Birth Injuries
While childbirth is taken for granted to be a routine safe life event, many mothers and babies experience trauma and injuries during labor and delivery. Prior to the 20th Century mothers and babies commonly died during childbirth. The death rate for both has declined dramatically in the past 100 years, but injury still occurs in about 7 per every 1,000 births. This may seem like a small number, but if you are one of the seven the consequences can be severe and life-altering. There is evidence that this number is greatly underestimated. In 2003 a Dr. Cowan found that even when babies are born at 40 weeks with no sign of previous injury during pregnancy or at time of birth babies can still be injured during birth, and not show it immediately. In his study some babies developed seizures within 72 hours of a normal birth and showed injury to the brain on MRI in nearly 70% of these babies.
The degree of brain injury, however, doesn’t have to be so severe as to cause a seizure. The severity can vary greatly between patients. Some babies experience severe trauma while others can sustain a more subtle injury that’s not appreciated until the baby is not gaining weight, not making normal milestones, or having developmental or behavioral problems. When these occur pediatricians often attribute them to the wide variability in childhood development and our genetic differences. Ascribing them to the birth process is usually avoided due to liability problems. No pediatrician or neurologist wants to be the one to point to a birth event as the causative agent of injury when a lawsuit may end up filed against the obstetrician. As a result, parents are often sent on wild goose chases exploring rare genetic and metabolic causes of the developmental problem. Rarely are any found. The only important point to appreciate is that the baby has a wound to the brain and wounds are treatable with hyperbaric oxygen therapy.
Birth Injury Causes
The most common forms of birth injury are ones that are sustained to the head, neck, and face of the baby. In the last 10-20 years, forceps deliveries have become less common due to the cumulative evidence that birth injury took place when using forceps. Unfortunately, even with safety measures in place, birth injuries still happen. This is especially true during prolonged labor or when the baby’s head stalls in the birth canal. During passage of the head through the birth canal the head is compressed since the birth canal is smaller than the baby’s head. Normally the baby moves through the birth canal rather quickly, but when the baby stalls or there is prolonged pushing the compression of the head can result in reduced blood flow and oxygen to the baby’s brain. A similar problem can also occur when the mother is artificially induced to begin labor and the child is precipitously born before the birth canal has had time to widen. This was the cause of a severe birth injury to the first cerebral palsy child Dr. Harch treated with HBOT in 1992.
Birth injuries can occur from other problems, such as breech, face-up, or angled presentations. In addition, injury can occur from placental, uterine, or umbilical cord problems such as ruptures, tears, separations, and bleeding, all of which cause low blood flow and lack of oxygen to the baby. Elective C-sections avoid most of these problems, but emergency C-sections are often done after the injury has occurred. Some birth injuries are preventable, others are simply the result of an unfortunate birthing situation.
Birth Injury Symptoms
The most serious birth injuries are usually sustained to the head of the infant. This includes bleeding under one or more of the cranial bones, swelling or bruising of the head, and most importantly injury to the brain itself. Signs of injury to the face and scalp can be indicative of injury to the brain. Facial injuries are usually broken blood vessels in the face or in the eye of the newborn. Other common birth injuries include broken clavicles (collarbones) and injured shoulders. These are usually apparent right after birth and often don’t require invasive treatment. Babies heal so quickly that many of these injuries heal without consequence. The exceptions are nerve and brain injuries. The nerves behind the clavicle are called the brachial plexus and this collection of nerves can be injured during shoulder births (shoulder dystocia). There is no treatment for this injury and the nerves heal extremely slowly. Similarly, brain injuries are very slow to heal.
Both brachial plexus injuries and brain injuries often result in residual signs and symptoms. With brachial plexus injury it is weakness, decreased use, and lack of sensation in the arm and hand on the side of injury. With brain injuries there is a wide range of signs and symptoms depending on the area of the brain that is injured. Babies can be extremely irritable, unable to be consoled unless constantly held, have severe reflux, extreme sleepiness, decreased use of one or more limbs, floppiness, stiffness, problems with sucking and swallowing, abnormal movements, jerking, decreased vision, decreased hearing, and many other abnormalities. As the newborn grows older they can have delayed milestones, abnormal behavior, emotional problems, problems with balance, delayed speech, learning difficulties, attention deficit, withdrawal, aggression, mood disturbances, and socialization problems. Frequently, the child’s problems escape a formal diagnosis. Other times the child is assigned multiple diagnoses by different doctors in an attempt to characterize the problem.
Regardless of diagnosis, however, once again the key to understanding the baby or child’s problems is to acknowledge that an injury or wound to the brain has occurred at birth. Once this is appreciated, treatment for the wound can begin. More importantly, the world’s best treatment for wounds, hyperbaric oxygen therapy, can be delivered as soon as possible.
Hyperbaric Oxygen Treatment of Birth Injury
The benefit of HBOT for birth injury is that it is a safe, effective, and simple treatment for the wounds caused during childbirth. A wound anywhere in the body is on a timeline from injury to complete healing. Usually, this timeline is about a year in adults, less in children and babies. The goal of HBOT is to begin treatment as soon as possible to stop the injury process and stimulate tissue repair. Like most treatments in medicine the earlier in the injury process that HBOT is delivered the better the results. However, HBOT is beneficial at all stages of injury. In the first 15-20 years of Dr. Harch’s neurological HBOT practice 95% of all patients were treated over one year after their injury or disease onset. The results, reputation, and publications were all based on these chronic cases. Now that patients are discovering HBOT sooner after their injuries, outcomes are even greater.
Since newborn babies, especially brain injured babies, are so fragile, the ideal treatment should be non-invasive and have minimal side effects. This is the case with HBOT. HBOT, when dosed properly, has minimal side effects, is non-invasive, and can be painlessly delivered. For the baby it is a passive treatment; they don’t have to do anything to experience the healing effects of HBOT. But while it is passive to babies, even when they are sleeping in the hyperbaric chamber, HBOT is actively treating and repairing the wounds in their brains. Dr. Harch encourages the mother or father to accompany the baby in the chamber and medically clears the parent with a detailed history and physical exam before chamber treatments.
The Benefit of HBOT for Birth Injury
The benefits of HBOT for birth-injured children are as numerous and varied as the injuries which they incur during birth. When an injured area of the brain that is responsible for the signs and symptoms described above is treated with HBOT those signs and symptoms can improve. Irritable babies can become calm, babies with poor weight gain can begin to gain weight and grow, impaired vision can improve, motor and behavior deficits can be lessened, learning disability can be lessened, and other deficits can be partially or completely reversed. Many of these improvements have been published in HBOT studies in cerebral palsy children and other birth-injured children. The benefits of HBOT for birth injury are different for each child, but a great deal of babies and children achieve faster, measurable, and life-changing results. When HBOT is properly tailored/dosed to the child and their brain injury it can alter the trajectory of the child’s life.
Sources:
https://www.birthinjuryguide.org/treatments/hyperbaric-oxygen-therapy/
https://www.mayoclinic.org/tests-procedures/forceps-delivery/about/pac-20394207
https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02340
Cowan F, Rutherford M, Groenendaal F, Eken P, Mercuri E, Bydder GM, et al. Origin and timing of brain lesions in term infants with neonatal encephalopathy. Lancet. 2003;361(9359:736-42.
