Some cases of placenta previa are treated through bed rest and steroid injections, but if the mother is bleeding, an emergency C-section may be required. If placenta previa is not diagnosed and treated quickly, the infant can suffer from birth injuries, such as:

• Infant Brain Damage
• Cerebral Palsy
• Premature Birth
• Death

Post-term Pregnancy Causes and Risks

A pregnancy that lasts 40 weeks is considered full-term. If the pregnancy lasts longer than 42 weeks it is considered post-term. Post-term pregnancies are considered high risk and are linked to a variety of complications that are risky to mother and infant. The most dangerous risks associated with post-term pregnancy are:

• Fetal Macrosomia
• Placental Insufficiency
• Meconium Aspiration Syndrome

These conditions can all further lead to serious birth injuries. (See “Cerebral Palsy”, “Brain Ischemia”, “Infant Brain Damage”, “Brachial Plexus Injury”, “Hypoxic Ischemic Encephalopathy”, “Horner’s Syndrome”, “Infant Broken Bones”, “Infant Fractures”, “Seizures”, “Subcutaneous Fat Necrosis” and “Shoulder Dystocia”).

Preeclampsia

Preeclampsia is one of the most common complications of pregnancy. This condition occurs when the mother’s blood pressure rises and causes the body to start shutting down. Both mother and infant are at risk for complications and injuries if preeclampsia is not diagnosed and treated immediately. Without immediate care, preeclampsia can cause:

• Eclampsia (high blood pressure accompanied by seizures)
• HELLP syndrome (elevated liver enzymes)
• Placental Abruption
• Placental Insufficiency

The only cure for preeclampsia is delivering the infant. Unfortunately, that often means an emergency C-section and preterm birth. This can further increase the risk of birth injuries. Infants born to mothers with preeclampsia are at a higher risk of:

• Oxygen Deprivation
• Hypoxic Ischemic Encephalopathy (HIE)
• Infant Brain Damage
• Cerebral Palsy

Premature Cord Clamping

After an infant is born, the doctor clamps the umbilical cord, generally within 30 seconds. But some doctors clamp the cord much sooner, just seconds after birth. Some research shows that premature cord clamping can be dangerous for the infant because it cuts off vital nutrients from the placenta. When there is low blood flow to the placenta, the infant may be at risk for iron deficiency and blood loss.

Blood loss can further result in oxygen deprivation, which can lead to the following birth injuries:

• Infant Brain Damage
• Cerebral Palsy
• Respiratory Distress
• Bleeding in the Brain

Preterm Labor and Birth

A pregnancy generally lasts around 40 weeks. Those that last 37-40 weeks are considered full-term. When the infant is born prior to 37 weeks, it is considered a preterm birth. Preterm labor and birth happen for many reasons, often because of a complication or medical condition that needs to be addressed immediately, such as preeclampsia. When a mother goes into labor early, sometimes doctors can stop labor in an effort to give the infant every benefit of developing in the womb.

If it is safer to deliver the infant prematurely, then most often, a C-section will be scheduled or ordered, depending on the circumstances. There are some possible risks with preterm labor and birth. Preterm infants are vulnerable to:

• Lung Problems
• Developmental Delays
• Cerebral Palsy
• Ocular Injuries
• Hearing Loss
• Jaundice
• Anemia
• Intraventricular Hemorrhage

For more information about how preeclampsia can lead to preterm labor and birth: (See “Preeclampsia”).

Umbilical Cord Compression

Umbilical cord compression occurs when the umbilical cord is flattened due to pressure. A flattened umbilical cord can restrict the flow of blood, oxygen and nutrients to the infant. This can result in serious injuries, including:

• Necessary C-Section
• Infant Brain Damage
• Death

Umbilical cord compression may be caused by other umbilical cord problems. (See “Nuchal Cord”, “Umbilical Cord Prolapse” and “Umbilical Cord Knots”).

Vacuum Extraction Injury

A vacuum extraction tool is used to assist with difficult deliveries. The tool has a soft cup that is applied to the top and back of the infant’s head. The doctor then uses suction to help pull the infant through the birth canal. There are risks to using vacuum extraction, especially if the infant is large or if the infant is abnormally positioned. If the vacuum is used unnecessarily or is misused, it can result in vacuum extraction injuries including:

• Brachial Plexus Injury
• Infant Skull Fractures
• Shoulder Dystocia
• Erb’s Palsy
• Klumpke’s Palsy
• Bleeding in the Brain
• Cerebral Palsy

Wrongful Pregnancy

Couples who decide they don’t want to have children, or who have completed their family, have options for sterilization that should mean they never get pregnant again. Unfortunately, as sterilization options increase, so do medical mistakes related to these procedures. If a doctor or surgeon botches the sterilization procedure and the couple becomes pregnant, the couple may be able to sue the doctor for wrongful pregnancy.