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In the normal course of events at birth, the baby's head being the advancing end, a great deal of molding of the head may occur. This is especially true if the baby is large or firstborn, if the labor is prolonged, or if the mother has a narrow pelvis or a rigid cervix. As the baby's head is squeezed through the cervix, it's narrowed on both sides and gets higher in the back. With pressure from the cervix, the base of the skull swings inward and the forehead does the same. The result is a head narrow from side to side and front to back, but elongated and somewhat pointed at the rear. A dunce cap wouldn't fit badly.
As the bones shift under this pressure, spaces between them may be temporarily obliterated, and it may be impossible to determine whether or not the fontanels are of normal size. As a result of the distortion of the shape of the skull, it may also be impossible to get an accurate measurement of the baby's head circumference. At this point, most head measurements are falsely low. On the other hand, because the back of the baby's head is pushed up and back, measurements of his entire length will be falsely high, If you ever wanted a tall baby, now is the time to measure his length. He may lose several centimeters by the next sunrise.
Within a few short hours, most of the baby's head molding disappears. By six days, his head has shifted back to its unmolded shape. Upsetting as it may be to see your beloved baby arrive resemblingba Conehead, chink of the alternatives and consider what problems the baby would have if his head weren't moldable: it would probably break or transfer the tremendous compression to the brain itself. "Better the shell should mold than the yolk get scrambled." As for the "lucky" babies without molding, they're the ones whose heads never went one-on-one with a pelvis. This group includes babies delivered by Cesarean section, babies delivered from a breech presentation, and babies whose heads are abnormally small. Wouldn't you settle for a bit of molding?
Soft Swelling over Skull (Caput Succedaneum)
The scalp overlying the advancing part of the baby's skull may develop a diffuse, mushy swelling that often includes bruises. Since the swelling is the result of tissue fluid and blood in the scalp over the bones, its borders won't be restricted to any individual bone of the skull. The swelling will cross over the borders of bones and may cross over the midline. This swelling is present at birth, and practically every baby has at least some of it. Caput succedaneum is usually gone by the second day of life, although the associated bruise may last a bit longer.
Sharply Demarcated, Balloonlike Swelling of Head (Cephalohematoma)
If bleeding occurs under the membrane surrounding one of the bones of the skull, the swelling that results is referred to as a cephalo- (head) hematoma (collection of blood). This type of swelling feels very different from caput succedaneum. Rather than mushy and diffuse, the cephalohematoma is balloonlike and springy and its borders don't extend beyond the edges of the bone that it covers. Cephalohematomas occur in 0.5 to 2.5 percent of births and are associated with difficulties in delivery such as largeness of the baby, firstborns, the mother's small pelvis, and so on. They're more common in baby boys (they have bigger heads), and appear on the right side of the head three times more often than the left. Typically cephalohematomas aren't seen in the delivery room. They're usually noticed during the first 24 hours of life, and they grow larger Head I 59 day by day for two to five days. Over the next few weeks to months, the borders of the swelling elevate and the center sinks in, creating a crater. Gradually thicker bone develops in the border area, and after one to two months the swelling is completely gone, leaving no traces.
At one time, doctors thought that all babies with cephalohema-tomas should have X rays of their skulls to see if there was a fracture underneath the swelling. We now know that only 5 percent or so actually have fractures, and unless there was considerable trauma connected with the delivery, such as very prolonged labor, vigorous application of forceps, or a very big baby, most doctors will opt not to take the X ray. Another thing that babies with cephalohematomas are spared these days is being stuck with a needle to draw out the blood. Inserting a needle in a cephalohematoma is asking for trouble since it introduces the risk of infecting the swelling. A large cephalohematoma can become a significant source of additional bilirubin and is often the reason for excessive jaundice in the newborn. Accordingly, your doctot might follow your baby's bilirubin count extra-closely if your baby has one of these swellings.
Soft Spots That Feel Like Ping-Pong Balls (Craniotabes)
When pressure is applied to a bone for a long time, the bone softens. If the bone happens to be the skull, the condition is called craniotabes (cranium means skull; tabes is wasting). It's usually limited to the precise spot on the baby's head that was jammed against the mother's bony pelvis while in the womb. For most babies, this means that the back of the skull, near the rear fontanel, will be softer than the rest of the skull. It feels like an old Ping-Pong ball when you push on it. After one or two months, the softness disappears. Look for this condition if your baby's head was engaged in your pelvis, i.e., was "dropped" for a particularly long time. Craniotabes is harmless. We know of at least one baby whose entire head was softened but, after three months, hardened normally.
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