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OBJECTIVE: To evaluate the trends, proportions, risk factors, resource utilization, and outcomes of neonatal birth trauma in the US. STUDY DESIGN: This cross-sectional study of in-hospital births used the Nationwide Inpatient Sample for 2006-2014. We divided the cases by type of birth trauma: scalp injuries and major birth trauma. Linear regression for yearly trends and logistic regression were used for risk factors and outcomes. A generalized linear model was used, with a Poisson distribution for the length of stay and a gamma distribution for total spending charges. RESULTS: A total of 982 033 weighted records with neonatal birth trauma were found. The prevalence rate increased by 23% from (from 25.3 to 31.1 per 1000 hospital births). Scalp injuries composed 80% of all birth traumas and increased yearly from 19.87 to 26.46 per 1000 hospital births. Major birth trauma decreased from 5.44 to 4.67 per 1000 hospital births due to decreased clavicular fractures, brachial plexus injuries, and intracranial hemorrhage. There were significant differences in demographics and risk factors between the 2 groups. Compared with scalp injuries, major birth trauma was associated with higher odds of hypoxic-ischemic encephalopathy, seizures, need for mechanical ventilation, meconium aspiration, and sepsis. Length of stay was increased by 56%, and total charges were almost doubled for major birth trauma. CONCLUSIONS: Neonatal birth trauma increased over the study period secondary to scalp injuries. Major birth trauma constitutes a significant health burden. Scalp injuries are also associated with increased morbidity and might be markers of brain injury in some cases.

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Abstract Introduction The birth experience of adolescents is understudied even though they are a particularly vulnerable population to experience a negative birth event, given that they exhibit many known risk factors. Objective To ascertain whether a cesarean birth mediates the impact of infant complications on the birth experience of adolescent mothers. Methods Using a secondary analysis of data collected from 303 postpartum adolescents previously evaluated for depression and post-traumatic stress, we employed counterfactual causal analysis to determine if delivery type mediated the birth experience at different levels of depression. Noted limitations pertain to methodological assumptions and computational feasibility as well as potential sample bias. Results We found that the mediating effect of delivery mode depended on the adolescent's depression level as well as on the specific operationalization of the birth experience. At low levels of depression, the odds of a negative birth appraisal were reduced by around 30% when operationalized as a single item subjective rating. In contrast, at high levels of depression, the odds of a negative birth experience increased by 80% when operationalized as an Impact of Event Scale (IES) subconstruct. Conclusion Depression level plays a pivotal role in moderating how delivery mode mediates the birth experience. The direction of impact also depends on how the birth experience is operationalized.

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Quando a psicanálise passou a se interessar pelos primórdios da vida psíquica do bebê, esse interesse se concentrava na relação mãe-bebê a partir do advento da natalidade. A partir da teoria das relações objetais, notabilizada pela Escola Inglesa de Psicanálise, alguns autores passaram a repensar o bebê a partir da vida pré e pós-natal e como essas experiências influenciam seu psiquismo. Nesse sentido, o presente artigo busca analisar as primeiras relações materno-infantis a partir das três proposições teóricas: o trauma do nascimento, a observação de bebês em útero com o advento da ultrassonografia e o método de observação de bebês na prevenção de traumas psíquicos. Essas teorias são analisadas através do referencial teórico de Donald W. Winnicott, a partir da teoria do desenvolvimento emocional primitivo e do conceito de memória corporal, os quais enfatizam as experiências intrauterinas sentidas pelo feto e o contato do bebê com a mãe em termos da fisicalidade dos corpos vivos, após seu nascimento. O autor conclui que as primeiras relações materno-infantis, pré e pós-natais, constituem em si mesmas a via de acesso à saúde psíquica do indivíduo adulto.

When psychoanalysis became interested in the origins of psychic life of the baby, this interest focused on the mother-child relationship and the baby birth. Some authors from the British School of Psychoanalysis started to reconsider the baby from the pre and postnatal life and how these experiences influence his psyche through the object relations theory. Thus, this paper aims analyzes the first mother-child relationship from the three theoretical propositions: the birth trauma, the observation of babies in the womb, with the advent of ultrasound and the baby observation method in preventing psychological traumas. These theories are analyzed through Donald W. Winnicott theories, named: the theory of emotional development and the concept of body memory which emphasizes intrauterine experiences felt by the fetus and the baby contact with the mother in terms of physicality of alive bodies after his birth. The author concludes that the first mother-child relations, pre and postnatal, is in itself, a way of access to mental health of the adult.

Cuando el psicoanálisis se interesó en los orígenes de la vida psíquica del bebé, este interés se centró en la relación madre-bebé desde la natalidad. A partir de la teoría de las relaciones de objeto, notada por la Sociedad Psicoanalítica Británica, algunos autores comenzaron a reconsiderar la vida del bebé pre y postnatal y cómo estas experiencias influyen en su psique. En este sentido, este trabajo analiza las primeras relaciones madre-bebé en tres proposiciones teóricas: el trauma del nacimiento, la observación de bebés en el útero con el advenimiento de la ecografía y el método de observación de bebés en la prevención de traumas psicológicos. Estas teorías son analizadas a través de referencia teórica de Donald W. Winnicott, de la teoría del desarrollo emocional y el concepto de memoria del cuerpo que hace hincapié en las experiencias intrauterinas sentidas por el feto y el contacto del bebé con su madre en cuanto a la físicalidad de cuerpos vivos después de que su nacimiento. El autor concluye que las primeras relaciones madre-bebé, pre y postnatal, es en sí misma, una forma de acceso a la salud mental del adulto.

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Al analizar los efectos psíquicos del nacimiento, Rank concluyó que la separación del vientre materno debía ser considerada como un evento traumático, a partir del cual podría explicarse, no sólo la neurosis, sino la humanización en general. Lo que parecía ser una nueva contribución a la causa psicoanalítica, sería, finalmente, un desafió a los supuestos freudianos que definían el complejo de Edipo, la función paterna, la castración y la represión, como los fundamentos de la teoría y la práctica del Psicoanálisis. El presente trabajo buscará ilustrar los debates generados por la difusión de las tesis de Rank entre los miembros del Comité, para concluir que las hipótesis sobre el trauma del nacimiento provocaron una verdadera controversia en la historia del movimiento psicoanalítico y, a su vez, marcaron la ruptura definitiva de Rank con Freud y los miembros del Comité.

In the analysis of the psychic effects of birth, Rank concluded that the separation of the womb should be considered a traumatic event, from which, not only neurosis, but also humanization in general, could be explained. What appeared to be a new contribution to the psychoanalytic cause would finally be a challenge to Freudian assumptions that defined the Oedipus complex, the father's function, castration and re pression, as the foundations of psychoanalytical theory and practice. The current work will seek to illustrate the discussions generated by the dissemination of Rank's thesis among the members of the Committee and will conclude that the hypothesis about the trauma of birth led to a genuine controversy in the history of the psychoanalytic movement and, in turn, will define Rank's final break with Freud and the members of the Committee.

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Al analizar los efectos psíquicos del nacimiento, Rank concluyó que la separación del vientre materno debía ser considerada como un evento traumático, a partir del cual podría explicarse, no sólo la neurosis, sino la humanización en general. Lo que parecía ser una nueva contribución a la causa psicoanalítica, sería, finalmente, un desafió a los supuestos freudianos que definían el complejo de Edipo, la función paterna, la castración y la represión, como los fundamentos de la teoría y la práctica del Psicoanálisis. El presente trabajo buscará ilustrar los debates generados por la difusión de las tesis de Rank entre los miembros del Comité, para concluir que las hipótesis sobre el trauma del nacimiento provocaron una verdadera controversia en la historia del movimiento psicoanalítico y, a su vez, marcaron la ruptura definitiva de Rank con Freud y los miembros del Comité.(AU)

In the analysis of the psychic effects of birth, Rank concluded that the separation of the womb should be considered a traumatic event, from which, not only neurosis, but also humanization in general, could be explained. What appeared to be a new contribution to the psychoanalytic cause would finally be a challenge to Freudian assumptions that defined the Oedipus complex, the father's function, castration and re pression, as the foundations of psychoanalytical theory and practice. The current work will seek to illustrate the discussions generated by the dissemination of Rank's thesis among the members of the Committee and will conclude that the hypothesis about the trauma of birth led to a genuine controversy in the history of the psychoanalytic movement and, in turn, will define Rank's final break with Freud and the members of the Committee.(AU)

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Objective. To identify risk factors associated with birth trauma. Setting. Servicio de Neonatología, Hospital General "Dr. Manuel Gea González", Secretaría de Salud. Design. Case-control, prolective study. Patients. There were 129 cases and 134 controls. Measures. We recorded the following variables: a) maternal and delivery: age, weight, height, prenatal care, pre-existing disease or gestational disease, mode of delivery, anesthetic management during labor, use of external maneuvers or forceps; b) newborn: birth weight, gestational age, academic degree of attendant physician at delivery, and type of birth injury. Results. The independent risk factors associated to birth injury were: for ecchymoses; general anesthesia (OR 13.7, 95% CI - 3 - 62.6), breech presentation (OR 6.4, 95% IC 95% = 1.4 - 27.9) and gestational age < 32 weeks (OR 6.4, 95% CI = 1.3 - 31.1); for lacerations, vaginal dystocic delivery or cesarean section (OR 19, 95% CI = 4.4 - 81.1) and use of external maneuvers (OR 5.6, 95% CI = 1.5 - 21.6); for cephalhematoma maternal height < 1.54 m (OR 7.4, 95% CI = 2.3 - 23.7) and external maneuvers (OR 7.2, 95% CI = 2.3 - 23.7); for caput succedaneum, external maneuvers (OR 3.4, 95% CI = 1.5-7.7) and maternal age < 19 or > 36 years (OR 3.0, 95% CI = 1.4 - 6.4). Conclusions. Risk factors associated with birth injuries identified in this study involved maternal conditions, neonatal conditions and mechanism of delivery.

Objetivo. Identificar los factores de riesgo asociados a lesiones originadas durante el nacimiento en recién nacidos. Lugar. Servicio de Neonatología, Hospital General "Dr. Manuel Gea González", SS. Diseño. Casos y controles, prolectivo. Pacientes. 129 casos y 134 controles. Mediciones. Las variables estudiadas fueron, a) maternas y del parto: edad, peso, talla, control prenatal, enfermedad previa o durante el embarazo, características del trabajo de parto, tipo de anestesia, aplicación de maniobras externas, uso de fórceps; b) en el recién nacido: peso al nacer, edad gestacional, grado académico del médico que atendió el nacimiento y tipo de lesión. Resultados. Los factores que se asociaron en forma independiente a la presentación de traumatismo al nacimiento fueron para equimosis: anestesia general (RM 13.7, IC 95% = 3 - 62.6), presentación pélvica (RM 6.4, IC 95% = 1.4 - 27.9 y edad gestacional < 32 semanas (RM 6.4, IC 95% =1.3 - 31.1); para laceración, nacimiento vaginal distócico o cesárea (RM 19, IC 95% = 4.4 - 81.1), y maniobras externas (RM 5.6, IC 95% = 1.5 - 21.6); para cefalohematoma talla materna < 1.54 m (RM 7.4, IC 95% = 2.3 - 23.7) y maniobras externas (RM 7.2, IC 95% = 2.2 - 23.7); para caput succedaneum maniobras externas (RM 3.4, IC 95% = 1.5 - 7.7) y edad materna < 19 o > 36 años (RM 3.0, IC 95% = 1.4 - 6.4). Conclusiones. Los factores de riesgo asociados a lesiones durante el nacimiento identificados en este estudio involucran tanto características maternas como del recién nacido y de la atención del parto.

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