Medical Malpractice
When the delivery of an infant becomes somehow complicated, like when the baby’s head gets stuck momentarily, the sensitive bones and tendons of a child can quickly become injured.
Although swelling from delivery complications usually decreases in a few days, some more severe cases may result in permanent birth injuries. This is especially true when the brain is involved.
After this, it is not uncommon to observe acquired scalp swelling. When considering potential diagnoses, medical professionals typically look at caput succedaneum, cephalhaematoma, subgaleal hemorrhage, and subgaleal CSF collection.
Caput succedaneum, the focus of this article, is one swelling that may lead to permanent injuries in rare cases.
This Article Addresses:
- What Is Caput Succedaneum and How Does This Type of Injury Usually Occur?
- What are Some Examples of Permanent Injuries Caused by Swelling Associated with Caput Succedaneum?
- What Causes Caput Succedaneum?
- Is Caput Succedaneum Evidence of a Birth Injury?
- What is the Difference Between Caput Succedaneum and Cephalohematoma?
- Example of a Classic Caput Succedaneum Birth Injury Case
- Sample Verdicts and Settlements in Birth Injury Lawsuits
What Is Caput Succedaneum and How Does This Type of Injury Usually Occur?
When a baby becomes stuck during delivery, physicians sometimes use a device known as a vacuum to help dislodge the infant. Sometimes the force of this vacuum impacts the infant’s soft skull, causing severe swelling that may result in permanent brain injuries if the swelling does not subside in a few days.
Caput succedaneum refers to a swelling that develops beneath the subcutaneous tissue and above the galea aponeurotica of a newborn’s scalp. This extracranial hematoma is considered a common and usually benign condition, arising primarily during vaginal births due to prolonged pressure on the infant’s head against the cervix, which obstructs venous return in the presenting part of the scalp. This venous congestion results in fluid accumulation and swelling, which often crosses cranial suture lines and may be accompanied by skin bruising or ecchymosis. The good news is that this injury is usually temporary and has no lasting impact on the child. But it can be a marker for trouble.
According to neurosurgical literature, prolonged vaginal deliveries and vacuum-assisted extractions are the most significant risk factors for caput succedaneum formation. These swellings are typically visible immediately after birth and are frequently managed conservatively. Most cases resolve within a few days without any lasting cosmetic or neurological effects. However, their presence, particularly in conjunction with abnormal neurological signs, should prompt close observation, as they may serve as early indicators of deeper trauma such as arachnoidal hemorrhage or brain swelling.
Caput succedaneum occurred significantly more often in infants who had abnormal neurological signs. Although no harmful effects could be attributed to the caput succedaneum per se, we believe that it is likely to be an indication that similar circulatory disturbances occur at deeper structures or the fetal head (e.g., arachnoidal hemorrhage or localized brain swelling).
There is no correlation between abnormal neurological signs and plain cephalhaematoma. The latter is often seen after a normal delivery but is not usually associated with abnormal neurological findings.
If the swelling does not subside, it could lead to permanent brain damage. Brain damage in an infant is a tragic injury that forever changes a child’s future.
Vacuum-Assisted Delivery as a Contributing Factor in Caput Succedaneum and Related Injuries
Vacuum-assisted delivery is a well-recognized risk factor for caput succedaneum. During this procedure, negative pressure is applied to the infant’s scalp to assist with extraction from the birth canal. While this can be life-saving in cases of prolonged or stalled labor, it also significantly increases mechanical stress on the newborn’s head—particularly the scalp and subcutaneous tissues. This pressure often leads to swelling in the soft tissue layers, resulting in caput succedaneum.
Clinical data from a retrospective review found that 70% of neonates diagnosed with serious scalp hemorrhages were delivered using vacuum extraction, and an additional 20% underwent vacuum-assisted cesarean deliveries. In these cases, many newborns exhibited tender, fluctuant swelling that crossed suture lines, consistent with caput succedaneum or more serious injuries like subgaleal hemorrhage. Notably,90% affected infants also presented with intracranial or extracranial complications, including subdural hemorrhage, cerebral infarcts, and skull fractures.
These complications are not always immediately obvious. Swelling related to vacuum delivery may first appear similar to benign caput succedaneum but can progress insidiously, leading to symptoms such as apnea, seizures, anemia, and abnormal vital signs. In severe cases, fluid accumulation in the scalp tissue can be extensive enough to shift the position of the ear lobes or cause puffiness around the eyelids, indicating more diffuse subgaleal bleeding.
Although caput succedaneum typically resolves within a few days, its presence following vacuum extraction should not be dismissed. The same study found that infants with delayed diagnosis or missed signs of progressive swelling had higher rates of long-term neurological complications, including cerebral palsy, epilepsy, and global developmental delay. Conversely, neonates who were promptly evaluated and monitored immediately after birth, with hourly head circumference checks and appropriate supportive care, showed a significantly higher chance of healthy development.
These findings underscore that while vacuum extraction remains a valuable obstetric tool, it must be used with great care and followed by vigilant postnatal assessment. Any signs of scalp swelling, bruising, or neurological instability in newborns delivered via vacuum warrant immediate evaluation for both caput succedaneum and deeper, potentially life-threatening complications.
Who Is Responsible?
But who is to blame? Sometimes the physician may have used negligent delivery methods that caused the baby to be stuck, or the doctor may have used too much force in dislodging the infant with a vacuum or other device, both capable of causing caput succedaneum injuries.
An interesting thing about caput succedaneum is that doctors have found a relationship between caput and mode of delivery. The larger the caput, the greater the likelihood of the obstetrician ordering an operative delivery with cesarean section or vacuum extraction.
Examples of Severe Outcomes Associated with Caput Succedaneum
While caput succedaneum is often harmless and resolves without intervention, in rare and extreme cases, it can be associated with more serious complications. Below are examples of adverse outcomes that have occurred when caput succedaneum signaled or contributed to more significant underlying trauma:
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Cerebral Injury Following Traumatic Extraction: An infant who became lodged in the birth canal was delivered using excessive vacuum force. The resulting caput succedaneum was accompanied by diffuse brain swelling, ultimately leading to a diagnosis of cerebral palsy and permanent developmental delays.
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Deformity from Prolonged Pressure and Failed Delivery Intervention: In a prolonged labor, excessive pressure on the infant’s skull caused severe swelling. The resulting caput succedaneum did not resolve and contributed to long-term cranial deformity requiring surgical correction.
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Neurologic Complications Linked to Delayed C-Section: A baby exhibiting signs of fetal distress during labor developed a large caput succedaneum after a failed vacuum-assisted delivery. The delay in transitioning to a cesarean section was cited as a factor in the child’s postnatal seizures and eventual diagnosis of hypotonic cerebral palsy.
These examples underscore the importance of prompt, appropriate clinical decision-making during labor and delivery. While caput succedaneum itself is typically benign, it may serve as a visible indicator of deeper complications requiring immediate medical attention.
What Causes Caput Succedaneum?
Caput succedaneum is caused by external pressure on the baby’s head during labor and delivery. This pressure can result from the baby’s head passing through a tight birth canal. The pressure can also be caused by using a vacuum pump extractor to facilitate delivery.
Is Caput Succedaneum Evidence of a Birth Injury?
Caput succedaneum is a very common condition in newborns, and 98% of the time, babies with caput are perfectly fine and healthy. However, in some cases, caput succedaneum can be one of the earliest indicators of birth trauma, resulting in more serious underlying injuries. Most babies with neurologic damage during birth also display caput succedaneum.
What is the Difference Between Caput Succedaneum and Cephalohematoma?
The main difference is that caput succedaneum is common and not severe, whereas cephalohematoma is uncommon and can be very serious. Both conditions result in swelling of the baby’s head, but cephalohematoma is caused by the pooling of blood just outside the skull and can cause brain damage.
Examples of Verdicts and Settlements in Caput Succedaneum Cases
- Pennsylvania: $1,800,000 Settlement. In this Pennsylvania birth injury case, the plaintiffs alleged that the doctors and hospital failed to properly manage her labor and failed to recognize and respond to fetal distress, including caput succedaneum. The baby suffered hypoxic-ischemic encephalopathy due to the delay before eventually performing an emergency C-section. The injury allegedly caused developmental delays, requiring various therapies and support services. The defendants claimed they did not breach the standard of care but eventually settled the case for $1.8 million.
- Wisconsin: $23,200,000 Verdict. A mother alleged that her baby suffered brain injuries caused by caput succedaneum when the doctor performing her delivery failed to timely order a C-section in a timely manner. The mother had difficulty inducing labor, but the physicians did not notice until it was too late. The physicians instead used a vacuum to remove the baby, who then became stuck in the birth canal. When the baby was forcefully dislodged, it suffered a large caput succedaneum injury as well as shoulder dystocia. The parents sued the doctors and hospital, claiming they were negligent in failing to perform a C-section delivery at the first sign of distress. The claim the jury apparently believed is that Defendant OBGYN left the delivery room and was in his office when significant caput succedaneum presented during delivery, resulting in a series of complications. Juries quickly lose patience with doctors who do not seem to be doing everything they can. When the doctor eventually came back to the delivery room, he attempted several times to extract the baby with forceps without success. He then used a vacuum to facilitate delivery, at which point the baby became stuck in the birth canal again. The baby was delivered with multiple skull fractures and eventually diagnosed with cerebral palsy. The defense lawyers argued in vain that the baby’s type of CP was caused by a stroke and not anything related to the complicated delivery. To establish causation, the plaintiff presented several prominent expert witnesses, including a top pediatric neuroradiologist. Good experts are often crucial, and they were in this case. The jury ruled in favor of the plaintiff and awarded $23.2 million in damages.
- New York: $5,000,000 Settlement. A 36-year-old woman, was admitted to St. Luke’s -Roosevelt Hospital (now Mount Sinai West) in New York by her obstetrician, Dr. Mary Wilson, for a vaginal birth induction. She was more than a week overdue at the time. Before induction, the fetal heart monitor revealed abnormal activity in the mother’s uterus. The baby was born with caput succedaneum and permanent brain damage. The mom alleged that Dr. Wilson never considered the abnormal uterine activity when selecting induction methods. Plaintiff alleged that the OBGYN and hospital failed to properly monitor and manage uterine activity. Specifically, the plaintiff claimed that fetal monitors showed hyperstimulated uterine activity, but the defendants went ahead and gave her Pitocin to induce labor instead of doing a C-section, resulting in a long and stressful delivery. As a result, the baby was eventually born with caput succedaneum, conjunctival hemorrhages, and other injuries, which required two separate surgeries to correct. Sometime later, he was diagnosed with hypotonic cerebral palsy. The doctors contended that the baby’s cerebral palsy was not caused by anything during delivery. After a jury was selected for the trial, the insurance company (CCC Insurance) agreed to settle the case for $5 million.
- Missouri: $48,100,000 Verdict. In this Missouri birth injury case, the plaintiffs alleged that hospital staff failed to act on signs of fetal distress and delayed performing a cesarean section, resulting in a prolonged and traumatic labor. The infant became lodged in the birth canal and was eventually delivered with evidence of severe scalp swelling consistent with caput succedaneum. According to the plaintiffs, the swelling was an external marker of deeper trauma, including hypoxic injury and diffuse brain damage. After delivery, the child exhibited seizures and was later diagnosed with cerebral palsy and significant developmental delays. The plaintiffs claimed that the obstetricians ignored abnormal fetal heart tracings and failed to transition to an emergency C-section when it was medically indicated. The defense argued that the brain injury was due to an unavoidable stroke unrelated to the delivery. The jury rejected that argument and awarded $28.1 million in compensatory damages and an additional $20 million in punitive damages, for a total verdict of $48.1 million. This was the largest birth injury verdict in Missouri history at the time.
- Pennsylvania: $2,000,000 Verdict. The mother was diagnosed as having a high-risk pregnancy. She went to Rolling Hill Hospital in Philadelphia after going into labor. During labor, her physicians administered Pitocin to induce contractions. The fetus reportedly became wedged in her pelvis and developed caput succedaneum. An emergency C-section was performed, but the child suffered caput succedaneum and was sadly diagnosed with cerebral palsy and decreased cognitive functioning.
- New York: $875,000 Settlement. In this New York birth injury case, the plaintiffs alleged that improper use of a vacuum extractor during a prolonged labor caused their newborn to suffer a caput succedaneum injury. The baby later developed neurological complications, which the plaintiffs argued stemmed from head trauma caused by the delivery method. The injury, consistent with either caput succedaneum or cephalohematoma, led to developmental delays and ongoing therapy needs. The plaintiff’s case centered on the failure to perform a timely cesarean section and the negligent use of assisted delivery tools. Defendants maintained that the delivery was within the standard of care and denied that the caput injury caused any long-term harm. The parties ultimately reached a settlement in the amount of $875,000.
The Attorneys at Miller & Zois Are Experienced in Handling Birth Injuries
Birth injuries are complex cases. They are painful and emotional for everyone, including the attorneys. But they are also potentially worth significant compensation for children and their families who desperately need money to care for their child.
If you are a parent whose infant has been injured during delivery, please contact Miller & Zois for a free claim evaluation. We are experienced and dedicated advocates who will fight to bring you justice. You can contact us at 800-553-8082 or get a free case evaluation online.