Birth trauma is an umbrella term referring to any physical or emotional distress experienced during or after childbirth. It can range from mild to severe and affect both the birthing parent and infant.

Most parental birth injuries are minor and heal without treatment, and many birth injuries in newborns are temporary. However, more complex issues may require treatment.

Birth trauma can be mental and physical. For example, a physical injury may look like a perineal tear or nerve damage, while emotional distress can manifest as post-traumatic stress disorder (PTSD).

Some form of newborn birth injury is common during delivery, but severe birth trauma is rare. These can include bruising of the scalp, fractures, and nerve damage.

Read on to learn about the various types of birth trauma and ways to manage it.

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Birth trauma is any wound or damage that happens as a result of childbirth. Although trauma can be physical, such as a birth-related injury, it can also be psychological or emotional.

There are several types of birth trauma. The following sections discuss birth trauma according to whether it is a physical injury or emotional distress.

Injuries to the birthing parent typically involve damage to the perineal area or pelvic floor.

Perineal tear

Perineal trauma is relatively common during childbirth. It involves a tear or surgical cut to the area between the vaginal opening and the anus.

Approximately 53–89% of people experience some tearing during delivery. Around 4–11% of individuals experience severe tearing.

Learn about the types and the treatment of perineal tears.

Nerve damage

The pudendal nerve is a significant nerve in the pelvic region that sends motor and sensation information to the brain. Due to its location, this nerve is vulnerable to stretch injuries during childbirth.

Injuries may cause sensation loss, urinary and fecal incontinence, and sexual dysfunction. Some people also experience pudendal neuralgia, which causes severe pain along the nerve pathway.

Muscle damage

The pelvic floor is a group of muscles and connective tissue that support the pelvic organs, such as the bladder, bowel, and internal reproductive organs.

Vaginal delivery is associated with pelvic floor disorders. This occurs when there is weakening or injury to the pelvic muscles and connective tissue, which may result in issues with bladder and bowel control.

Learn more about pelvic floor dysfunction.

Pelvic organ prolapse

The muscles and tissues in the pelvis support the pelvic organs, such as the bladder, uterus, and rectum. If the muscles and tissues become weak or damaged, they can no longer support these organs, causing one or more of them to drop into or out of the vagina.

A 2021 systematic review confirmed a strong link between vaginal birth and pelvic organ prolapse. However, people may experience prolapse without giving birth or when they have had a cesarean delivery.

Learn more about pelvic organ prolapse.

A 2018 study reported that some degree of newborn birth injury is common during delivery, but severe birth trauma is rare. Although cesarean delivery may injure some newborns, the incidence is 60% lower than vaginal delivery.

Newborn birth injuries may include the following:

Bruising and swelling of the scalp

Some newborns may have minor injuries during delivery and show signs of bruising on the face or scalp. Trauma from passing through the birth canal and contact with the pelvic bones and tissues typically cause this bruising.

Forceps use in delivery may leave temporary marks on the newborn’s face and head, and delivery by vacuum extraction can cause scalp bruising or cuts.

Shortly after birth, newborns may have scalp swelling called caput succedaneum. Even when fully dilated for delivery, the cervix and vaginal canal can squeeze and pull the newborn’s head.

This trauma to the head causes fluid to accumulate between the protective covering of the skull and the scalp, leading to swelling that generally resolves within 48 hours.

Cephalohematoma is when the force on the skull and scalp during delivery causes blood vessels to rupture, resulting in blood pools in the space under the newborn’s scalp. It is typically harmless and happens in 0.4–2.5% of all live births. It presents as a bulge on the scalp but gradually resolves.

Fractures

Bones may fracture before or during delivery.

Clavicle fractures are the most common, occurring in up to 15 in 1,000 live births. The humerus — the upper arm bone — is the second most fractured bone associated with newborn delivery. Other fractures, such as femur and rib fractures, may occur but are rare.

Nerve damage

Some newborns can experience nerve damage from delivery. For example, a complicated birth may injure the facial nerve, the brachial plexus, or the spinal cord.

Facial nerve injuries are the most common nerve injury associated with a traumatic birth, occurring in around 10 in 1,000 live births. Pressure on the newborn’s face from labor or delivery may injure the facial nerves. It may also occur when health professionals use forceps to help with delivery.

Brachial plexus injuries occur in up to 2.5 in 1,000 live births. The brachial plexus is a network of nerves between the neck and shoulder that provide sensation and muscle control in the fingers, hand, arm, and shoulder.

A brachial plexus injury can happen when the baby is in a breech position, weighs more than 8 pounds 13 ounces, or during an assisted delivery. Most brachial plexus injuries are stretch injuries and improve without treatment or with physical therapy.

Spinal cord injuries occurring from overstretching during labor and delivery are rare.

Brain injury

Hypoxic ischemic encephalopathy (HIE) is a brain injury from the brain not receiving enough oxygen before or shortly after birth.

Some children experience no health issues or mild to moderate effects from HIE. Other children may have long-term physical and cognitive impairments, such as developmental delay or cerebral palsy.

Brain bleeds

A brain bleed, also called intraventricular hemorrhage (IVH), is an uncommon type of birth injury. It occurs when the pressure or trauma of labor and delivery ruptures the blood vessels that carry blood to and from the brain, and the blood pools in the fluid-filled areas surrounding the brain.

This condition primarily affects premature newborns with blood vessels that are not yet fully developed.

Outcomes for an infant depend on the severity of the bleed. A 2022 study found that preterm infants with low grade IVH typically had similar neurological outcomes to other preterm infants born at a similar gestation. However, higher grade IVH was associated with neurodevelopmental disability.

When some people talk about birth trauma, they are referring to their experience after childbirth. According to the American Psychiatric Association, birth-related PTSD affects around 17% of postpartum parents.

A person can find a birth traumatic for many reasons. It could be that they experienced prolonged pain or the infant experienced a drop in heart rate that resulted in an emergency cesarean delivery. Having a newborn spend time in intensive care can also be traumatic.

These experiences could cause feelings that do not disappear, even after everyone involved is safe and well. Individuals may experience severe anxiety, flashbacks of the event, or physical responses such as a racing heartbeat or sweating.

People who think they have PTSD should speak with a healthcare professional who can help them get the treatment they need to feel better.

Learn more about PTSD.

Most parental birth injuries are minor and heal without treatment, and many birth injuries in newborns are temporary. For example, a minor perineal tear likely will not require stitches, and minor newborn soft tissue injuries improve without intervention.

For more complex perineal tears or damage to the pelvic muscles, a person may need surgery to repair the tissue and to perform core exercises to strengthen the pelvic floor and improve pelvic floor dysfunction.

If a newborn has a bone fracture, it may heal on its own if it is a clavicle fracture, or an arm or leg may need to be held in position with supports or splints. Newborns with damaged nerves may need physical or occupational therapy.

For people with postpartum PTSD, a healthcare professional may suggest:

Many healthcare professionals can help support an individual’s treatment and recovery from physical and emotional birth trauma.

A person should speak with a doctor if they experience ongoing symptoms, such as bladder and bowel issues or pelvic pain. Parents or caregivers who have concerns about their newborn’s health should also contact a healthcare professional as soon as possible.

Mental health professionals, such as therapists, counselors, psychologists, and psychiatrists, can assist people with postpartum PTSD.

Birth trauma is any injury or emotional distress that results from childbirth and can range in severity.

Injuries a person may experience during labor and delivery may include perineal tears, pelvic muscle damage, and nerve damage. Birth-related injuries to a newborn may include bruising, fractures, nerve damage, and, in rare cases, brain injury or bleeds.

People may also have symptoms of PTSD following a traumatic birth experience, such as distressing flashbacks and severe anxiety.

Treatments for birth trauma depend on the type of injury and its severity. Healthcare professionals can help support a person and their newborn throughout treatment and recovery.