Birth Injury Statistics & Facts

For every 1,000 infants born in the United States, 6 to 8 have a birth injury.

How Maternal Weight Impacts Pregnancy

• Maternal obesity (a body mass index greater than 30) is associated with a higher risk of birth injury.
• In the largest prospective multicenter study, the rate of failed trial of labor increased from 15% in normal-weight mothers to 30% in obese mothers to 39% in severely obese mothers, with the rate of uterine rupture increasing with maternal weight.

How Maternal Age Impacts Pregnancy

• 35 years of age and over is considered “advanced maternal age,” which is known as a high-risk factor in pregnancy.
• Compared with women under 30 years of age, women over 40 had a more than 4 times higher overall c-section rate.
• Women age 19 or younger and 35 or older are at higher risk of having preterm labor.

Fetal Weight and Birth Injury

• The term low birth-weight is used to describe infants weighing less than 5.5 lbs (2500 g) at birth.
• Fetuses which are small or growth restricted and below the 10th percentile are at increased risk for HIE and stillbirth.
• For fetuses over 8.818 lbs (4000 g), the incidence of birth injury rises as the fetal size increases.
• In one study, the incidence of birth injury was 7.7% in infants whose birth weight exceeded 9.921 lbs (4500 g).

Premature Delivery and Birth Injury

• In 2015, the overall preterm birth rate in the U.S. was 9.6%.
• Preterm birth rates are higher among socially disadvantaged populations, including women with low levels of education, women who receive late or no prenatal care, and minorities.
• Preterm birth rates are higher among women younger than age 20 and older than age 35.
• Multiple gestations account for about 10% of all preterm births in the U.S.: 30-50% of multiple gestations deliver prior to 37 weeks, with the higher order of multiple gestation delivering the earliest.
• The incidence of breech presentation at 28 weeks gestation approaches 25%.
• About 50% of preterm births are considered idiopathic preterm births, or are considered possibly amenable to prevention efforts.

How Fetal Position Impacts Pregnancy

• Fetal position other than head-first presentation is called malpresentation, and is associated with a higher risk of birth injury.
• Especially serious complications and potential birth injuries can result from breech presentation, which occurs in 3-4% of all deliveries in the United States.
• Malpresentation occurred in 38.1 per 1000 live births in 2002, with higher rates among women 40-54 years of age.

Fetal Gender

• According to the National Healthcare Quality Report, in 2000, 5.06 birth trauma injuries occurred per 1,000 live female births, while 6.83 birth trauma injuries occurred per 1,000 live male births.

Delivery Circumstances

• When compared to non-operative vaginal delivery, an operative vaginal delivery (a delivery with use of vacuum extraction or forceps) is associated with a higher risk of birth injury.
• Between 2000 and 2006, the injury rate for mothers having instrument-assisted vaginal births was 30% higher than the injury rate for those not having instrument-assisted vaginal births.
• In a study of singleton live births in the United States between 1995 and 1998, vacuum delivery was associated with a lower risk of birth injuries, neonatal seizures, and need for assisted ventilation than forceps delivery.

• Cerebral palsy is the most common disability in childhood and is commonly a result of birth injury.
• The incidence of cerebral palsy is reported to be between 1.5 and 3 in every 1000 live births in the United States.
• Spastic cerebral palsy is by far the most common type of cerebral palsy, occurring in 70- 80% of all cases.
• Ataxic cerebral palsy occurs in roughly 5-10% of all cases of cerebral palsy.
• Athetoid/dyskinetic cerebral palsy occurs in roughly 15% of cerebral palsy cases.
• The rate of cerebral palsy in infants born before 36 weeks of gestation and weighing less than 4.4 lbs (2000 g) has been reported to be 12%.
• A study done by the CDC of 8-year-old children in certain areas of the U.S. revealed that CP was more common in black children than white children and more common among boys than girls. It also showed that 58.2% of the children who had CP could walk independently and 77.4% of the children who had CP had spastic CP.

Common conditions associated with cerebral palsy include:

• 50-75% of people with cerebral palsy experience pain symptoms.
• 50-85% of people with cerebral palsy are also diagnosed with cognitive disabilities.
• 40-60% of people with cerebral palsy experience communication or speech-language disorders from cerebral palsy.
• 25-45% of people with cerebral palsy experience epilepsy and seizure disorders.
• 30% of people with cerebral palsy experience visual impairments.
• 10-20% of people with cerebral palsy experience hearing impairments.
• 30% of people with cerebral palsy experience hip displacement.
• 25-40% of people with cerebral palsy experience behavioral disorders.
• 30-60% of people with cerebral palsy experience incontinence.
• 20% of people with cerebral palsy experience sleep disorders.
• 20% of people with cerebral palsy experience saliva control problems.
• 7% of people with cerebral palsy experience gastrostomy-tube dependence.
• 90% of people with cerebral palsy experience gastrointestinal disorders.

• HIE is estimated to occur in about 2-9 per 1,000 live births, making it the most common type of neonatal encephalopathy (NE).
• Roughly 10-40% of babies with HIE die in the newborn period.
• At least 25% of babies with HIE that survive go on to live with significant brain damage and long-term neurodevelopmental impairments.
• In studies of preterm infants who met the criteria for HIE, placental abruption was more likely to be identified as the antecedent event than cord prolapse or uterine rupture. Intrauterine asphyxia brought on by clotting of placental arteries, cord prolapse, circulatory problems, placental abruption, inflammatory processes, and uterine rupture are more common events among term infants with HIE.
• Clinical studies have shown a reduced mortality and accompanying reduced disability among newborns with HIE that were enrolled in hypothermia treatment within 6-24 hours after birth.

The most common birth injuries are soft-tissue injuries, including:

• Infant lacerations
• Subcutaneous fat necrosis
• Infant bruising
• Petechiae (tiny brown-purple spots resulting from bleeding under the skin)

An Intracranial Hemorrhage (ICH) can result from a birth injury. Reported incidences of ICH occurred in 0.00037% of unassisted deliveries, 0.00162% of vacuum-assisted deliveries, and 0.0017% of forceps-assisted deliveries. Different types of hemorrhages include:

• Subdural hemorrhage (SDH): Generally thought to be the most common intracranial hemorrhage in newborns, although this is somewhat debatable.
• Subarachnoid hemorrhage
• Intraventricular hemorrhage
• Epidural hemorrhage
• Cerebral hemorrhage

Infant facial injuries include:

• Nasal septal dislocation: Occurs in approximately 0.6 to 0.9% of deliveries.
• Ocular injuries: Significant ocular injuries can occur, including vitreous hemorrhage, lacrimal duct or gland injury, orbital fracture, hyphema, and disruption of Descemet’s membrane of the cornea. These occur in about 0.2% of deliveries, and their incidence increases in deliveries involving the use of forceps.

Extracranial injuries are those which occur during delivery as a result of edema or bleeding into various locations within the skull and scalp. These include:

• Caput succedaneum
• Cephalohematoma: Occurs in approximately 1 to 2% of all deliveries and is more company in deliveries involving vacuum extraction or the use of forceps.
• Subgaleal hemorrhage (SGH): Occurs in roughly 0.0004% of spontaneous vaginal deliveries and 0.0059% of deliveries involving vacuum extraction. The reported mortality of infants with SGH is between approximately 12 and 14%.
• Skull injuries: Linear fracture, depressed fracture, and occipital osteodiastasis.

Neonatal neurologic injuries include:

• Facial nerve injury: Occurs in approximately 0.1-0.7% of births.
• Brachial plexus injury: Occurs in approximately 0.04-0.2% of births. Brachial plexus injury is most often associated with Erb palsy and can also be associated with such traumatic lesions as fractured humerus (10%), fractured clavicle (10%), subluxation of cervical spine (5%), cervical cord injury (5-10%), and facial palsy (10-20%). Other plexus injuries include Klumpke paralysis, total (mixed) brachial plexus injury,
• Horner syndrome, diaphragmatic paralysis, and lumbosacral plexus injury.
• Phrenic nerve injury
• Spinal cord injuries: Occur rarely, or about 0.14 per 10,000 live births.
• Laryngeal nerve injury

Infant fractures that can occur include:

• Clavicle fractures: The most common fractures in newborns. Clavicle fractures due to birth trauma occur in about 0.5-1.6% of deliveries.
• Femur fractures: Fractures of the femur occur in about 0.0013% of live births.
• Humerus fractures: Humerus fractures occur in about 0.002% of deliveries.
• Skull fractures: The incidence of depressed skull fractures in one report was 3.7 per 100,000 deliveries.

Preterm infants are at a greater risk for birth-associated fractures than term infants and fractures, with fractures in the ribs being most common for preterm infants.

Dislocations caused by birth trauma can also occur, although they are less common.

Infant intra-abdominal birth trauma can occur, most commonly affecting the spleen, liver, and adrenal gland.

Neonatal infections, such as sepsis, bacterial meningitis, and others, can also be acquired during birth. Some facts about neonatal infections include:

• Sepsis is one of the most significant causes of neonatal morbidity and mortality.
• Sepsis has many different maternal risk factors, such as: low socioeconomic status, poor nutrition, substance abuse, and poor prenatal care.
• Sepsis also has intrapartum risk factors, including premature labor, maternal urinary tract infection, premature rupture of fetal membranes, maternal fever, chorioamnionitis, prolonged labor, rupture of membranes after 12-18 hours.
• Sepsis has neonatal risk factors, such as birth asphyxia, male gender, twin or multiple gestation, meconium aspiration, galactosemia, congenital anomalies of skin or mucous membranes, malnourishment, prolonged hospitalization, low birth weight or prematurity, and absence of spleen.
• Bacterial meningitis affects 1 in 2500 live-born infants.

Medical malpractice is the third leading cause of death in the United States. One type of medical negligence is a birth injury, or any type of impairment to an infant’s body function or structure due to an injury occurring at or around the time of birth. Birth injuries typically refer to those injuries caused by a lack of oxygen to the baby’s brain or a brain infection. Birth trauma refers to those injuries caused by mechanical damage.In 2006, roughly 157,700 injuries to newborns and mothers occurred during childbirth. Unfortunately, many of these injuries were due to preventable mistakes/medical malpractice.

The information presented above is intended only to be a general educational resource. It is not intended to be (and should not be interpreted as) medical advice. These facts and figures are by no means exhaustive and may vary based on a number of factors.

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