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

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