A birth injury is harm that happens to a baby around the time of labor or delivery. Unlike birth defects, which develop during pregnancy as organs and structures form, birth injuries involve damage caused by physical trauma or oxygen loss during the birthing process itself. Roughly 6 to 7 out of every 1,000 babies born in the United States experience some form of birth injury, which translates to about 30,000 affected newborns each year.
Birth Injury vs. Birth Defect
These two terms are easy to confuse, but they differ in both timing and cause. A birth defect begins during pregnancy, when a baby’s heart, brain, spine, or other organs develop differently in the womb. Some birth defects stem from genetic abnormalities, others from maternal illness, infections, or environmental exposures, and many have no identifiable cause at all.
A birth injury, by contrast, involves damage rather than abnormal formation. It typically occurs during labor or delivery, when complications arise that put physical stress on the baby. That stress might come from a prolonged or difficult labor, the baby’s position in the birth canal, the use of delivery instruments like forceps or vacuum extractors, or a failure to respond quickly to signs of fetal distress.
The Most Common Types
Birth injuries range widely in severity. Many are minor and heal on their own within days or weeks. Others can have lasting effects. The Cleveland Clinic groups them into several broad categories: scalp injuries, bone fractures, eye injuries, bleeding inside the skull, nerve damage, and brain injuries.
The most frequently seen birth injuries include:
- Broken collarbone: The most common bone fracture during delivery, especially when there is difficulty delivering the shoulders.
- Scalp swelling or bruising: Soft tissue swelling on the top of the head or blood pooling beneath the scalp. These usually look alarming but resolve without treatment.
- Brachial plexus injuries: Stretching or tearing of the nerves that run from the neck into the arm, causing weakness or paralysis in the affected limb. The most well-known form is Erb’s palsy, which affects 1 to 2 out of every 1,000 births.
- Facial nerve paralysis: Pressure on the facial nerve during delivery can cause one side of the face to droop or not move normally.
- Brain bleeds: Bleeding inside the skull from ruptured blood vessels, which varies in severity depending on location and volume.
Less common but more serious injuries include brain damage from oxygen deprivation, spinal cord injuries, and internal organ damage such as bleeding in the liver or spleen.
How Oxygen Deprivation Causes Brain Injury
The most devastating birth injuries involve the brain losing its oxygen supply, a condition doctors call hypoxic-ischemic encephalopathy, or HIE. It affects roughly 1.5 to 1.7 out of every 1,000 live births in developed countries.
When blood flow or oxygen to the brain drops during labor, brain cells begin to fail. Without oxygen, cells can’t produce energy, fluid builds up inside them, and they start to die. The extent of the damage depends on how long the deprivation lasts and how severe it is, though pinpointing the exact moment of injury is often difficult even for specialists.
HIE can result from a compressed umbilical cord, placental problems, uterine rupture, or prolonged labor where the baby’s distress goes unrecognized. If identified quickly, a treatment called cooling therapy can reduce the damage. The baby’s body temperature is lowered to about 33.5°C (roughly 92°F) within six hours of birth and held there for 72 hours. This slows the cascade of cell death and improves the chances of a normal neurological outcome.
What Increases the Risk
Certain conditions make birth injuries more likely. A baby’s size is one of the biggest factors. When a newborn weighs more than about 8 pounds, 13 ounces, a complication called shoulder dystocia, where the baby’s shoulder gets stuck behind the mother’s pelvic bone, becomes much more common. It occurs in less than 1.4% of average-weight deliveries, but that rate jumps to 5% to 9% for larger babies.
Diabetes during pregnancy, whether pre-existing or gestational, plays a role because it increases the likelihood of a larger baby. About 20% of people with diabetes deliver babies above that 8-pound, 13-ounce threshold. Other maternal risk factors include being over 35, having a short stature, carrying twins or multiples, giving birth past the due date, and having experienced shoulder dystocia in a previous delivery.
Labor and delivery factors matter too. Assisted vaginal delivery using forceps or a vacuum extractor is one of the strongest risk factors. A very long first stage of labor, a very short or very long pushing phase, and the use of labor-inducing medications can all contribute. When a baby needs to be delivered quickly under these conditions, the physical forces involved increase the chance of nerve stretching, fractures, or bruising.
How Birth Injuries Are Detected
Some injuries are visible immediately. Doctors assess every newborn’s color, posture, muscle tone, activity level, and cry before even touching the baby. Arms and legs should appear symmetrical and move with normal tone. Newborns are also tested for basic reflexes, including sucking, grasping, and the startle reflex, where the baby throws its arms out in response to a sudden change in position. Absent or asymmetric reflexes can signal nerve damage.
The Apgar score, assigned at one and five minutes after birth, gives a quick snapshot of a baby’s overall condition. A five-minute score of 7 to 10 is considered reassuring. A score of 4 to 6 is moderately abnormal, and a score of 0 to 3 is low and may be one of the first signs of brain injury. A score that remains at zero beyond 10 minutes is associated with very poor neurological outcomes. These scores are screening tools rather than diagnoses, but they help medical teams decide how aggressively to intervene in those first critical minutes.
Nerve Injuries and Recovery
Brachial plexus injuries happen when the network of nerves running from the neck to the arm gets stretched during a difficult delivery. This commonly occurs when there is shoulder dystocia and the baby’s head has delivered but the shoulder is stuck behind the pelvis. If force is applied to free the baby, the nerves on the stretched side of the neck can be damaged.
The good news is that most infants with brachial plexus injuries recover both movement and feeling in the affected arm. Nerves grow and heal slowly, though, and a full recovery can take up to two years. During that time, physical therapy helps maintain range of motion and encourage nerve regrowth. In severe cases where the nerve is torn rather than stretched, surgery may be needed to repair or graft the damaged nerve.
Long-Term Effects of Severe Injuries
Most birth injuries, particularly fractures and mild nerve injuries, heal completely. But injuries involving the brain can have lasting consequences. Cerebral palsy is the most common severe long-term outcome, affecting roughly 2.9 to 3.6 out of every 1,000 live births in the United States. It is a group of disorders that affect movement, balance, and posture, and it is the most common motor disability in childhood.
Cerebral palsy and other developmental disabilities resulting from birth-related brain injuries typically begin to show signs during the first year or two of life as a child misses expected milestones for sitting, crawling, or walking. These conditions usually last throughout a person’s lifetime, though early intervention with physical therapy, occupational therapy, and other support can significantly improve function and quality of life. The severity varies enormously, from mild coordination difficulties to profound physical and cognitive challenges, depending on how much of the brain was affected and how quickly treatment began.
Male infants experience birth injuries at a higher rate than female infants, at 6.9 per 1,000 births compared to 5.1, likely because male newborns tend to be larger on average.