Birth Injury

Overview

A birth injury is an injury that happens to a baby during labor or delivery. It can range from mild bruising to more serious damage to nerves, bones, or soft tissues. Most birth injuries are not serious and heal with time, but some may need extra care.

Birth injuries are fairly uncommon. They happen in about 2 to 4 out of every 1,000 live births, especially after difficult or assisted deliveries.

Birth injuries affect newborn babies. They are more likely after a long labor, when the baby is very large, or when tools like forceps or a vacuum are used during delivery.

Symptoms

Common symptoms

• Baby not moving one arm or leg
• Weak grip or one hand that seems limp
• Swelling, bruising, or a soft lump on the head or face
• Crying or discomfort when touching one part of the body
• Stiff or unusually floppy muscles
• Breathing difficulty
• Trouble feeding or swallowing

Symptoms in children

• A child who had a birth injury may show delays in reaching motor milestones like crawling or walking
• One arm or hand may be weaker or smaller than the other
• Limited movement or range of motion in a joint
• Tingling, weakness, or uneven posture

Symptoms in older adults

• Adults who had a birth injury might have long-term weakness or limited movement in the affected area
• Some may have chronic pain or arthritis in a joint that was injured
• In rare cases, there may be lasting issues with coordination or posture

Causes

Main causes

• Difficult or prolonged labor
• A very large baby (macrosomia)
• Breech or abnormal fetal position
• Use of forceps or vacuum extractor during delivery
• Shoulder dystocia (the shoulders get stuck after the head is born)
• Premature birth, because the baby is more fragile

Risk factors

• High birth weight (over 4 kilograms)
• Maternal diabetes
• Prolonged pregnancy (post-term)
• Narrow maternal pelvic shape
• Assisted delivery with instruments
• Multiple births (twins or more)
• Emergency cesarean section

When to see a doctor

See a doctor urgently if:

• Baby shows signs of breathing trouble or blue skin
• Any seizure or convulsion
• A limb appears weak, limp, or completely still
• A soft swelling on the head is growing rapidly

Book a routine appointment if:

• If you notice any limitation in movement that persists beyond a few days
• If the baby cries consistently when you move a certain arm or leg
• If feeding is still difficult after a week
• If you have any concern about your baby's development at any age

Diagnosis

Doctors diagnose birth injuries by examining your baby, checking their movement, reflexes, and skin, and asking about the labour and delivery. They may also order imaging tests to look at bones, muscles, or nerves.

Tests that may be done

• Physical exam with movement and reflex checks
• Ultrasound to look for fluid or soft tissue damage
• X-ray to detect broken bones
• CT scan or MRI for detailed images of the brain or spine
• Nerve conduction studies or electromyography (EMG) to check nerve function

What to expect at your appointment

The doctor or midwife will gently examine your baby, possibly over several visits. If a problem is found, they may refer you to a pediatric specialist, physiotherapist, or surgeon. You will be closely involved in decisions about your baby's care.

Treatment

Treatment for a birth injury depends on the type and severity. The main goals are to relieve pain, help the injury heal, and restore normal movement. Many babies only need gentle positioning and supervised exercises, while others benefit from physiotherapy or more specialised care.

Self-care at home

• Gently move the baby's arms and legs as shown by your healthcare provider
• Position your baby comfortably during feeding and sleep
• Avoid pulling or stretching the affected limb
• Follow your physiotherapist's recommended exercise routine
• Give extra cuddles and comfort to reduce distress

Medical treatments

Medical care may include physiotherapy, occupational therapy, and sometimes pain relief. In more serious cases, specialists may use splints, casts, or nerve reconstruction surgery. Medications are only used when needed and are always prescribed and monitored by a doctor.

When is surgery considered?

Surgery is rarely needed for birth injuries. It may be considered if a nerve is completely torn, if a fracture is out of line, or if there is bleeding around the brain that requires drainage. A pediatric surgeon will explain all options and risks before any procedure.

Living with this condition

Caring for a baby with a birth injury involves patience and gentle handling. Follow your healthcare team's advice on exercises, sleeping positions, and feeding. Keep a diary of progress and raise any questions at follow-up appointments.

Lifestyle tips

• Attend all physiotherapy and follow-up appointments
• Create a calm, supportive home environment
• Ask family and friends for practical support when needed
• Take time to rest and care for yourself
• Track your baby's milestones and celebrate small wins

Diet and exercise

Your baby's nutrition should follow normal infant feeding recommendations. The exercises are not a substitute for professional care; they are taught by a physiotherapist or therapist and should be done exactly as prescribed.

Mental health and emotional wellbeing

It is completely normal to feel anxious, sad, or overwhelmed when your baby has a health concern. Talk about your feelings with your doctor, partner, or a counselor. Your emotional wellbeing matters and supports your baby's wellbeing too.

Prevention

Not all birth injuries can be prevented, but good prenatal care and skilled birth attendance reduce the risk. Doctors and midwives monitor labour for warning signs and can choose safer delivery methods when needed.

Vaccines

Vaccines do not directly prevent birth injuries, but keeping your baby up to date with routine immunisations protects against infections that could cause additional health problems.

Screening programmes

Prenatal scans and check-ups help identify risk factors like a large baby or breech position. This allows your birth team to plan the safest delivery approach.

Complications

If left untreated

• Permanent weakness or limited movement in an arm or hand
• Nerve injury that does not heal, leading to muscle wasting
• Delayed motor development
• Persistent pain or deformity from an improperly healed fracture
• In rare cases, severe bleeding in the brain can cause long-term disability

Long-term outlook

The outlook for most birth injuries is very positive. With gentle care, physiotherapy, and time, the vast majority of babies improve within the first year. Many children go on to lead completely normal, active lives without lasting problems.

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