Birth Trauma

Excerpt

Birth trauma refers to both physical and psychological trauma that occurs during, or as a result of, the birthing process, involving the individual giving birth, the neonate, or both. Although physical injuries are more frequently considered when birth trauma is considered, the birthing process is a psychologically and physiologically stressful event that can impact patients' mental health as well.

Maternal Birth Trauma

Maternal physical injuries primarily include perineal lacerations, which can have both short and long-term effects. Perineal lacerations are the most common somatic injury, occuring in up to 90% of vaginal deliveries. Perineal lacerations are graded from first degree (interruption of vaginal mucosal only) to fourth degree (injury comprising the vaginal mucosa, pelvic floor muscles, external and internal anal sphincters, and the rectal mucosa). Even after repair, lacerations often lead to pain, dyspareunia (pain with intercourse), pelvic floor dysfunction, and mood concerns. Third and fourth degree lacerations involve obstetric anal sphincter injuries (OASI) and pelvic floor injuries of the levator ani muscles, which can lead to long term pelvic floor dysfunction including urinary or fecal incontinence and pelvic organ prolapse. These physical complications can limit the birthing person's ability to care for their newborn and may impact their future sexual intimacy. Please see StatPearls' companion resources, "Perineal Lacerations" and "Pelvic Floor Dysfunction", for further information on these topics.

Psychological birth trauma includes posttraumatic stress disorder (PTSD), postpartum depression, anxiety, and other acute mood disorders. Numerous risk factors contribute to this form of trauma, which often arises in conjunction with physical birth trauma rather than as an isolated experience. Psychological birth trauma, like its physical counterpart, can produce long-term consequences for both the birthing person and the newborn, affecting emotional well-being, maternal-infant bonding, and overall family health.

Neonatal Birth Trauma

Neonatal birth trauma encompasses a broad spectrum of injuries, ranging from minor to severe, caused by mechanical forces during labor and delivery. These injuries include head trauma, intracranial and extracranial hemorrhages, and brachial plexus injuries. Please see StatPearls' companion resource, "Brachial Plexus Injuries", for further information. Birth injuries differ from congenital malformations and can typically be distinguished through focused clinical assessment shortly after delivery.

Over recent decades, birth trauma rates have declined due to advances in obstetrical techniques and an increased reliance on cesarean delivery, particularly in cases of labor dystocia where operative vaginal deliveries using vacuum or forceps might previously have been performed. Between 2004 and 2012, the rate of birth trauma dropped from 2.6 to 1.9 per 1,000 live births. This trend aligns with a consistent decrease in operative vaginal deliveries and a corresponding increase in cesarean section rates over the past 30 years.