Spinal Cord Injury and Birth Trauma

Injury to a baby’s spinal cord during birth has become rarer over the years, due to improvements in prenatal healthcare and obstetrical practices (1). However, spinal cord damage is still a potential outcome of traumatic birth injury – that is, when the infant experiences excessive mechanical force during labor and delivery. In many cases, perinatal spinal cord injury and other forms of birth trauma are the result of medical malpractice.

Although infants with spinal cord injuries may recover some function, the long-term damage can be profound, including paralysis and problems with breathing, eating, and digestion. Newborns with spinal cord injury should receive immediate medical attention in order to minimize permanent effects. They will also likely require extensive treatment, therapy, and support throughout their lives, which can help to alleviate negative symptoms and maximize function/independence.

During the birthing process, the spinal cord cord may sustain a bruise (contusion), partial tear, or complete tear (transection) (2). Spinal cord injuries caused by birth trauma most often affect the area near the neck and upper/mid back (the cervical and thoracic sections) (1, 2).

The following factors can cause or increase the risk of spinal cord injury during birth (3, 4):

• Abnormal fetal presentation, especially breech
• Versions (when a physician attempts to rotate the baby into a better position for vaginal birth)
• Excessive traction
• Cephalopelvic disproportion (CPD)
• Macrosomia
• Prolonged labor and delivery, especially deep transverse arrest of descent
• Labor that is too rapid
• Oligohydramnios
• Vacuum extraction or midcavity forceps use (learn more about these tools and associated dangers here)
• Extreme prematurity or very low birth weight
• Fetal abnormalities
• A mother who has never been pregnant before (prima gravida)
• Traction on the spinal cord during a delivery involving shoulder dystocia

In breech deliveries, the lower cervical and upper thoracic regions of the spinal cord are most likely to be injured. In vertex (head-down) deliveries, the upper and mid-cervical regions are more often affected.

It is very important that physicians be well aware of these causes and risk factors, so that they can prevent spinal cord injury before it occurs. In some cases, this will involve performing a necessary C-section delivery (3).

The spinal cord is made up of nerves which carry messages between the brain and other parts of the body (2); the effects of a spinal cord injury vary depending on the extent and location of the damage.

The severity of the injury determines whether it is “complete” or “incomplete.” If someone has a complete spinal cord injury, that means that below the site of injury, they have no movement or feeling. If they have an incomplete injury, there is still some degree of movement or feeling.

Injuries higher up the spinal cord usually result in more severe symptoms; if the damage is near the neck, respiratory function is more likely to be affected.

The main signs and symptoms of spinal cord injury include the following. An individual may experience only some or all of these (1, 2, 3):

• Weak muscles (hypotonia)
• Inability to move (or difficulty moving) muscles in the chest, arms, or legs
• Reduced or no feeling in the chest, arms, or legs
• Reduced bowel and bladder function
• Respiratory issues
• Difficulty regulating heart rate, blood pressure, sweating, and body temperature

Serious spinal cord injuries are often classified as paraplegic (loss of feeling and movement in the lower half of the body) or quadriplegic/tetraplegic (loss of feeling and movement from the chest down) (5).

Sometimes, spinal cord injuries are mistaken for other types of birth injury, such as hypoxic-ischemic encephalopathy (HIE) (3). HIE is a type of brain damage caused by oxygen deprivation, which can lead to cerebral palsy and other disabilities.

Because the signs of a spinal cord injury may resemble other birth injuries and medical issues, it is very important to consult a doctor for diagnosis (2).

The full damage caused by a spinal cord injury may not be immediately apparent. Whenever one is suspected, doctors should conduct a full medical evaluation and provide the baby with immediate medical attention (2).

In addition to a physical examination and consideration of medical history, doctors typically use MRIs or CT scans in order to make a diagnosis (1, 2, 3). They may also do blood work and X-rays (2).

Spinal cord injuries often result in permanent damage. However, there are a variety of medical interventions that can minimize negative symptoms and maximize function. These include the following (1, 2, 3):

• Immobilization
• Corticosteroids
• Acetyl-1-Carnitine
• Methylprednisolone
• Supportive treatment
• Physical therapy
• Occupational therapy
• Surgery
• Mechanical ventilation
• Bladder catheterization
• Insertion of a feeding tube

It is important for doctors to promptly diagnose and initiate treatment for a baby with a spinal cord injury because the sooner they intervene, the better the outcome will be. An infant with a spinal cord injury should also be very carefully monitored throughout the treatment process, for complications involving blood pressure, body temperature, and other vital functions (2).

Currently, long-term treatment for children with spinal cord injuries involves an interdisciplinary medical team, which works to manage pain, prevent muscle wasting and contractures, improve independence, etc. For more detailed information on treatment options for children with spinal cord injuries, click here.

Recent research on the central nervous system (CNS) indicates that it is much more capable of recovery than previously thought. In the future, treatments to promote neuron regeneration may be much more effective and available (1).

Medical professionals can often prevent spinal cord injuries and other forms of birth trauma by carefully monitoring patients’ pregnancies and deliveries, and intervening as necessary. If doctors use birth-assisting tools such as forceps or vacuum extractors, or attempt to rotate a baby into a better position for birth, it is critical that they do so carefully and as indicated.

1. Haq, I. U., & Gururaj, A. K. (2012). Remarkable recovery in an infant presenting with extensive perinatal cervical cord injury. BMJ case reports, 2012.
2. Stanford Children’s Health. (n.d.). Retrieved October 30, 2018, from https://www.stanfordchildrens.org/en/topic/default?id=acute-spinal-cord-injury-in-children-90-P02590
3. Birth Trauma. (2017, January 07). Retrieved October 30, 2018, from https://emedicine.medscape.com/article/980112-overview#a2
4. Byers, R. K. (1975). Spinal‐cord injuries during birth. Developmental Medicine & Child Neurology, 17(1), 103-110.
5. Spinal Cord Injury | Boston Children’s Hospital. (n.d.). Retrieved October 30, 2018, from http://www.childrenshospital.org/conditions-and-treatments/conditions/s/spinal-cord-injury