Types of Birth Injuries: The Complete Guide for Parents

Types of Birth Injuries: The Complete Guide for Parents

Childbirth is one of the most significant and emotional moments in life. But sometimes, things don't go as planned. A birth injury is any harm caused to the baby or the mother during the delivery process, due to medical malpractice or improper treatment.

Birth injuries can be devastating:

• Lifelong cerebral palsy
• Permanent disabilities
• Developmental delays
• Severe psychological harm to the mother

As parents, you have the right to know — what are the different types of birth injuries, how do they occur, and what can be done about them.

In this comprehensive article, we will review all common types of birth injuries, explain the causes, the warning signs, and the long-term consequences.

Understanding the Basics — What Is a Birth Injury?

The Definition

A birth injury is physical or neurological damage caused to a baby (or mother) during:

• Late-stage pregnancy
• The delivery process itself
• Care immediately following delivery

The Difference Between a Birth Injury and a Birth Defect

It's important to distinguish between the two:

Birth Injury:

• Caused during delivery or due to improper treatment
• Preventable (in most cases)
• The result of negligence, error, or a poor medical decision

Birth Defect:

• Developed during pregnancy
• Generally not preventable (genetic or developmental)
• Unrelated to medical care during delivery

Example:

• Birth Injury: A baby suffered oxygen deprivation during prolonged labor, and the team failed to perform a cesarean section in time → brain damage → cerebral palsy
• Birth Defect: A baby born with Down syndrome (an extra chromosome) — this is unrelated to the delivery

Statistics

How common are birth injuries?

In Israel:

• Approximately 2–3 out of every 1,000 deliveries involve a significant injury to the baby
• That means 300–450 cases per year

Most Common Types:

• Oxygen deprivation to the brain (Hypoxia/Asphyxia) — 30% of cases
• Nerve injuries (especially brachial plexus) — 25%
• Fractures — 20%
• Brain hemorrhages — 15%
• Other injuries — 10%

Types of Birth Injuries — A Comprehensive Review

1. Cerebral Palsy (CP)

This is the most severe and most common injury in birth malpractice claims.

What Is Cerebral Palsy?

Cerebral Palsy (CP) is a neurological disorder that affects:

• Movement — difficulty with coordination and muscle control
• Posture — difficulty sitting, standing, and walking
• Muscle tone — muscles that are too stiff or too loose

Causes

Cerebral palsy is typically caused by brain damage during or around the time of delivery.

The Most Common Cause: Oxygen Deprivation (Hypoxia/Asphyxia)

Fetal distress that went untreated:

• The fetus doesn't receive enough oxygen
• The monitor shows signs of distress
• The medical team doesn't act quickly enough to perform a cesarean section

Prolonged labor:

• Labor that lasts far too many hours
• The baby is "stuck" in the birth canal
• The brain doesn't receive enough oxygen

Umbilical cord problems:

• The umbilical cord wraps around the baby's neck
• Compression of the umbilical cord
• Not addressed in time

Placental Abruption:

• The placenta detaches before delivery
• The baby doesn't receive oxygen
• An emergency cesarean is needed — if not performed in time → damage

Infection:

• An infection in the mother that passes to the baby
• Causes inflammation in the brain

Types of Cerebral Palsy

By severity:

• Mild: Minor movement difficulties, can walk with minimal assistance
• Moderate: Requires significant assistance, difficulty walking
• Severe: Fully dependent, requires a wheelchair, difficulty with speech and eating

By type:

• Spastic CP (70%): Stiff muscles, rigid movements
• Dyskinetic CP (10%): Involuntary movements
• Ataxic CP (10%): Balance and coordination problems
• Mixed CP (10%): A combination of the three types above

Early Signs

In the first months:

• Baby is unusually floppy or unusually stiff
• Not reaching developmental milestones
• Difficulty breastfeeding
• Not holding up the head (by 3–4 months)

At age one:

• Not sitting independently
• Not crawling
• Using one side of the body more than the other

Formal diagnosis: Typically at 12–24 months of age.

Treatment and Prognosis

There is no cure for cerebral palsy. However, treatments can help:

• Physical therapy — to improve movement
• Occupational therapy — to improve daily functioning
• Speech therapy — if there are speech difficulties
• Surgery — to release stiff muscles
• Medication — to relax muscles
• Assistive equipment — wheelchair, prosthetics

Prognosis:

• Depends on severity
• In mild cases — the individual can live an independent life
• In severe cases — requires 24/7 care for life

Costs:

• Lifelong treatments: millions of shekels
• This is why compensation in cerebral palsy claims is the highest of all birth injury cases

2. Erb's Palsy

This is an injury to the nerves of the arm, causing paralysis or weakness in the arm.

What Is Erb's Palsy?

Erb's Palsy is damage to the brachial plexus — a network of nerves that extends from the spinal cord in the neck to the arm, controlling movement and sensation in the arm.

How Does It Happen?

Usually during a difficult delivery:

Shoulder Dystocia:

• The baby's head emerges, but the shoulder gets stuck behind the mother's pubic bone
• The delivering physician pulls forcefully to deliver the baby
• The pulling injures the nerves in the neck → Erb's Palsy

Causes

Improper use of delivery instruments:

• Forceps or vacuum applied with excessive force
• Pulling at an incorrect angle
• Nerve damage

Oversized baby (Macrosomia):

• Baby weighing over 4 kg (8.8 lbs)
• Difficulty delivering the shoulders
• The team should not have attempted a vaginal delivery — a cesarean was indicated

Signs

Signs immediately after birth:

• One arm doesn't move (appears to "hang")
• The baby doesn't move the arm at all
• Weak grip on one side
• The arm is rotated inward toward the body

"Waiter's Tip Position": The arm is rotated inward, the elbow is straight, the palm faces outward — resembling a waiter waiting for a tip.

Severity

Mild:

• Temporary nerve damage
• Recovery within 3–6 months with physical therapy
• 90% of cases

Severe:

• Nerve tear or complete detachment
• Permanent weakness or full paralysis of the arm
• Requires surgery (nerve transfer)
• 10% of cases

Treatment

Physical therapy:

• Exercises begin immediately (as early as two weeks of age!)
• Preventing joint stiffness
• Improving movement

Surgery:

• If no improvement within 3–6 months
• Nerve transfer or repair

Prognosis:

• In mild cases: full recovery
• In severe cases: permanent weakness, partial loss of arm function

3. Perineal Tears

This is an injury to the mother, not the baby — but it's important to be aware of.

What Is a Perineal Tear?

A perineal tear — a tear in the perineum, the area between the vagina and the anus — is very common during deliveries, especially first deliveries.

Not every tear constitutes malpractice! Minor tears (Grade 1–2) are normal. However, severe tears (Grade 3–4) can be the result of negligence.

Grades of Severity

Grade 1:

• Superficial skin tear
• No stitches needed (or minimal stitches)
• Quick recovery

Grade 2:

• Tear in the skin and perineal muscle
• Requires stitches
• Recovery within several weeks

Grade 3:

• Tear that damages the internal anal sphincter muscle
• This is a significant injury!
• Requires complex suturing
• Risk of long-term complications

Grade 4:

• Tear that penetrates the rectal tissue or even the bowel
• This is a very serious injury!
• Requires complex surgery
• High risk of long-term complications

When Is It Malpractice?

Severe tears can be caused by:

1. Improper use of delivery instruments:

• Episiotomy (intentional incision) at an incorrect angle
• Forceps or vacuum applied with excessive force

2. Failure to perform an episiotomy when indicated:

• In certain cases, it's preferable to make a small controlled incision rather than allow an uncontrolled tear to develop

3. Failure to identify and improper treatment:

• The team didn't identify the tear (Grade 3–4)
• Didn't properly suture the sphincter muscle
• This leads to long-term complications

4. Overly rapid delivery without control:

• The team didn't properly guide the mother
• Uncontrolled "pushing"

Long-Term Complications

In Grade 3–4 tears that were not properly treated:

• Gas or fecal incontinence (loss of anal sphincter control)
• Chronic pain in the perineal area
• Pain during intercourse (Dyspareunia)
• Recurring infections
• Fistula (abnormal connection between the vagina and the anus)

Impact on quality of life: Very severe! Women suffer for years, and sometimes require additional surgeries.

Treatment

Grade 3–4 tears:

• Suturing immediately after delivery — mandatory!
• Layered suturing (each layer separately)
• Antibiotics to prevent infection
• Physical therapy to strengthen pelvic floor muscles

If not properly treated:

• Corrective surgery (sometimes multiple surgeries)
• Long-term physical therapy

4. Fractures

Fractures during birth are less common, but they can occur.

Clavicle Fracture

The most common fracture during birth. It typically occurs during shoulder dystocia — the team pulls and fractures the clavicle to deliver the baby.

Signs:

• Baby doesn't move the arm on the fractured side
• Crying when the area is touched
• Swelling or bruising at the shoulder

Treatment and recovery:

• Usually heals on its own within 2–3 weeks (babies heal much faster than adults)
• No cast required
• Excellent prognosis — no long-term consequences

Is this malpractice? Not necessarily! Sometimes a clavicle fracture is intentional — to save the baby from more severe harm. However, if it occurred due to improper use of delivery instruments or excessive force — that is malpractice.

Skull Fracture or Injury

Rare, but serious. Usually caused by improper use of forceps or vacuum, or an overly rapid delivery with impact to the head.

Signs:

• Depression in the skull
• Swelling
• Bleeding beneath the cranial membrane

Risks:

• Brain hemorrhage
• Neurological damage

Treatment:

• Close monitoring
• Surgery may be required

Other Fractures (Rare)

• Femur (thighbone)
• Arm bones
• Typically in very difficult deliveries

5. Brain Hemorrhages

Brain hemorrhages are among the most severe birth injuries.

Types

Subdural Hemorrhage:

• Bleeding between the brain and the cranial membrane
• Caused by rupture of blood vessels

Intraventricular Hemorrhage (IVH):

• Bleeding within the brain's ventricles
• Especially common in premature infants

Intracerebral Hemorrhage:

• Bleeding within the brain tissue itself
• The most severe!

Causes

Trauma:

• Improper use of forceps or vacuum
• Excessive pressure on the head during delivery

Oxygen deprivation:

• Causes damage to blood vessels in the brain

Premature birth:

• Blood vessels in the brains of premature infants are very fragile
• Prone to bleeding

Signs

In the newborn:

• Unusual limpness
• Seizures
• Difficulty breastfeeding
• Weak or inconsolable crying
• Abnormally large head (hydrocephalus)

Diagnosis: Brain ultrasound, CT, or MRI.

Complications

Mild hemorrhages:

• May be absorbed on their own
• No long-term consequences

Severe hemorrhages:

• Permanent brain damage
• Developmental delays
• Cerebral palsy
• Death (in the most severe cases)

Treatment:

• Close monitoring
• Surgery (in severe cases) — to drain the hemorrhage
• Supportive care

6. Hypoxia (Oxygen Deprivation) Without Cerebral Palsy

Not all oxygen deprivation leads to cerebral palsy. Sometimes there is cognitive or developmental damage without cerebral palsy.

Signs

• Speech delays
• Learning difficulties
• Behavioral problems
• ADHD
• Autism (in certain cases)

The challenge: These signs only appear at age 2–5 — not immediately at birth! This makes it harder to prove the connection to the delivery.

How Is It Proven?

• Documentation of fetal distress during delivery
• Low Apgar scores (the score given to the baby immediately after birth)
• Need for resuscitation
• Brain MRI (showing a specific type of damage)

7. Additional Injuries (Less Common)

Facial Nerve Palsy

• Caused by pressure from forceps
• Injury to the facial nerve
• Sign: One side of the face doesn't move (especially when crying)
• Recovery: In most cases — full recovery within weeks to months

Caput Succedaneum

• Soft swelling on the scalp
• Caused by pressure during prolonged labor
• Not dangerous — resolves within days

Cephalohematoma

• Blood collection beneath the skull bone (not on top of it)
• Appears as a "bump" on the head
• Resolves within weeks to months
• Generally not dangerous, but requires monitoring

Infections

• Blood infection (sepsis)
• Meningitis
• Caused by: poor hygiene, overly prolonged labor (membranes ruptured long ago), untreated infection in the mother

Severe Jaundice (Kernicterus)

• High levels of bilirubin in the blood
• If untreated — brain damage
• Prevention: Phototherapy treatment (blue light)

When Is a Birth Injury the Result of Malpractice?

Not every birth injury is malpractice! Sometimes, despite excellent care, complications arise.

However, a birth injury constitutes malpractice if:

The team failed to properly monitor the fetus:

• Didn't use a fetal monitor
• Ignored signs of fetal distress

The team failed to act in time:

• Observed fetal distress but didn't perform an emergency cesarean
• Waited too long

Improper use of delivery instruments:

• Forceps or vacuum applied with excessive force
• Using instruments when they weren't necessary

Failed to perform a cesarean when indicated:

• Baby too large for vaginal delivery
• A situation with known high risk

Failed to properly manage complications:

• Placental abruption — didn't act immediately
• Umbilical cord prolapse — didn't perform an emergency cesarean

Failed to identify problems:

• Didn't identify shoulder dystocia
• Didn't identify a severe tear and didn't suture properly

Summary — Birth Injury Table

Injury Type	Frequency	Severity	Prognosis
Cerebral Palsy	2–3/1,000	Very severe	Lifelong disability
Erb's Palsy	1–2/1,000	Moderate–severe	90% full recovery
Grade 3–4 tears	3–4%	Severe (to mother)	Depends on treatment
Clavicle fracture	1–2%	Mild	Full recovery
Brain hemorrhage	Rare	Very severe	Depends on severity
Developmental delay	Varies	Moderate	Depends on severity

Birth injuries are a devastating trauma for parents. Understanding the different types, the warning signs, and the causes — that's the first step toward determining whether malpractice occurred, and what can be done about it.

If you suspect malpractice — contact an expert attorney. You have rights.

This article provides general information only and does not constitute medical or legal advice.