Birth Trauma, Brain Injuries, Folklore and Science

It has become an entrenched belief in America that trauma during birth leads to brain injuries among newborns. Cerebral palsy in particular has come to be associated with birth problems, even among labor and delivery nurses who joke that "if they don't get that baby out quick, it's gonna be riding the short bus." Lawsuits over birth trauma have led to millions of dollars in awards, raised malpractice premiums for obstetricians, driven some out of business altogether, and encouraged the ever-rising rate of caesarean section.

The thing is, there has never been any convincing evidence that birth trauma causes brain damage to newborns. Oxygen supply to the newborn is commonly reduced for a brief period during birth, so obviously it is possible for this to be prolonged to the point that brain damage could occur. That doesn't mean it does happen, and it certainly does not mean that any particular brain-damaged baby was harmed by a botched delivery.

Back in 2003, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics published a document titled Neonatal Encephalopathy and Neurologic Outcome that reviewed some of the evidence. Now they have produced an updated version, which is focused on some criteria that might be used to determine if a birth injury took place:

According to the 2003 report, fewer than 10 percent of children with cerebral palsy, the most severe such brain injury, showed signs of asphyxia at birth. Unless certain clear-cut symptoms are present then, brain abnormalities are probably not the result of a complication during labor or delivery, the new report states.

You can read more about this at the Times if you are curious. I am simply fascinated that things get entrenched in our beliefs about medicine, even in the beliefs that doctors have about medicine, without there being any good evidence for them. Whole medical specialties like coronary bypass surgery can flourish in an evidential vacuum. In the case of cerebral palsy, we have decided as a society that the cost of caring for these disabled children will be met largely by lawsuits against obstetricians, in defiance of both science and justice. To protect babies against the phantom menace of birth trauma, and themselves against the real menace of lawsuits, doctors perform tens of thousands of unnecessary caesarean sections, each of them carrying a risk of serious harm.

We really ought to stop.