What is Newborn Cephalohematoma?

Cephalohematoma results from pressure or trauma to a newborn’s head mostly during vaginal delivery. Small blood vessels in the scalp rupture or are damaged, causing blood to pool below the scalp but outside the skull. An infant’s brain is generally protected from pressure or damage because of the location of the cephalohematoma.

It may take hours or potentially days to notice the formation of the cephalohematoma because the bleeding is slow. While most cases of cephalohematoma are self-correcting, it is still vital to be aware that this is a medical condition with potential side effects. A birth injury lawyer in Portland may be able to help if your child’s cephalohematoma develops into a health problem.

Causes of Cephalohematoma

Cephalohematoma occurs in 0.4% to 2.5% of all live births. Male fetuses are more susceptible to this injury than females, but the reason for this has not been identified. Cephalohematoma can occur in vaginal births, experiencing no assistance from birthing devices. However, it is more common in births that require birth assistance devices. Cephalohematoma may occur in:

  • Fetal macrosomia
  • Primigravidae, an individual experiencing a first pregnancy
  • Fetuses in an occipital posterior position or head down but face up
  • Fetuses in a transverse occipital position, positioning of the fetus facing the left or right
  • Multiple gestations birth, including twins, triplets, or more
  • Fetuses whose heads hit the pelvic bone during labor

When the fetus is malpositioned for childbirth, manual rotation of the fetus may eliminate the use of forceps or vacuum extraction. Any of these circumstances may necessitate a forceps or vacuum-assisted delivery. According to the above-referenced report in the National Library of Medicine, 11.7% of vacuum-assisted deliveries result in cephalohematoma. In comparison, 6.35% of forceps-assisted and cesarean delivery births after a natural birth was initiated resulted in cephalohematoma.

The Use of Obstetrical Forceps and Vacuum Extractors

Uterine contractions are the primary source of movement of the fetus through the birth canal. When contractions alone fail to move the fetus, forceps or a vacuum extractor may assist in moving the fetus. Both devices are used to grip the newborn’s head.

Medical malpractice may not always be the cause of these injuries. Even using these tools appropriately and with care can lead to cephalohematoma. The amount of pressure placed on the head of the newborn may still result in damage to the blood vessels.

Epidurals used to manage pain during labor may also contribute to the body’s inability to effectively move the fetus through the birth canal and out of the body because it numbs the lower part of the body. When this occurs, birthing assistance devices may be used.

Diagnosing Cephalohematoma

A doctor will physically examine the newborn at the first pediatrician’s visit after release from the hospital. These appointments should occur within one to three days to allow for the detection of any injuries that may have been undetectable immediately following birth. A pediatrician may note a bulge indicating cephalohematoma, but additional testing may include:

  • Ultrasound
  • MRI
  • CT Scan
  • X-Ray

Risks Associated With Cephalohematoma

While cephalohematoma is harmless and often goes away without treatment, other risks associated with this birth injury can lead to additional health complications. Jaundice is a common complication that results from cephalohematoma. Bilirubin levels in the blood may increase as the mass is broken down and reabsorbed by the body. An increase in bilirubin leads to the potential of developing jaundice.

Jaundice generally corrects on its own. Quickly rising bilirubin levels, levels already occurring at a high level, or newborns born prematurely may require medical intervention for jaundice. Phototherapy is a standard treatment to break down bilirubin in the infant’s skin. More severe cases of jaundice may require a blood transfusion.

High bilirubin levels will likely be detected. High bilirubin levels that go undetected may result in severe complications. Serious risks may include:

  • Deafness
  • Cerebral palsy
  • Kernicterus, brain damage resulting from high bilirubin levels


Bleeding from the scalp’s vessels causing cephalohematoma route needed blood from a newborn’s circulatory system. Anemia may occur when this happens. Anemia is a low red blood cell count. Medication or blood transfusion may become necessary when anemia does not correct on its own. A newborn’s ability to breast or bottle feed effectively can help eliminate anemia.

Skull fracture

Linear skull fractures may occur with cephalohematomas. According to the Cleveland Clinic, as many as one in four newborns experiencing cephalohematomas experience linear skull fractures. The bones of the skull do not move in this type of bone fracture and should heal over time.


Cephalohematomas may harden and form bone deposits called calcifications when they are long-lasting. These calcifications can impact skull formation. Corrective surgery is required to remove the hardened material and prevent cranium deformities.


Lesions occurring on the skin at the site of a cephalohematoma can lead to infection. Most of these infections are the result of E. coli, and fever and inflammation accompany the infection. These infections can be severe and harmful to newborns. Treatment may include antibiotic treatment or drainage of the area.

Symptoms of Cephalohematoma

Observant new parents may notice a slight bulge near the back or top of a newborn’s head several days after birth. There is typically no sign of reddening, bruising, or cuts in the area. This bulge may initially feel soft.

Over several weeks, calcification can make the area feel more dense and hardened.

When the cephalohematoma begins to shrink, a noticeable cratering in the center of the bulge may appear. This crater-like appearance occurs as the center dissolves before the outer edges, a natural part of the healing process.

Additional observable symptoms may also include yellowing of the skin or eyes, as mentioned, due to jaundice. Other symptoms will likely require medical testing to detect. A pediatrician will offer additional information on what to monitor for.

Discuss an Incident of Cephalohematoma With our Oregon Birth Injury Attorneys

The hope of every parent is that an Oregon birth injury will completely heal with time. When injuries progress into more severe injuries, costly treatment and care may be required. Contact our Portland medical malpractice attorneys if your child suffered a cephalohematoma, resulting in further complications. A free case evaluation allows us to advocate for the compensation you deserve.