The process of birth, even under the most favorable, controlled circumstances, is potentially a traumatic event for the fetus. Many of the skeletal and visceral injuries incurred at birth—a long and varied list—are well known. However, one form of birth injury, of lethal consequence, often escapes consideration: Mounting clinical and pathological evidence suggests that the death of the newborn, may, in many instances, be due to injury to the upper spinal cord and the joining brain stem, injury incurred during parturition.
Most of the signs of neonatal injury observed in the delivery room are neurological. Respiratory action, cardiac function, muscle tone, reflex irritability, and other elementary signs in the neonate are essentially dependent on the functional integrity of the cord and brain stem. Correspondingly, in many instances disturbances in respiration and other vital functions may have their origin in lesions, not in the peripheral organs, not in the forebrain, but