A birth injury is any harm that an infant experiences during the birthing process, and it can range from minor injuries to life-threatening conditions. Birth is an inherently risky process, and birth injuries can occur despite medical professionals’ best efforts. While some birth injuries are unavoidable, others can be linked to identifiable risk factors in the fetus. By recognizing these risk factors early, health care providers can often take steps to mitigate the risks. Here are some of the most common fetal risk factors that increase the likelihood of birth injury.
Multiple Gestation Pregnancy
Carrying more than one baby increases the risk of complications during pregnancy and delivery, which can lead to birth injuries. One of the most common risks of multiple pregnancies is preterm labor and birth, with over 60% of twins and almost all triplets and above being born before 37 weeks.
Some twin pregnancies can also result in a condition called twin-to-twin transfusion syndrome, where one twin receives more blood flow than the other, leading to potential birth injuries for both babies. Delivering multiple babies can also increase the likelihood of requiring interventions that make birth injuries more likely, such as forceps- or vacuum-assisted deliveries.
Growth Restriction
Fetal growth restriction, also known as intrauterine growth restriction (IUGR), occurs when a fetus does not grow at the expected rate inside the womb. This condition can lead to a variety of health issues, including an increased risk of birth injury.
Babies with growth restriction may have difficulty handling the stresses of labor and delivery, which makes them more susceptible to oxygen deprivation and other forms of injury. Placental insufficiency is sometimes the cause of fetal growth restriction, and those growth-restricted fetuses have a higher risk of stillbirth. Fetal growth restriction also increases the likelihood of a baby being born with cerebral palsy, a neurological disorder that can cause physical and developmental disabilities.
Macrosomia
On the opposite end of the spectrum from growth restriction is macrosomia, a condition where a fetus grows larger than average. A newborn who weighs more than 8.8 lbs. (4000 grams) is considered to be macrosomic. This condition can increase the risk of birth injuries, as larger babies may have a harder time passing through the birth canal and can become stuck during delivery.
This can lead to birth injuries like shoulder dystocia or brachial plexus injuries. Other potential adverse outcomes of macrosomia include meconium aspiration, skeletal injuries, prenatal asphyxia, and hypoglycemia. A baby who is stuck during delivery may also require the use of forceps or vacuum extraction, both of which can cause physical trauma to the baby’s upper body.
Abnormal Presentation
The ideal position for a baby at delivery is head down, facing the mother’s back. However, some babies present in positions that make vaginal delivery more complicated or risky, such as breech (feet or buttocks first) or transverse (sideways). These abnormal presentations significantly increase the risk of birth injuries without proper management.
Delivering a breech fetus vaginally can result in injuries to the baby’s legs or arms, such as dislocated or broken bones, or the baby’s head can get stuck in the birth canal. Umbilical cord problems are also a possible complication of vaginal breech birth, as the umbilical cord can flatten or twist during delivery and cut off the baby’s oxygen supply, resulting in neurological damage.
There’s also a risk of birth injury if the fetus is head down but facing the mother’s front. This position is known as an occiput posterior position and can prolong labor, which may require the use of interventions like forceps or vacuum extraction to assist in delivery. These interventions increase the risk of trauma to the baby’s head, neck, and spine.
Congenital Abnormalities
Congenital abnormalities are defects that often present before a baby is born. These conditions can have a significant impact on the delivery process.
For example, fetuses with congenital heart defects may struggle to withstand the stress of labor, and these births have a higher rate of instrumental deliveries, which can increase the risk of birth injuries. Fetuses with spina bifida, a neural tube defect, may experience spinal cord damage if allowed to deliver vaginally. Therefore, cesarean delivery is often recommended for these cases.
Prematurity
Premature birth, defined as delivery before 37 weeks of gestation, can also increase the risk of birth injuries. Premature infants have underdeveloped organs and are more susceptible to injury during labor and delivery. Their bodies are more fragile, particularly in the case of extremely premature infants, and may not be able to withstand the stresses of delivery without harm.
Cerebral palsy, breathing problems, heart problems, and learning disabilities are just a few of the potential consequences of premature birth. Health care providers can sometimes stop or delay premature labor to give the fetus more time to develop in utero and potentially reduce the risk of birth injuries. If the birth cannot be delayed, health care providers must take special precautions during delivery to reduce the risk of injury.
