Traumatic brain injury at birth

If your baby’s head was injured by forceps, vacuum or obstructed delivery, or their birth caused swelling or bleeding within their brain, they may have suffered a traumatic birth injury.

During childbirth you rely on your maternity team to deliver your baby safely using correct expertise, skill and care. Mistakes in the midwifery and obstetric management of your pregnancy and labour, or in the planning, monitoring and handling of your baby’s birth can cause serious injury, including lifelong disability from traumatic brain injury.

On this page, you will find the answers to many of the questions that families have about traumatic brain injury at birth: what it is, how it happens and when you should seek help.

Our birth injury solicitors have helped countless families of injured children to understand how their injury occurred and to claim the compensation and support that they need for their child. We can help you answer these questions with advice from trusted, independent medical experts, and secure the compensation and practical support that your baby deserves. If you would like to find out more about your baby’s traumatic birth injury, and what that means for your baby and family, or you have been contacted by MNSI or NHS Resolution, contact us to talk, free and confidentially, to one of our experienced birth injury solicitors.

What are common types of traumatic brain injury at birth?

A newborn baby’s skull is made of bones that are soft and flexible, with gaps (cranial sutures) and soft spots (fontanelles) between the plates of bone. This flexible bone structure allows the baby’s head to change shape temporarily whilst under pressure during labour and birth. These changes are a normal part of the birth process and usually resolve soon after birth. In time, as the baby’s brain grows to full size, the gaps between the bones of the skull will also close.

Traumatic injury to the baby’s head, however, is caused by excessive pressure or force during labour or delivery. These injuries can arise from the maternity team’s management of an obstructed or prolonged labour, or response to birth complications,  often requiring swift and skilled use of forceps, ventouse suction, disimpaction and delivery of a stuck baby or other emergency manoeuvres. Minor injuries, such as fluid collections, may resolve without long-term harm, but traumatic injury which affects your baby’s brain can result in lifelong disability.

Common types of traumatic brain injury at birth include:

• Subgaleal haematoma. This is a collection of blood in the space between the middle layer of the scalp and the membrane covering the skull, caused by injury to the emissary veins. Subgaleal haematoma is often caused by Ventouse (vacuum) delivery and may occur together with other birth injuries, such as skull fracture or cerebral oedema (brain swelling). Subgaleal haematomas involving intracranial haemorrhage (brain bleeding) can lead to severe brain injury from increased intracranial pressure.   
• Cephalohaematoma. This is a collection of blood (or bruise) that forms in the tissues under the newborn baby’s scalp. It is usually caused by pressure on the baby’s head from a difficult vaginal delivery or from birth assisted by forceps or Ventouse suction.  Cephalohaematoma often resolves without treatment but can increase the risk of neonatal jaundice, anaemia and infections. It can also accompany other more dangerous traumatic injuries to the baby’s brain.
• Skull fracture. The softness and flexibility of a baby’s skull makes it resilient to pressure and resistant to fracture during an uncomplicated birth. Skull fractures (broken bones) including depressed (ping-pong) fractures are often caused by excessive pressure being applied to the baby’s head, such as during forceps delivery or disimpaction of an impacted fetal head (IFH). Skull fracture can cause or accompany other types of traumatic birth-related brain injury, such as cephalohaematoma or intracranial haemorrhage (brain bleed).
• Intracranial haemorrhage (brain bleed). Pressure or excessive force to the baby’s head during birth, such as from incorrectly handled forceps delivery, can cause shearing injury to intracranial blood vessels resulting in intracranial haemorrhages (bleeds).  These damage the brain by increasing the pressure within the skull (intracranial pressure) and by reducing the flow of blood and oxygen to the tissues of the brain.  Intracranial haemorrhage is a type of stroke.
  
  Epidural haemorrhage, subdural haemorrhage and subarachnoid haemorrhage are types of bleeding within the skull but outside the brain. Intracerebral haemorrhage and intraventricular haemorrhages involve bleeding within the brain.

Babies who suffer major traumatic injury to their head and brain at birth may also have HIE birth injury, seizures (fits), respiratory (breathing difficulties) needing ventilation, meconium aspiration, and infection or sepsis.

Read more about HIE birth injury, meconium aspiration, or neonatal brain injury from infection.

Who is at risk of traumatic brain injury at birth?  

Traumatic birth injury which causes brain injury to the baby is often the result of negligent planning, monitoring or management of the labour and birth.  Where a mother or her unborn baby have risk factors for additional complications during labour and delivery, the mother should be advised about those safety risks and her birth options, and her risk and choices taken into account in the planning and management of her baby’s birth. 

Where risk factors such as slow progress, obstruction from impacted fetal head (IFH), breech presentation or other complications occur during labour or delivery, maternity teams should be able to recognise and respond to them in accordance with local protocols and guidance, escalate the mother’s care to a senior obstetrician and act swiftly and correctly to deliver the baby safely.

The risk of traumatic birth injury to the baby’s head and brain is higher for pregnancies and births where:

• the baby’s position at birth is not head-down with face towards mother’s back and chin tucked down (e.g. breech birth);
• the baby is large for dates (over 4kg), has a large head (macrosomia) or is post-term, or there is maternal high BMI, diabetes, or a family history of big babies;
• the baby is premature or has a very low birthweight;
• the baby’s head won’t fit through the mother’s pelvis owing to macrosomia, poor positioning of the baby, or the shape of the mother’s pelvis (cephalopelvic disproportion);  
• labour is precipitous and happens much faster than usual;  
• labour is prolonged or obstructed (IFH, shoulder dystocia);  
• forceps or Ventouse (vacuum) suction is used to reposition or deliver the baby.

Read more about birth injury claims involving  impacted fetal head (IFH) and breech birth.

Read more about claims for birth trauma to mothers during childbirth.

Can medical negligence at birth cause traumatic brain injury to the baby?

Mistakes in maternity care during pregnancy, labour and birth are a common cause of traumatic brain injury and cerebral palsy claims.

Medical negligence claims for traumatic birth injury resulting in brain injury, such as HIE and cerebral palsy, often involve one or more of the following mistakes:

• failure to follow maternity care protocols and guidelines;
• failure to assess the mother’s risks of obstructed labour (e.g. big baby, breech presentation, IFH);
• failure to discuss with the mother her risks and birth options and agree a plan for safe delivery;
• fetal heart monitoring errors;
• failure to recognise and respond to signs of failure to progress or obstructed labour;
• excessive use of Syntocinon during labour;
• failure to escalate complications or obstruction in labour or delivery to a senior obstetrician;
• leaving an inexperienced, junior doctor to manage obstructed labour or obstetric emergency;
• incorrect use of emergency manoeuvres or delivery technique (breech, shoulder dystocia or IFH);
• excessive force or multiple attempts at forceps or ventouse delivery;
• failure to offer or perform a caesarean section, where indicated;
• maternity team training and teamwork failures.

We have recovered compensation settlements for many families of children with cerebral palsy and neurodevelopmental disability from traumatic birth injury. Recent cases include an £18 million settlement for a baby whose HSV-infected forceps scalp wounds were left untreated, causing encephalitis brain injury and cerebral palsy; and judgment in a traumatic IFH birth injury claim for a child with severe, traumatic brain injury, skull fractures, haemorrhages and bruising to the brain caused by excessive force during multiple attempts by doctors to rotate the impacted head using forceps and ventouse suction.

If you would like to find out more about whether our experienced solicitors can help you secure compensation for your child through a traumatic birth injury claim, contact us to talk to a solicitor, free and confidentially.