Birth Asphyxia
Birth asphyxia happens when a baby did not get enough oxygen and/or blood flow before, during, or right after childbirth. It can cause permanent brain damage, hypoxic ischemic encephalopathy, and lead to lifelong disabilities like cerebral palsy and Erb's palsy.
What Is Birth Asphyxia?
Birth asphyxia, also referred to as neonatal asphyxia or perinatal asphyxia, occurs when a baby does not get enough oxygen and blood flow to the brain before, during, or after birth. This can injure the baby's brain and cause damage to other organs if it is not treated quickly.
Birth asphyxia is one of the most common causes of cerebral palsy. Depending on how quickly doctors responded, the severity of brain damage and symptoms can vary from mild to severe.
How Common Is Birth Asphyxia?
Birth asphyxia affects roughly 2-3 babies per 1,000 births in high-income countries, including the United States. In developing countries where neonatal and obstetric care is harder to access, the rate increases to as high as 10 babies per 1,000 births.
23% of all neonatal deaths are caused by birth asphyxia, around 900,000 deaths annually. Nearly 25% of babies with birth asphyxia suffer from permanent brain damage.
What Causes Birth Asphyxia?
Birth asphyxia usually happens because something interferes with the baby's oxygen supply or blood flow around the time of birth.
There are multiple ways this can happen, including:
Before Birth
- Severe maternal illness (for example, uncontrolled high blood pressure or severe infection)
- Problems with the placenta, such as abruption (when the placenta separates from the uterus too early).
- Restricted blood flow through the umbilical cord or placenta.
During Birth
- Umbilical cord compression or prolapse, where the cord is squeezed or slips out before the baby.
- Very prolonged, difficult, or obstructed labor (such as shoulder dystocia).
- Severe maternal bleeding, such as hemorrhaging, or very low blood pressure.
- Placental abruption or uterine rupture (where the uterus tears during labor).
If fetal monitoring spots warning signs such as oxygen drops or worrying heart rate patterns, the delivery team must respond quickly. Oftentimes, this involves changing the mother's position, giving medications, or performing an emergency C-section.
After Birth
- Severe breathing problems, lung disease, or pneumonia.
- Serious infections like sepsis that affect oxygen and blood pressure.
- Heart problems that limit blood flow.
What Are the Signs and Symptoms of Birth Asphyxia?
Doctors will look at patterns during the first minutes and hours after birth to determine if birth asphyxia occurred. The most common signs and symptoms of birth asphyxia include:
- Shallow breathing or difficulty starting or maintaining breathing
- Very poor or abnormal muscle tone (baby appears limp or unresponsive)
- Epilepsy (seizures) appearing within the first few hours or days of life
- Pale or bluish tint to the skin despite resuscitation
- Abnormal fetal heart rate during labor (possible sign of distress)
- Evidence of metabolic acidosis (high levels of acid in the blood)
How Is Birth Asphyxia Diagnosed?
The first and most common way of diagnosing birth asphyxia is with the Apgar score, which immediately evaluates a baby's breathing, heart rate, reflexes, muscle tone, and skin color at 1 and 5 minutes after birth. Depending on the baby's health, they will receive a score between 0 and 10.
Higher Apgar scores (7 or more) indicate good health, while lower scores (under 7) are a sign the baby needs medical attention. While it's unusual for most babies to have a perfect Apgar score of 10, a low score of 3 or less means that a baby is more likely to have birth asphyxia and should be evaluated.
Other Ways Birth Asphyxia Is Diagnosed
Other tests and evaluations doctors use to diagnose birth asphyxia include:
- Labor and delivery history: Doctors review if there were umbilical cord problems, uterine rupture, placental abruption, severe maternal hypotension, or other clear events.
- Fetal heart rate patterns: They check tracings to determine if there were any severe abnormalities before birth.
- Umbilical cord or early blood gas results: These show how severe oxygen deprivation was and if acid levels in the blood were higher than normal.
- Neurological exams: Doctors look for signs of brain damage like abnormal tone, poor feeding, seizures, or weak reflexes.
- Brain imaging: MRI can help detect patterns of brain injury caused by loss of oxygen.
How Is Birth Asphyxia Related to HIE and Cerebral Palsy?
When oxygen and blood flow are restricted or interrupted at birth, the cells in the area of the baby's brain that control movement and muscle control become injured or die. This is commonly known as hypoxic ischemic encephalopathy, or HIE, and is one of the most common causes of cerebral palsy in infants.
HIE can range from mild to severe depending on the level of injury. Some babies will make a full recovery, while others develop long-term disabilities and require lifelong care and support.
Note: Even though cerebral palsy is one of the most common outcomes of children with birth asphyxia, it's important for parents to know that:
- Not every child with cerebral palsy had birth asphyxia, and
- Not every baby with birth asphyxia develops cerebral palsy
How Is Birth Asphyxia Treated?
When doctors notice a baby is suffering from birth asphyxia, immediate action must be taken. The first priority is helping the baby to breathe and maintaining their circulation. A doctor may intervene by:
- Providing positive pressure ventilation or oxygen support by using a CPAP (continuous positive airway pressure)
- Chest compressions and using medications if needed
- Performing an emergency C-section
These first minutes are critical for survival and for limiting further brain damage. Early treatment helps significantly improve long-term outcomes for infants with birth asphyxia.
If asphyxia leads to HIE and is moderate to severe, doctors may move the baby to the NICU to be carefully monitored and use advanced treatments to help them recover, such as:
- Therapeutic hypothermia (cooling) by lowering the baby's internal body temperature to 92.3°F for 72 hours. This slows brain cell damage, reduces inflammation, and limits the spread of the brain injury.
- Dialysis to help support the kidneys by removing excess waste from the body.
- Seizure management with medications or EEG monitoring.
- Organ treatment and support for the kidneys, liver, and heart.
- Careful monitoring of breathing, blood pressure, blood sugar, and organ function.
- IV for nutrition if feeding is difficult or not possible.
- Nitric oxide supplied through a breathing tube.
- Heart and lung pumps for life support.
Can Birth Asphyxia Be Prevented?
Not every case of birth asphyxia can be prevented, but there are many ways to reduce risks, such as:
Before and During Pregnancy
- Good prenatal care to monitor maternal health and fetal growth.
- Properly managing high-risk conditions such as preeclampsia, diabetes, or severe anemia.
During Labor, Delivery, and After Birth
- Appropriate fetal monitoring and responding quickly to any concerning patterns of distress.
- Being prepared for emergencies like umbilical cord prolapse, placental abruption, or uterine rupture.
- Using induction, augmentation, delivery tools (such as forceps or vacuum), or performing a C-section if needed.
- Medical staff being ready to respond with neonatal resuscitation after delivery when the baby fails to breathe.
Can a Baby Recover From Birth Asphyxia?
Yes, many babies make full recoveries if the lack of oxygen was mild or treated quickly. Even in cases where babies experienced mild hypoxic ischemic encephalopathy, they often recover within days or weeks, especially if they received prompt care and early developmental follow-up.
Babies who experienced more severe birth asphyxia or HIE have a higher risk of long-term disabilities such as cerebral palsy, learning difficulties, or epilepsy. However, even in this group, outcomes can vary, with some children having significant disabilities while others make more progress than expected.
Since no one can know a baby's full potential in the first days or weeks, doctors will recommend long-term monitoring and treatment, including physical, occupational, and speech therapy when needed.
While treatment can't erase an injury, it helps your child build skills, prevent complications, and make the most of their unique strengths over time.
What Are the Long-Term Complications of Birth Asphyxia?
Since birth asphyxia affects the whole body, babies with moderate to severe birth asphyxia may face challenges, such as:
- Multi-organ injury, including damage to kidneys, heart, liver, lung, and coagulation system.
- Ongoing feeding difficulties or problems with digestion
Birth asphyxia can also cause neurological developmental disorders and may affect children in different ways, including:
- Autism and other behavioral challenges
- Cerebral palsy (typically spastic or dyskinetic)
- Lowered IQ and cognitive issues
- Learning differences
- Hyperactivity
- Erb's palsy
- Schizophrenia and other psychotic disorders
- Attention-deficit disorder
Not every child with birth asphyxia will necessarily have all or any of these symptoms. The type of challenges a child may experience depends on the severity of the injury and how quickly treatment was started.
Resources for Families of Children Who Suffered From Birth Asphyxia
Finding out that your child has suffered from birth asphyxia can feel heartbreaking. Just know that you are not alone. At Cerebral Palsy Hub, we've compiled resources to help families get through a difficult diagnosis and to connect with support and communities when needed.
What Parents Can Do After a Birth Asphyxia Diagnosis
If your baby has experienced birth asphyxia or HIE, you may feel overwhelmed and scared for their future. There are steps you can take to ensure that your child will have the best support possible.
- Ask questions. Setting up a family meeting with neonatology and neurology specialists can help you to understand what happened in detail and how to best prepare for your child's future.
- Request copies of key medical records, including discharge summaries, imaging reports, and NICU notes.
- Make sure your baby is referred to early intervention and follow-up neurology/rehab clinics.
- As your child grows, keep track of their developmental milestones and invest in physical, occupational, and speech therapy, and mobility aids or assistive devices if needed.
- Consider contacting a birth injury lawyer if you're concerned that medical negligence during labor and/or delivery may have contributed to your child's condition.
Most of all, remember this: Your baby is more than their MRI or diagnosis. Many children with a history of birth asphyxia show remarkable resilience and strength when they receive early and coordinated care. A supportive family that advocates for them can make all the difference in their condition and their future.
Birth Asphyxia FAQs
Written and Medically Reviewed by:
Cerebral Palsy Hub Team
Cerebral Palsy Hub was founded to help support children and their families with cerebral palsy and to create a safe space for those affected. We strive to provide the most accurate, up-to-date information, and tools to help give your child the life they deserve.
Last Updated: January 17, 2026
