Every mother and child should be carefully monitored during labor and delivery, though health care professionals can make catastrophic errors. Electronic fetal heart monitors can measure the duration and intensity of the mother’s contractions and the baby’s heart activity during and following each contraction. Healthcare providers monitor and examine these tracings to determine the well-being of the fetus during labor. If signs are present that indicate the fetus is not receiving enough oxygen, the baby will need to be delivered as quickly as possible. When delivery is delayed, however, the baby will lack sufficient oxygen. In such cases, an infant brain injury can occur. The failure to correctly interpret a fetal heart monitoring strip is just one example of negligence that can cause your child to suffer irreversible infant brain damage. There are many different types of birth injuries and having an attorney who understands the causes can make all the difference.
Cephalohematomas develop when hemorrhaging occurs between the skull and the periosteum, the outer covering of the bone. The area across the periosteum is rich in blood vessels, and when these vessels rupture, blood will collect and cause swelling, bruising and discoloration. A cephalohematoma may develop due to a prolonged second stage of labor or as a result of excessive contractions during active labor. However, they are much more common with the use of instruments during delivery, such as a vacuum or forceps. Although they frequently manifest externally, cephalohematomas may be indicative of serious internal damage to the brain. Moreover, a newborn may later develop jaundice (yellow skin tone), hyperbilirubinemia, which is a breakdown of blood cellular matter that can cause direct injury to the brain, anemia (low red blood count) and hypotension (low blood pressure).
Most cephalohematomas spontaneously resolve over the course of a few weeks without intervention as the blood clot is slowly reabsorbed into the baby’s body. However, the hematoma may harden and calcify that persists for months. Significant deformities of the skull may occur when calcification of the cephalohematoma occurs.
Another condition that can occur due to a prolonged labor is a hemorrhage between the scalp and the periosteum of a newborn. This is known as a subgaleal or subaponeutotic hemorrhage. The bleeding in this type of disorder tends to be more extensive and the mortality rate is much higher. This condition may present as a diffuse, fluctuant swelling of the head that shifts with movement. Expansion of the swelling due to continued bleeding may occur as well. The baby may have tachycardia (fast heart beats) due to blood loss.
Hypoxic-ischemic encephalopathy (HIE) is a type of birth injury that occurs when the brain is deprived of adequate oxygen (hypoxia) and/or blood flow (ischemia) which causes brain cells to die and may result in permanent brain damage. Encephalopathy refers to an acute dysfunction of the brain. When a child experiences HIE at birth, this can lead to cerebral palsy, epilepsy, or cognitive and/or motor impairment. HIE can be caused by a number of factors, including but not limited to:
If the hypoxic-ischemic event occurs over hours of negligent labor, the body has a coping mechanism that will redirect blood flow from parts of the brain that control higher cognitive functioning to preserve the parts of the brain that control breathing, heart rate, and the nervous system that control basic functioning. This type of injury is called a partial-prolonged hypoxic-ischemic injury.
If a baby is suddenly and totally deprived of oxygen and blood flow, the baby’s body does not have time to adapt and the resulting injury will often occur in the deep brain structures that control breathing, heart rate, and other vital functions. This type of injury is known as an acute-total hypoxic-ischemic injury. This type of injury often has a poor prognostic factor.
Instrumental delivery: Vacuum and Forceps:
During delivery, instruments such as vacuum and forceps may be used to overcome cephalopelvic disproportion, which is an anatomical mismatch between the size of the baby and the maternal pelvis. A medical professional may be liable for injury to a child due to unnecessary or excessive use of such instruments. Examples of improper use include the improper application of force, use of the instrument on a baby who does not fit the criteria, and use of the instrument when it is not indicated, such as when a different approach results in a better outcome for the patient (i.e. cesarean section). Moreover, it is well documented that an operative delivery by forceps or vacuum is associated with intracranial injury, such as subdural and subarachnoid hemorrhage, and a depressed neurologic outcome of a child.
Certain conditions should be met prior to a forceps extraction: the cervix must be completely dilated, membranes must be ruptured, and the fetal head must be engaged and present in a position that will permit delivery. The medical professional must be trained in and familiar with the use of forceps and must have the right type of forceps available for extraction. The forceps should be used with one hand while seated, and should be used to gently guide the infant to delivery, not to pull excessively on the fetal head.
Uncommon presentations such as a face presentation, occiput posterior position, or breech are often contraindications for proceeding with an instrumented delivery.
The use of vacuum to expedite delivery of an infant is not uncommon, but a baby should be delivered after one or two applications. If the vacuum “pops off,” it is usually an indicator that there is a mismatch between the size of the baby and the maternal pelvis. Multiple applications where the vacuum disengages from the fetal scalp are atypical and could be a sign that medical negligence has occurred.
The medical professional must also be aware of how far the baby has descended during labor to adequately gauge whether instrumental delivery is the right decision. Failing to properly determine this can result in the application of high forceps, an operative procedure that is universally condemned by the medical community, or excessive traction in the use of a vacuum.
A physician using an instrument to expedite delivery must also have a back-up plan in mind in case the delivery is unsuccessful and a caesarian section must be performed. This means he or she should notify the operating room and have a team on standby to transfer the mother and baby should the need arise. Proceeding with a delivery using forceps or vacuum with the assumption that it will work is a mistake that can cause delays in delivery if the procedure does not succeed, and these delays often have devastating results for a baby.
Injury Due to Cephalopelvic Disproportion (CPD):
Cephalopelvic disproportion (CPD) may occur in two different circumstances. Absolute cephalopelvic disproportion occurs when there is a mismatch between the size of an infant and the mother’s pelvis. Think of pushing a square peg through a round hole. A large baby, a petite mother, or a combination of the two makes it extremely difficult for a natural birth to occur, and attempts to do so will put abnormal amounts of stress on both the baby and mom during labor and delivery. Gestational diabetes as well as excessive weight gain in pregnancy are indications that CPD may be present.
Relative CPD may occur in unique scenarios when a cervix is slow to dilate, especially in first time mothers, or when a baby is in an unfavorable position for delivery, such as occiput posterior or breech. These would necessitate the relative size of the pelvis to increase in order to deliver the infant.
Physicians may be tempted to force delivery using oxytocin (Pitocin) or drugs that stimulate contractions or dilation of the cervix or by using an instrument such as a vacuum or forceps. This can result in catastrophic injuries to the mother and baby.
Neonatal Birth Injuries:
Neonatal failures such as failure to provide proper resuscitation after a traumatic birth, head or body cooling, necessary medications, or proper neonatal personnel such as a pediatrician or neonatologist to examine an infant during a difficult delivery are common causes of birth injuries. Additionally, improper monitoring of temperature, blood sugar, blood pressure, or jaundice can also cause injury. Negligence during labor and delivery may compound with negligence during the neonatal period, and may lead to a worsened outcome for the baby.
An experienced attorney can review the labor and delivery and neonatal period to help determine if a birth injury occurred, whether the appropriate steps were taken in the neonatal period, or whether negligent care continued, making the injury all the worse.
The following reviews from our clients do not constitute a guarantee, warranty, or prediction regarding the outcome of another legal matter. The cases mentioned in the reviews are illustrative of some of the matters previously handled by Grant & Eisenhofer involving various areas of birth injury law. These reviews are endorsements.