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Birth trauma describes physical injuries during labor and delivery, both to the neonate and to the birthing person, as well as psychological injuries or stress that can occur to the individual giving birth and those involved in the delivery process. The birthing process is a psychologically and physiologically stressful event for both the birthing person and the neonate. Physical birth trauma can include damage to the maternal pelvic organs, including perineal lacerations, particularly second through fourth degree tears, which are among the most common maternal injuries, leading to long-term complications such as dyspareunia, urinary and fecal incontinence, and pelvic organ prolapse, as well as life-threatening hemorrhage. Neonatal birth trauma can include minor scalp swelling, significant intracranial hemorrhage, brachial plexus damage, broken bones, and the sequelae of decreased oxygenation to the fetal brain during the delivery process. Moreover, psychological stress can include negative emotional distress related to unexpected events during or after the delivery process or any adverse reaction to the birthing experience, which can lead to long-term sequelae such as posttraumatic stress disorder (PTSD). This activity reviews common birth-related physical and psychological maternal and neonatal injuries, as well as the mechanism of injury, clinical features, and management of various birth-related traumatic events. This activity for healthcare professionals is designed to enhance the learner's competence in identifying and, when possible, preventing both physical and psychological birth trauma, performing the recommended evaluation, and implementing an appropriate interprofessional approach when managing this condition to optimize maternal and neonatal outcomes. Objectives: Identify the clinical manifestations of common intrapartum birth trauma injuries. Evaluate the most common risk factors associated with psychological maternal birth trauma. Determine the mechanism of injury underlying various types of birth trauma. Assess the importance of interprofessional team training and collaboration in the prevention and management of all forms of birth trauma. Access free multiple choice questions on this topic.

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.[1] 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.[2] 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.[3] 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

Psychological birth trauma includes posttraumatic stress disorder (PTSD), postpartum depression, anxiety, and other acute mood disorders.[3] 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.[4]

Effective prevention and management of birth trauma rely on the coordinated efforts of an interprofessional team comprising obstetricians, midwives, neonatologists, pediatricians, nurses, mental health professionals, social workers, and ancillary staff. Each team member plays a critical role in identifying, communicating, and mitigating risk factors during the prenatal, intrapartum, and postpartum phases of care. Advances in antenatal diagnostics allow clinicians to anticipate complications such as fetal malpresentation or congenital anomalies, thereby facilitating early preparation for high-risk deliveries. Clear communication between antepartum and intrapartum teams about potential physical and psychological risk factors—including fetal size, maternal pelvic anatomy, and mental health history—enhances preparedness and promotes patient-centered care. Collaborative education and planning, involving all members of the care team, reinforces high-quality prenatal management and reduces the likelihood of adverse events during labor and delivery. During the intrapartum period, structured role delineation and shared protocols enhance team performance and patient safety. Coordinated educational training among physicians, midwives, nurse practitioners, and nurses on maneuvers for resolving obstetric emergencies, such as shoulder dystocia, can reduce maternal and neonatal complications. Communication between pediatric and obstetric teams becomes especially important in scenarios like operative vaginal deliveries, where certain injuries are more likely. Newborns with birth trauma require ongoing monitoring by an interprofessional team to assess neurodevelopmental progress and implement early interventions, eg, occupational and speech therapy, when necessary. This integrative, patient-centered approach strengthens outcomes, supports family well-being, and reinforces safety and accountability throughout the perinatal care continuum.