Need an answer ASAP regarding skull fracture in newborn

[adoremybabe]

An aquaintance just had her first baby in a hospital. Her labor began with spontanious rupture of membranes. Her little 7 lb. girl was born 6 hours later. She didn't have an EPI, pushed for around 35 minutes, no episiotomy, no suction, or forceps. Her little dd's hands and feet were purple. The medical personel were very concerned that this child had a severe heart condition and rushed her to a more suitable hospital about 20 minutes away. The new mother had to be taken in her own family's vechicle a couple of hours later. No family member went along with the baby.

Now apparently, this little baby's heart is just fine but they found a skull fracture. Our big question is, how on earth did this precious little baby get a skull fracture? The medical personel say that it was from her mother progressing so fast in labor and only 35 minutes of pushing.

Call me ignorant but I was under the assumption that the skull was supposed to mold into shape during labor. I had my almost 11 pounder in 6 hours, and pushed for maybe 10-12 minutes and his skull molded to come out. He still has strong ridges where the plates overlapped.

So what should this family do? Should they suspect some sort of malpractice? Should they take any type of legal action to make sure that their daughter was taken care of properly? The family is questioning how this could happen. They feel unsettled.

Thank you so much far any advice.

[elanorh]

I don't know anything about this from a medical perspective (that is, medical education).

BUT - with dd2, I knew I was in labor at about 5pm and she was born at 6:40pm. I think I was pushing for maybe 5 minutes. Which is a significantly faster labor than your friend's, and no skull issues.

With dd1, I thought I *might* go into labor when I had bloody show (about 5pm) -- started feeling labor pressure at 9pm, at the hospital at 12:30, and dd1 was born at 4:30am. She was slower because she was posterior and didn't turn 'til I started to push, I think I pushed less than 20 minutes.

My instinct says that there's something fishy to their (hospital/EMTs) story. But I don't know enough to know whether maybe it could have been the sudden breaking of the bag of waters which banged her head down on the pelvis or something? Also, I labored 'til nearly push time with intact bags of water .... I don't know whether the lack of that cushion might have caused issues?

[Peacemamalove]

Originally Posted by elanorh

I don't know anything about this from a medical perspective (that is, medical education).

BUT - with dd2, I knew I was in labor at about 5pm and she was born at 6:40pm. I think I was pushing for maybe 5 minutes. Which is a significantly faster labor than your friend's, and no skull issues.

With dd1, I thought I *might* go into labor when I had bloody show (about 5pm) -- started feeling labor pressure at 9pm, at the hospital at 12:30, and dd1 was born at 4:30am. She was slower because she was posterior and didn't turn 'til I started to push, I think I pushed less than 20 minutes.

My instinct says that there's something fishy to their (hospital/EMTs) story. But I don't know enough to know whether maybe it could have been the sudden breaking of the bag of waters which banged her head down on the pelvis or something? Also, I labored 'til nearly push time with intact bags of water .... I don't know whether the lack of that cushion might have caused issues?

I agree with elanorh ! Maybe get a second opinion somewhere?

[SunShineSally]

My Ds was waayyy faster! I labored for only 30 minutes! and pushed for only 15minutes no water breaking no anything i went right into transition and he had no skull fractures he was blue as the cord was around his neck but pinked up with some oxygen and was perfect ever since! Now that is extreamily faster than your friends baby. I hope they find out why and what happened to her! I would get it investigated if I was her that is not even close to a good answer! Also I am not a professional or anything but i also have been told that their heads mold that is why they have soft spots to beable to pass through the birth canal

[lifeguard]

I wonder what they mean by skull fracture? Fracture can mean a whole range of severity.

[thefreckledmama]

I think a huge clue as to "what happened" would be the location of the skull fracture.

The thing is, baby bones are soft. I would imagine it would take quite a bit of blunt force to actually fracture a newborn's skull. If I were the family, I would definitely get a second opinion, and possibly consult with an attorney.

[katelove]

It really depends what type of fracture it is. A congenital skull fracture may be an early sign of a couple of rare diseases (usually a linear fracture) or it may be the result of the baby's head pressing against the pelvis (ping pong fracture).

Both of these scenarios are rare though. The type of investigation will depend of the type of fracture and any other signs which may be present.

[SeekingSerenity]

I have really fast, intense transitions and have never had a baby with such a problem. My last one, I went from 5cm to having a baby in 17 minutes. His was the largest head of any of my children - he came through the birth canal so fast that he didn't have a chance to turn. He just blasted out, a small moment of shoulder dystocia (he turned dark purple), and then there he was. All of my children are born this way (each one has been just a little faster than the one before). The water had already broken with Lil'Man, too, yet his head molded as it should.

I just wanted to share that - the labor and transition can go really fast, and there should not be something as extreme as a skull fracture. Although, with that said, I suppose you can't rule it out. If it was me, though, I'd be consulting a medical specialist and possibly legal counsel. That's just my thoughts. Poor little baby.

[hillymum]

I have never heard of fast labour causing any damage to a ies skull! I had two boys born in 90 minutes and their skulls were just fine. Someone is telling porkies!

[StrawberryFields]

Six hours of labor with "only" 35 minutes of pushing doesn't sound like a super duper fast one to me. My own pushing stage with dd lasted ONE MINUTE and I had never heard of skull fracture being a possibility. I would also get a second opinion because something does not seem right about that diagnosis. I am also not a professional and I have no experience with birth complications, but if I were in that situation that is how I would feel and what I would do.

[cathicog]

did somebody drop the baby? I would advise the parents to get a copy of the medical records for this event, just to read them...I have never heard of a skull fracture from a normal birth.

[Jane]

It's been known to happen after totally normal, totally un-interfered with labors.
Pretty rare. In in similar scenario, sometimes babies are born with deep bruising from seemingly gentle births, even cephalohematomas (deep bone bruising) from natural, "normal" spontaneous births.

She needs more information.

[BugMacGee]

My osteogenesis imperfecta (brittle bone disease) senses are tingling. Has baby been worked up for this?

[kcparker]

Originally Posted by BugMacGee

My osteogenesis imperfecta (brittle bone disease) senses are tingling. Has baby been worked up for this?

If that's the case, they should definitely get a diagnosis. There was a heartbreaking case of brittle bone disease that was undiagnosed (despite the parents' request), and the little girl in question was removed from her family for a year and a half because medical personnel reported them to Social Services for suspected child abuse.

[flapjack]

We don't know how common skull fractures are in normal births, because the majority of newborns have no reason to be examined for them. I'd suggest that a logical first place to start would be to request a copy of her (both her, actually- both mother and baby's) notes and see what happens and what turns up.

[citipeach]

Just wanted to give you my experience with skull fractures:

I was in labor for 36+ hours with broken membranes when my midwife handed care over to an OB at the birth center I was delivering at (I had been pushing for 2 hours already without much progress.) He proceeded with vaccuum extraction. My son had a large bruise on his head afterwards which made him a little jaundiced. After a day under the bili lights, the jaundice wasn't getting much better so the neonatologist ordered a CT of his head just to be on the safe side (to see how big the bruise was, if it was a bone bruise, etc.) Well, it turns out his skull was fractured by the vaccuum. My son was transferred to Children's in Boston to be examined by a neurosurgeon. In the end, it ended up being no big deal, as there was no brain swelling. The neurosurgeon described the fracture as a "ping pong" fracture. It's not a crack like we think of when we break and arm or a leg. It's more like a dent in the skull. In fact, he said in older children who present with this type of fracture, they use something in the ER that looks like what they use at an autobody to remove dents from cars.

Anyhow, the takeaways here are:

Skull fractures ARE possible, even with a soft malleable head.
Get a neuro consult, they can possible determine what kind of fracture and how it occurred.

Best of luck to your friend. I can imagine she is going through a lot of worrying, ESPECIALLY not knowing how the fracture occurred.

[kltroy]

Like a previous poster, I was going to suggest they check for osteogenesis imperfecta. A skull fracture from birth could easily result from something like this.

[Serenyd]

Originally Posted by SeekingSerenity

If it was me, though, I'd be consulting a medical specialist and possibly legal counsel.

nak

[ks3885]

Things like this can and do happen on occasion, maybe it was the AROM but I strongly doubt it. It doesn't sound like her birth had much in terms of intervention. I've seen second stages of 1-5 minutes with everything from lots of bruising and no bruising, cephalhematomas and perfectly shaped unmolded heads.

I would be less interested in legal counsel and more interested in finding out details about the fracture and ruling out bone disorders, etc. It sounds like she had a pretty ideal labor in terms of length, and no instruments at the birth that were applied to the baby so I really doubt this had anything to do with the providers at the birth. In my personal/professional opinion as an L&D nurse. I mean, I don't really see where her providers could be implicated if there wasn't even any instrumentation at delivery and no resus needed afterwards, etc. UNLESS it was the remote possibility that the AROM did it, if she was indeed AROMed.

Did she have an FSE (internal fetal monitor) during labor? I mean, that gets screwed into the baby's head, so that's possible but again those are used routinely and skull fractures are quite rare.

[BugMacGee]

Any updates?

If the baby was dropped, there would be one heck of an obvious bruise and probable evidence of other soft tissue injury.