Having a child can be one of the most joyful moments of anybody’s life. There can be few more proud and happy moments for a parent than the moment that they hold a child in their arms – the bundle of joy which represents the continuation of their lineage. The moment has been immortalised and romanticised in popular songs, television programs and films. Many young men and women dream of the day that they will become mother and father to children of their own.
However, the rose-tinted haze that is caused by popular media representations of birthing on the television and big screen is not always the norm. Indeed, the illusion that birth will be a smooth, manageable and risk-free process can actually be very damaging, particularly for those mothers who do suffer complications during pregnancy – whom, it must be noted, are far greater in number than many might think.
Indeed, in actuality 40% of pregnancies result in birth injuries or complications, a little known yet telling statistic about the reality of giving birth. Think about what this means – for nearly half of mothers, giving birth doesn’t turn out as planned. Understandably, birth injuries and defects can cause a number of adverse emotional effects. The intense connection a mother develops to her baby in the womb can make the possibility of her child facing harm – or even losing her child altogether – utterly devastating. Sadly, even the most extreme of birth injury cases, a stillbirth, is not uncommon. A 2013 survey from the National Audit Office highlighted one in 133 babies in the UK was a stillborn, or died within mere days of birth.
At the beginning of the 20th century, for every 1000 live births, six to nine women in the United Kingdom died of pregnancy-related complications, and approximately 100 infants before they reached even one year old. From 1915 through 1997, the infant mortality rate declined greater than 90% to 7.2 per 1000 live births, and in the same time period the maternal mortality rate also declined almost 99% to less than 0.1 average reported deaths per 1000 live births. Improvements in standards of living, nutrition, clinical medicine and health care in nutrition all contributed to this incredible decline, making pregnancy a far safer procedure than it had ever been up to that point in human history. While we have much to be thankful for, medical advancements are still unable to solve all the potential problems in delivery. We must all acknowledge that birth injuries can still occur and really aren’t all that abnormal when they do. This is especially so considering how comparatively risky pregnancy was just a century ago. Nonetheless, this doesn’t change the fact that birth injuries can shatter women’s lives, as they face the realisation that their baby either won’t receive its chance at life or will be permanently disabled.
At Asons, we frequently hear the concerns of these women, commonly in the form of questions. ‘How often does this happen? Is this normal? Am I to blame?’ Feelings of isolation, depression, and even guilt are normal for women without the appropriate resources available to them to help them understand and cope with what happened during their pregnancy. The following guide has been written to address a subject which doesn’t get discussed enough. It definitively details the many types of birth injuries and the frequency of their occurrence, and providing information on support and guidance available for mothers suffering from these complications.
As mentioned, before actually giving birth themselves, all most women have to go on are the experiences and stories of other mothers, perhaps a guide or two on the Internet, and, most prevalently, film representations of the process. This can often mean that when they imagine their pregnancy, they see in their mind’s eye the spectacle of holding a happy, healthy baby in their arms afterwards. While of course this would be desirable, all too often real-life births don’t turn out quite so Hollywood. With more than 140 million babies born worldwide each year – just under five babies every second – the reality is that it would be wishful thinking to assume that all cases will progress as smoothly as on the silver screen.
During the birth process, a baby may suffer physical injury simply as a result of being born. These cases are known as instances of ‘birth trauma’ or ‘birth injury’. Birth injuries range from mild to severe – ranging from minor bruising to nerve or brain damage. Although most birth injuries are not life-threatening and will usually heal on their own, others can cause lifelong consequences for the baby – and others still may even be fatal. Perhaps the most well-known example of a birth injury is cerebral palsy; the most common lifelong birth injury. This guide will detail this and also other, rarer cases, such as injury caused by misuse of forceps.
It is the responsibility of our midwives and doctors to be aware of the risks of birth and conduct pre-natal checks to ensure births are progressing as they should be. However, because our NHS is both overworked and underfunded (and indeed, because medical practitioners are only human) it is a good idea for mothers to become aware of some of the most common types of birth injuries. This will allow them to read into their own symptoms, just in case something may be wrong. After all, no-one experiences their own individual case of giving birth but the mother herself.
Many birth injury cases are blameless, resulting from difficulties encountered due to the placement of the child during delivery, or the baby’s size causing problems. Patterns have emerged specific to the recorded instances of birth injuries. Listed below are some of the risk factors identified:
Large Babies – As mentioned, a baby’s size can determine whether or not a successful birth is possible. Generally speaking, babies weighing more than 4kg (8 lbs 13oz) are associated with more difficult births, which can result in birth injury. The current average birth weight is 7lb 8oz for boys and 7lb 4oz for girls.
Prematurity – When a baby is born before 37 weeks of pregnancy, the likelihood of birth injury increases due to their generally more fragile bodies, which can injure more easily. There is also a chance that certain faculties haven’t developed properly at the time of birth – for example, underdeveloped lungs are not uncommon.
Cephalopelvic disproportion – Occurring in an estimated 1 in 250 pregnancies, cephalopelvic disproportion (CPD) is the term used to describe a condition where the size and shape of the mother’s pelvis is not adequate for the baby to be born vaginally. This may be due to a small pelvis, a nongynecoid pelvic formation, a large foetus, an unfavorable orientation of the foetus, or a combination of these factors. CPD is usually diagnosed once labour begins, and can rarely be spotted before then.
Abnormal birthing presentation – Occurring in 4 out of 100 births, abnormal birthing presentation describes cases where the baby is in any position other than a head-down position upon delivery. Abnormal presentations are described by naming the part of the baby that is lowest in the womb, just above the birth canal. Abnormal births may be breech presentations (where the buttocks or feet emerge first), transverse lie or shoulder presentation (when the baby lies sideways rather than up or down and the shoulder is above the birth canal), brow presentation (the baby is head-down and the chin is not tucked in on the chest), or face presentation (with the face coming down the birth canal first). Each of these cases requires special management during delivery.
Dystocia – Dystocia describes an abnormal, slow, or difficult childbirth, which may usually be attributable to disordered or ineffective contractions of the uterus. Approximately 2 in every 100 births in the UK are cases of dystocia. There are two types of dystocia – cervical and shoulder. Cervical dystocia occurs when the woman’s cervix does not dilate during labour, which can be due to a pregnant woman’s previous cone biopsy, cauterisation for cervical dysplasia, or trauma. Shoulder dystocia occurs when the infant’s head is delivered but the shoulders cannot follow, becoming stuck in the pelvic brim. The chances of shoulder dystocia vastly increase if the mother’s pelvis is small or if the baby is particularly heavy or presents abnormally. When the shoulders become stuck at this position, it is imperative that the infant is delivered quickly, as although they can inhale, their chest cannot expand as it is stuck in the pelvic brim. This may rapidly result in hypoxia and death of the baby if not delivered quickly.
Foetal Distress (Hypoxia) – Also known as perinatal asphyxia, foetal distress occurs when an unborn foetus is deprived of oxygen. Often a result of umbilical cord complications, an abnormal heart rate indicates the onset of hypoxia, and should be carefully monitored. If hypoxia is confirmed, immediate steps which may be taken to prevent birth injury include providing more oxygen to the mother, turning her onto her side, or quickly delivering the child before complications can develop, using either forceps or Caesarean section. As mentioned, dystocia is a common cause of hypoxia.
First-time pregnancy – Occasionally, a woman’s body is just not ready for the foreign strains and stresses of carrying a child the first time, and birth injuries may occur as a result.
Needless to say, medical practitioners and midwifes responsible for overseeing birthing should be aware of these risk factors and take the utmost precaution when handling cases where one or more of them are present. This is necessary because some cases of birth injury may be directly attributed to medical negligence – a midwife, for example, failing to spot the signs of birth injury, or taking improper measures during the birth itself. This will be discussed in greater detail later.
The following is a list of the most common types of birth injuries which may prove permanent:
Cerebral Palsy – Perhaps the most well-known condition resulting from birth injury, cerebral palsy is actually an umbrella term denoting a number of different kinds of brain injuries which may occur before, during, or shortly after birth. A variety of symptoms are associated with CP, including speech, learning, and movement difficulties, which will normally begin to present during the first three years of a child’s life. It is around this stage where a diagnosis of a particular CP type is made dependent on the exact nature of symptoms – for more information on the many individual types of cerebral palsy, http://cerebralpalsy.org/about-cerebral-palsy/types/ is a useful resource. Whilst there is no known cure for cerebral palsy, there are numerous palliative treatments available to manage an individual’s independence as much as possible, including physiotherapy, occupational therapy, and medication to relieve muscle spasms and general numbness. Specialist equipment may be required depending on the extent of the brain damage – while some individuals may be able to move without assistance, others will be wheelchair bound and may need a device to help them communicate. Cerebral palsy is thought to afflict 1 out of every 400 children in the UK.
Erb’s Palsy – Erb’s palsy results from a traumatic injury whereby the baby’s shoulder becomes stuck behind the mother’s pubic bone during birth, which may cause severe nerve damage in the neck and arm. This damages the brachial plexus (the group of nerves which supplies the arms and hands). Most commonly found in cases where difficulty is experienced in delivering the baby’s shoulder (shoulder dystocia), other symptoms include lack of muscle control and loss of feeling or strength in the arm, hand or wrist, the arm hanging down at the side of the body, and occasionally also intense pain spanning from the neck down to the arm. Sometimes individuals may be fortunate and make a full recovery of sensation and movement. Although movement should return within a few months as bruising and swelling around nerves desists, severe cases where the nerve has been torn may result in permanent nerve damage. In the worst instance, permanent paralysis may be sustained. Common treatments for Erb’s Palsy include occupational therapy and physiotherapy, which varies in effectiveness.
Kernicterus (Severe Jaundice) – Kernicterus is a form of brain damage caused by excessive jaundice. Jaundice results when a liver-produced substance known as bilirubin is so high that it can move from the blood into brain tissue, damaging the cell tissue. Symptoms of kernicterus include difficulty staying awake and alert, a high-pitched cry, lack of muscle tone, fever, and arching of the head and back. When the first symptoms appear it is an emergency situation, requiring a doctor’s treatment immediately and without interruption to prevent brain damage. If treatment is not swiftly and correctly administered, the baby may be left with complications such as hearing loss, learning/developmental difficulties, and involuntary twitching, and, in some cases, cerebral palsy.
Congenital Hip Dysplasia – Although hip dysplasia may develop in adulthood, the risk of the condition is greatest in the first few months of life, particularly during the birthing process. Congenital hip dysplasia, also known as DDH (development dysplasia of the hip) is an abnormality where the hip joint has developed in such a way that the thigh bone is unstable in the hip socket. The bones of an infant’s hip joint are often far softer than an adult’s, meaning misalignment is far more common. The ligaments within the hip joint generally become stretched and loose with varying severity dependent on the individual case. In the worst case, the thigh bone can become completely displaced from the hip socket as the baby develops. Despite the similarity of the two words, ‘congenital’ does not necessarily refer to a genetic disorder. Congenital conditions (also known as neonatal diseases) are defined as those existing at birth and often before birth, or that develop during the first months of life, regardless of how they are caused. The exact causes of congenital hip dysplasia are unknown, but one proposed risk factor is a breech delivery, which increases pressure on a baby’s hips in the womb. There is also some small genetic influence – if a family member already has DDH there is a 1 in 10 chance that a newborn infant will have some hip instability.
Brain Injuries Caused by Forceps/Vacuum Extractors – The risk of brain damage is greater for babies who experience difficult deliveries involving usage of delivery tools. Forceps, the tool to grip a baby’s head during delivery, may be gripped too tightly for the infant’s relatively soft skull or twist the baby’s head in the wrong direction. Other medical errors may be using the device at the wrong side of the baby’s head or at the wrong stage of labour. Misuse of forceps has been known to cause severe brain damage, bruising, indentations, blood loss, or cephalohematoma. Similarly, the use of vacuum extractors is not without risk either – the equipment has been known to cause lacerations, blood clots, surface bruising, bruising under the scalp or skull, or severe swelling of the scalp. In some cases, this may cause permanent damage. Roughly one in 664 babies delivered using medical forceps suffers a brain injury, as do one in 860 infants delivered using vacuum extraction, making brain injury in these instances almost twice as likely as a regular birth.
Spinal Cord Injuries – In some rare cases, particularly awkward births may cause damage to the nerves in the spinal cavity, which can enact a myriad of effects. When spinal cord injuries occur, it is usually as a result of either traction on the infant’s trunk during breech delivery, rotational stresses applied to the spinal axis, traction on the cord via the brachial plexus in shoulder dystocia, or hyperextension of the foetal head in breech delivery or transverse presentation. Regardless of the age they are sustained, spinal cord injuries may cause difficulties with movement, cognition, and feeling throughout the individual’s life. Because infants generally have more fragile skeletons than adults, spinal cord injuries resulting from birth are usually quite serious, often requiring costly lifelong treatment to manage, such as a wheelchair if the infant is paralysed. This treatment is mainly supportive, although a few affected children learn to live with their disability, and a tiny minority recover surprisingly well.
There are many more common conditions which may result after birth which may not cause permanent damage. In most cases, this means a recovery can be made. However, due care must still be taken in treatment to ensure further harm cannot be caused. Some of these include:
Clavicle Fractures – As the most frequently encountered birth injury by some distance, clavicle fractures may be detected by noticeable pain experienced by the baby at the site of the fracture. The bone should heal quickly in young babies, but to ensure a speedy recovery, doctors should strap the arm to the chest.
Femur Fractures – Femur fractures (broken thigh bone) occur as the leg is awkwardly twisted during delivery. A femur fracture is a rare injury, occurring far less frequently than clavicle fractures, as most birthing positions will not put particular pressure on the baby’s thigh joint. Symptoms are again noticeable pain, usually when the child is moved. The recommended treatment of a femur fracture in a newborn is to use a worn device called a Pavlik harness, which is worn for about four weeks and keeps the hip joint secure and aligned.
The list above, however, is by no means exhaustive. If a baby is born with complications resulting from a difficult pregnancy, the likelihood is that he or she has sustained a birth injury during labour. Thankfully, most cases of birth injuries see the child making a full recovery over time.
If you feel your birth injury case could have been handled better by the medical professionals involved, it is worth consulting with an experienced medical negligence solicitors. The compensation secured from a successful birth injury claim can help raise children born with difficulty due to birth injury by providing recompense. Although sadly nothing can bring a stillborn child back or heal a child’s brain damage, families often welcome at least the small sense of closure a lawsuit can bring.
If you feel like you were mistreated by the professionals responsible for your care, you are certainly not alone. We work with many women who feel they have been let down by their midwife or doctor in their case of delivery. However, you should also bear in mind that medical negligence is (mercifully) very rare, and in the majority of cases, medical professionals work to the utmost of their ability to ensure the safety of both mother and baby. For example, whilst Cerebral Palsy may result from medical malpractice, it may also be genetic, caused by problems early in pregnancy, or caused as a result of prematurity. To determine whether a negligence claim is possible often requires thorough evaluation of the prenatal records, labour and delivery records, foetal monitor strips, newborn records, and records from treating doctors. An experienced solicitor will be able to advise on the process involved.
Coping in the aftermath of a birth injury can be incredibly difficult for the parents of a child who may either have been prematurely snatched away from them or must instead grow up with developmental disadvantages. Negative psychological symptoms are common, which may range from mild difficulties focusing at everyday tasks to Post Traumatic Stress Disorder (PTSD).
The feelings of grief and loss upon birthing a stillborn can be particularly devastating, and especially so for the mother, who may often become emotionally attached to her child whilst carrying in the womb. Similarly, when babies are born with birth-related diseases, parents may also experience intense stress and worry about how their infant’s condition will be managed. The burden of how best to raise a disabled child in a world lacking empathy for such conditions may cause intense pressure. It is difficult to prepare for the unexpected, and many parents feel out of their depth on discovering they must raise a child who will have lifelong special needs.
The most commonly diagnosed psychological condition which may result from birth injury is PTSD. Although once assumed only to affect war veterans and victims of grievous bodily harm, PTSD following birth injury has been gaining media attention. A 2009 Childbirth Connection survey entitled ‘New Mothers Speak Out: Women’s Postpartum Experiences’ determined that up to 9% of women who have given birth meet all the criteria for PTSD. However, as with many serious mental conditions, it is likely that this number is in fact much higher due to cases that have just gone unreported because of fear, shame, and guilt.
Symptoms of PTSD may include a mental re-experiencing of the traumatic event which may manifest intrusively as upsetting memories, flashbacks or nightmares. These feelings may prompt intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating). Sufferers may need to avoid activities, places, thoughts, or feelings which remind them of the trauma. Everyday activities are negatively affected by the distractions, and individuals may even feel a loss of interest in activities and life in general alongside feelings of being detached from others and emotionally numb. PTSD is often accompanied by insomnia, which may be linked to a general anxiety and hypervigilance. Mothers may even wrongly blame themselves for what happened to their child, which can be devastating to their self-esteem.
The Birth Trauma Association (BTA) was established in 2004 to be a sympathetic and understanding provider of support to women suffering from post-natal Post Traumatic Stress Disorder (PTSD), a common condition encountered after birth injury, and other negative psychological conditions. It commented: “If you are suffering from birth trauma, you are not alone. It’s estimated that around one in ten women will experience some symptoms of post-natal post-traumatic stress disorder (PN-PTSD). The Birth Trauma Association works to support those women, and their families through providing peer support via email and social media. We also ensure that birth trauma is on the agenda at the highest levels of government and the NHS, and we work towards a better understanding and awareness of the condition among medical professionals.
Birth trauma does not stop at the hospital door. It leaves scars that refuse to heal. It can affect the relationship between the mother and her child, her relationship with her partner, and how she sees herself – and it can last for years. Yet there’s still a deep stigma in admitting that your birth was less than perfect, and that what was touted as the most fulfilling experience of your life has gone so horribly wrong. All too often, women are told that they will ‘forget’ the pain, that they should be grateful they survived, and that they are making a fuss about nothing. The BTA is here to assure those women that they have every right to be angry, to say that they need help, and to seek it. Please get in touch with us via our Facebook page, our website or our Twitter feed.”
Similarly, the PANDAs foundation, an abbreviation for Pre and Postnatal Depression Advice and Support, can also provide guidance to mothers struggling to cope with the loss or disability of their baby, or their child.
CerebralPalsy.org is a comprehensive resource established to provide parents a compassionate voice of guidance for all things related to caring for a child with cerebral palsy, and other neurological conditions.
ErbsPalsyGroup is the only UK based organisation offering advice, information and support to families affected by Erb’s Palsy.
STEPS charity is a national charity offering help and support to children and adults affected by a lower limb condition such as congenital hip dysplasia.
In addition to the support groups listed above, there are also a number of excellent bloggers who have candidly opened up about their experiences pertaining to birth injury, which may offer community support to sufferers and relief in understanding that they are truly not alone. Blogs often prove an invaluable way to get beyond the numbers and statistics on occurrence and actually grasp the significance of birthing injuries – and, for that matter, just what can be achieved in spite of them, by mother and child alike.
Robyn Broyles, author of My Angel Has Cerebral Palsy, is one such blogger. She commented:
“When it was first suspected that my son Phoenix had cerebral palsy, I spent many sleepless nights scouring the internet looking a miracle cure. Now, seven years later, I realize that he is the miracle. I have vigilantly insisted that he participate in life and as a result, he does not see himself as different in any way. Special, unique and popular, yes. Disabled, definitely not. Blessed with a determined spirit, he exudes joy and happiness and inspires everyone he comes in contact with. Recently, he started taking singing lessons and has aspirations to be a rock star. In my mind, he already is.”
There is little doubt that birth injuries enact significant consequences on mother and child. However, with the right support and the understanding that the incident is often blameless, lives may be rebuilt. It is hoped that this guide has helped to demonstrate not only that these injuries are far more common than might have been presumed, but also that raising a child with a birth defect is not only possible, but immensely rewarding.