birth trauma
Forceps Combined with Rotation Causes Serious Complications
- High cervical spinal cord injury in
neonates resulted as a serious complication of forceps
rotations of 90 degrees or more. The common feature in
all cases was a forceps cephalic delivery, almost always
a rotation of 90 degrees or more from the occipitoposterior
or occipitotransverse position. High cervical spinal
cord injury in neonates is a specific complication of
forceps rotation. High cervical spinal cord injury in
neonates delivered with forceps: report of 15 cases Menticoglou
SM, Perlman M, Manning FA. Obstet
Gynecol. 1995 (Oct); 86 (4 ~ Pt 1): 589-594
Forceps Causing Multiple Traumas and Even Death
- The neonatal mortality rate attributable to use of the forceps was 34.9 per 1000. The incidences of delayed onset of respiration (17.4%), birth trauma (15.1%), and abnormal neurological behaviour--namely, apathy or irritability or both--(23.3%) significantly exceeded those in a matched group of babies born spontaneously. Fetal asphyxia played a major part in the aetiology of neonatal complications.
- Babies on whom Kielland's forceps were used, however, had a significantly greater incidence of abnormal neurological behaviour even in the absence of fetal asphyxia (14.3%), and in all of these babies the abnormal behaviour was transient and did not necessitate admission to the special-care baby unit
- The results suggest
the neonatal complications are caused by the forceps and
not related to the process of birth itself. Kielland's
forceps: association with neonatal morbidity and mortality Chiswick
ML, James DK.
Br Med J 1979 Jan 6;1(6155):7-9
Forceps Related to Facial Paralysis
- This study published in "Plastic Reconstructive
Surgery" retrospectively identifies and characterizes
patients with facial palsy related to birth trauma and
describes the natural history of this disorder. This
retrospective study revealed that 91% of all children
who had suffesed with facial paralysis were delivered
with forceps. The incidence of additional birth injuries
also was substantially higher among affected subjects
than among the general population of newborns. Facial nerve palsy in the newborn: incidence and outcome Falco
NA, Eriksson E.
Plast Reconstr Surg 1990 Jan;85(1):1-4
Fetal Skull Fractures from Vacuum Extraction Devices
- The vacuum extractor is being increasingly
advocated as the instrument of first choice for assisted
vaginal delivery. It is widely believed that the vacuum
cup will dislodge before causing serious fetal trauma.
The vacuum extractor exerts considerable traction force.
Fetal skull fracture can result, and its true incidence
may be higher than expected, considering that few neonates
with normal neurologic behavior undergo skull x-ray.
Skull fracture caused by vacuum extraction Hickey K, McKenna P. Obstet Gynecol 1996 Oct;88(4 Pt 2):671-6
- In only 134 vacuum extraction-assisted
deliveries there were 28 infants with scalp trauma, including
17 superficial lacerations, six large caputs, and 12
cephalohematomata; one infant had subgaleal, subdural,
and subarachnoid hemorrhages. The proportion of injuries
was greater for applications exceeding 10 minutes (6
of 9) than for those 10 minutes or shorter (22 of 121,
P < .01). Cosmetic scalp trauma occurred in 21% of
our newborns delivered by vacuum extraction and was more
common after longer vacuum applications, longer second
stages, and paramedian cup placement.
Vacuum extraction: does duration predict scalp injury? Teng FY, Sayre JW. Obstet Gynecol 1997 Feb;89(2):281-5
Vacuum Extraction Increases Neurological Deficits in Children.
- A case of growing skull fracture following birth trauma
and caused by vacuum extraction is reported in order to
emphasize the incidence of this peculiar head injury at
the beginning of extrauterine life and to point out its
relation to possible neuropsychological disturbances that
may appear later in childhood. Delivery by vacuum extraction
increases the incidence of perinatal injuries and consequently
the incidence of neurological deficits in children. Neurosurgical
repair is advocated as the appropriate treatment, with
the aim not only of cosmetically correcting the lesion's
typical subgaleal protuberance with cranioplasty, but also
of performing a water-tight closure of the dura, enabling
the cerebral cortex to "fill in" the intracerebral lesion.
The surgical technique and gross pathology of the lesion
are described together with radiological findings before
and after surgery. Reports by other authors are reviewed
in an attempt to identify the conditioning factors and
pathological features of this traumatic injury to skull
and brain in neonates and infants. The literature on cranial
fractures associated with intracerebral lesions at this
age shows a significant difference in recovery and outcome
from that after similar lesions in older children.
Craniocerebral birth trauma caused by vacuum extraction: a case of growing skull fracture as a perinatal complication Papaefthymiou G, Oberbauer R, Pendl G.
Childs Nerv Syst 1996 Feb;12(2):117-20
Spinal Cord Injury During Birth
- Recognized causative factors are 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, and hyperextension of the fetal head in breech delivery or transverse presentation. Recognition of these factors is the basis for prevention of this terrible accident.
Spinal-cord injuries during birth Byers RK; Dev
Med Child Neurol 1975; 17(1):103-10
Additional Articles:
Birth Trauma: A Modern Epidemic
Jeanne Ohm, DC
The reality
"Birth today has become a technological experience where a natural process has
been replaced with artificial procedures and schedules. Without the necessary
support during pregnancy, women enter the birth process with fear and are led
to rely on drugs instead of their bodies' own natural strengths. These
drugs weaken her body's ability to function and lead to even further interventions.
The more interventions used in birth, the greater the risk of injury to both
the mother and baby.
Routine labor procedures such as inducing labor, pain medications,
and restrictive maternal positions lead to further complications and
the resultant use of forceful pulling and operative devices such as forceps,
vacuum extractions and c-sections.
The Cause
Standard obstetric managenent includes grasping the infants head during birth
usually accompanied by some degree of pulling and rotation. Further intervention
including the application of obstetric devises creates an environment where
an even more serious injury is bound to happen.
Although the studies sited below mostly deal with the excessive trauma caused
by obstetrical, operative devices it is important to note this comment by Dr.
Abraham Towbin, medical researcher on spinal injury, He says, 'the birth process,
even under optimal, controlled conditions is a traumatic potentially crippling
event for the fetus.'
"Spinal cord and brain stem injuries often occur during the process of birth
but frequently escape diagnosis. Respiratory depression in the neonate is a cardinal
sign of much injury. In infants, there may be lasting neurological defects reflecting
the primary injury."
"Routine procedures such as inducing labor,
pain medications and restricted maternal positions are known
to cause greater difficulty in labor and lead to further
interventions."
"Medical research on birth trauma tells us , 'Forceful pulling on the baby's
neck particularly when combined with stretching of the spine- has been considered
the most important cause of infant spinal and brain stem injury.'
A recent study published in the New England Journal of Medicine revealed startling
data. It reports: difficult labor itself and the method of delivery may lead
to brain injuries and deaths in babies.
Brain injuries were found in:
one out of every 664 infants delivered with forceps;
one out of every 860 deliveries by vacuum extraction and
one out of every 907 infants delivered by c-section.
Another published medical study reports: "mechanical stress imposed by obstetric
manipulation-even the application of standard orthodox procedures may prove
intolerable to the fetus. Difficult breathing in the newborn is a classic indication
of such injury"
It further states ," Survival of the newborn is governed mainly by the integrity
and function of the vital centers in the brain stem. Yet paradoxically, the
importance of injury at birth to the brain stem and spinal cord are matters
which have generally escaped lasting attention."
Birth trauma causes spinal injury. The effect is lifelong impairment
- Latent spinal cord and brain stem injuries in newborn infants Towbin A. Develop Med Child Neurol 1969; 11, 54-68
- Towner D et al. Effect of Mode of Delivery in Nulliparous Women on Neonatal Intracranial Injury NEJM 1999; Vol. 341, No. 23
- Neglected
spinal cord, brain stem and musculoskeletal injuries
stemming from birth trauma Gottlieb MS. J
Manipulative Physiol Ther 1993 Oct;16 (8):537-43
(The excerpts listed above are taken from the text of the documentary, " Birth Trauma: A Modern Epidemic" by Dr. Jeanne Ohm)
Birth Trauma Has Lasting Psychological Effects
Although almost addressing trauma to the nervous system when looking at birth
trauma, there is growing evidence that the traumas of birth have lasting psychological
effects.
"Although controversy can still be generated, especially among persons who are
not acquainted with contemporary findings, we should not proceed arrogantly with
the routine traumatization of our infants at birth! Fortunately, an increasing
number of therapists are being privately trained to recognize and work to resolve
prenatal/perinatal trauma, but there could never be enough of them to do the
work that is piling up. It would take an army of therapists to keep up with endless
production line of trauma at birth! Their work could be--and should be--eliminated
with the prevention of unnecessary traumas of contemporary obstetrics. But there
is no end in sight at this time." Read
entire article