Michigan Birth Injury Attorneys
What Are Birth Injuries? What Causes Birth Injuries?
A birth injury is an injury with long-term consequences that happens to a baby during or near the time of delivery. Most often, birth injuries (also known as birth trauma) are associated with permanent brain damage and conditions such as hypoxic ischemic encephalopathy (HIE), cerebral palsy, seizures, meningitis, periventricular leukomalacia (PVL), intellectual disabilities and developmental delays. Throughout this page, our Michigan birth injury attorneys will cover everything you need to know about medical malpractice, birth injuries and birth trauma cases.
What is a Birth Injury?
Birth injuries can occur during delivery, shortly before birth, or during the neonatal period. The complications involve a lack of oxygen to the baby’s brain (birth asphyxia), brain bleeds, placental abruption, uterine rupture, umbilical cord problems such as the cord wrapped around the baby’s neck, premature birth, delayed C-section, Pitocin, Cytotec, and neonatal ICU injuries. These conditions and many others are described below. We also discuss different types of brain damage and nerve injuries, what the treatments are for these conditions, and what the outlook may be for a child with a birth injury.
Underlying brain injuries in a baby can then lead to other diagnoses stemming from that initial brain injury. These may include:
- Cerebral palsy (CP)
- Hypoxic-ischemic encephalopathy (birth asphyxia)
- Seizures and epilepsy
- Intellectual and developmental disabilities (I/DD)
- Erb’s palsy
- Periventricular leukomalacia (PVL)
- Brain bleeds
What Does Birth Injury Look Like?
Birth injuries vary in appearance. Often, babies will have seizures either immediately after or within the first few days after birth. In other cases, children may not show signs of birth injury until after they begin to miss developmental milestones. There are numerous potentially concerning signs of birth injury.
Potential Signs of Birth Injuries in a Baby:
- Baby born pale or blue, has weak breathing, and/or a slow heart rate
- Sluggish or lethargic baby
- Exhibits odd face, arms, or leg movements
- Favors one side of the body
- Has no interest in feeding or difficulty feeding
- Has or had seizure activity
- Needed to be resuscitated at birth
- Looks weak or lacks muscle tone
- Has poor head position
Potential Signs of Birth Injuries in Older Children:
- Abnormal muscle tone (e.g. slouching over while sitting), reflexes, motor development and coordination
- Contractures (permanently fixed, tight muscles and joints)
- Spasticities, spasms, other involuntary movements (e.g. facial gestures)
- Unsteady gait (body movement / propulsion)
- Problems with balance
- Soft tissue problems such as decreased muscle mass
- Scissor walking (where the knees come in and cross) and toe walking
How Do Birth Injuries Occur?
In many cases, birth injuries occur when physicians and other members of the medical team fail to notice when a baby in the womb is in distress. Fetal distress is detectable through the fetal heart rate monitor and and tests such as a nonstress test (NST), biophysical profile (BPP), amniotic fluid index test and Doppler velocimetry. These tests are performed during pregnancy. Sometimes, some of these tests are performed during labor.
During labor and delivery, the baby’s heart rate should always be monitored on the fetal heart rate monitor. When the fetal heart monitor shows that the baby is in distress, it almost always means the baby is being deprived of oxygen. When this occurs, physicians must quickly address the situation that is causing the oxygen deprivation. Typically, babies in distress must be delivered immediately, often by emergency C-section.
A number of complications occurring near or during the time of delivery can result in oxygen deprivation or other injuries to the baby. Sadly, in many cases, permanent injuries are completely preventable and are due to errors made by medical staff. Some examples include:
- Birth asphyxia (hypoxic-ischemic encephalopathy) due to undiagnosed or improperly treated conditions during pregnancy, labor and delivery.
- Failure to quickly deliver the baby when umbilical cord problems occur. Cord problems may include:
- Failure to properly monitor the baby’s heart rate during labor and delivery
- Improper placement of a vacuum extractor on the baby’s head
- Excessive pulling or compression with forceps
- Birth trauma and intracranial bleeding (brain bleeds) from prolonged labor. This often occurs when the mother has cephalopelvic disproportion (baby too large to fit through mother’s pelvis) and/or the baby is macrosomic (too large for gestational age).
- Failure to perform a prompt emergency C-section when the baby is in distress. Umbilical cord compression, uterine rupture and placental abruption are common causes of fetal distress.
- Improper administration of labor induction drugs such as Pitocin or Cytotec.
- Failure to identify and treat infections in the mother, which can infect the baby at birth and cause sepsis and meningitis.
- Failure to properly use anesthetic agents, causing critical hypotension
- Failure to diagnose and treat neonatal hypoglycemia.
- Failure to identify and treat seizures following delivery.
Birth Asphyxia and Hypoxic Ischemic Encephalopathy (HIE)
One of the most common causes of birth injuries is a lack of oxygen to the baby’s brain, causing an injury known as hypoxic ischemic encephalopathy (HIE). There are many conditions that can occur during or near the time of delivery that can cause oxygen deprivation, including placental abruption, uterine (womb) rupture and umbilical cord problems. When these and other oxygen-depriving conditions occur, the baby will have a non-reassuring heart tracing on the fetal heart rate monitor, which is known as fetal distress.
When fetal distress occurs, the baby almost always needs to be delivered immediately by emergency cesarean (C-section). The longer a baby’s brain is deprived of oxygen, and the more severe the oxygen deprivation, the more severe the brain damage will likely be. The medical team must quickly remove the baby from the oxygen-depriving conditions.
When a baby is in distress, delayed emergency C-section delivery is a significant cause of HIE and lifelong problems such as cerebral palsy, intellectual and developmental disabilities (I/DD), and seizure disorders.
Placental abruption occurs when the placenta separates from the uterus before the baby is delivered. The placenta delivers oxygen from the mother to the baby prior to birth. A placental abruption can cause extreme bleeding, which can cause shock (major loss of blood to the mother and baby) and severe oxygen deprivation in the baby. If the abruption occurs at the umbilical cord, the baby will be completely cut off from its oxygen supply. Because minor abruptions can become severe in a short period of time, it is critical that medical staff quickly diagnose an abruption, prepare for emergency C-section delivery, and monitor the mother and baby very closely.
When a placental abruption occurs, standards of care require prompt delivery. If a minor placental abruption is present and the baby is full term, the standard of care is delivery. If the baby is not at full term and the placental abruption is minor, the mother and baby should be closely monitored by the medical team. If the abruption worsens, a prompt C-section delivery must occur. Magnesium sulfate may be given to help protect a premature baby’s brain.
Physicians should check for conditions that increase the risk of a placental abruption in the mother, such as:
- Mothers who have had a placental abruption previously
- Mothers with high blood pressure or preeclampsia
- Mothers over the age of 35
When physicians decide to wait and monitor an abruption, the abruption can be treated with blood transfusions and IV fluid replacement. The mother should be carefully monitored for symptoms of fetal distress and shock. The baby’s heart rate must be monitored to ensure it is neither too low nor too high and to make sure contractions do not cause a non-reassuring heart rate. Maternal bleeding or fetal distress usually require an emergency C-section.
Umbilical Cord Problems: Cord Prolapse and Compression
The umbilical cord is the baby’s lifeline. Through the umbilical cord, oxygenated blood is transported from the placenta to the baby. Any disruption in normal blood flow and gas exchange through the umbilical cord can lead to fetal oxygen deprivation.
An umbilical cord prolapse, or a prolapsed cord, is when the umbilical cord descends or falls ahead of the part of the baby that is being delivered, often referred to as the “presenting part.” When the cord is in front of the baby, it often gets compressed by the baby and birth canal, which can reduce or stop the flow blood flow to the baby.
Umbilical cord prolapse can also result in vasospasm (blood vessel constriction) in the umbilical cord, and a prolapsed cord may decrease in temperature. These conditions can further impair the transfer of oxygenated blood to the baby.
Umbilical cord prolapse is frequently associated with malpresentation, where a part of the body other than the baby’s head comes out first. In most situations, the baby is delivered in the vertex position (head-first). Malpresentation occurs when a baby’s buttocks or feet are the presenting part. Whenever a baby is assessed as being in a breech or transverse lie, or in a face presentation, the physician should be alerted that umbilical cord prolapse is likely.
An umbilical cord prolapse is an obstetrical emergency and the baby must be delivered right away, usually by emergency C-section.
Nuchal Cord (Umbilical Cord Wrapped Around the Baby’s Neck)
Nuchal cords occur when the umbilical cord wraps around a baby’s neck. These may sometimes be benign (forming and disentangling), but they can also sometimes reform, or persist. Nuchal cords can sometimes compromise fetal blood flow, decreasing fetal development and movement. A nuchal cord can cause the baby to be deprived of oxygen due to the following reasons:
- The tightness around the neck restricts blood flow to the head
- The blood from the veins gets backed up, decreasing circulation
- The vessels in the cord itself get compressed due to the cord compression
Nuchal cords can cause severe oxygen deprivation when:
- The cord is wrapped tightly around the neck
- The cord is wrapped more than once
- The cord is compressed due to low amniotic fluid levels (oligohydramnios)
During delivery, the cord may get tighter, and this is especially dangerous if there is a true knot in the cord. Nuchal cords during delivery are obstetrical emergencies that almost always requires an emergency C-section.
Nuchal cords have been associated with:
- Fetal demise
- Impaired fetal growth
- Meconium-stained amniotic fluid
- Increased rate of fetal heart rate abnormalities
- Increased rate of forceps and vacuum extractor use
- Umbilical artery acidemia (acidic blood, indicating oxygen deprivation).
Other Umbilical Cord Problems
Other umbilical cord complications include a short umbilical cord, a cord that is in a true knot, and vasa previa, which is when an umbilical cord blood vessel crosses the cervix under the baby and is torn. In these circumstances, the baby may experience fetal distress due to decreased oxygen and blood flow. Close monitoring of the baby is essential, and prompt delivery by C-section must occur when fetal distress is present.
Preeclampsia is a pregnancy complication characterized by hypertension (high blood pressure), and most often occurs in first pregnancies. Women are at increased risk of preeclampsia if they have:
- Maternal age 35+
Preeclampsia can be mild, moderate or severe. Even mild preeclampsia can be a cause for concern, as preeclampsia can progress from mild to severe very quickly. Moderate and severe preeclampsia can cause dysfunction in the mother’s kidneys, liver and blood vessels. Undiagnosed or untreated preeclampsia can also lead to eclampsia (maternal seizures), a potentially deadly consequence associated with significant maternal mortality and severe oxygen deprivation in the baby.
In undiagnosed or untreated preeclampsia, the baby can have prolonged oxygen deprivation as blood flow from the placenta to the baby decreases. In moderate to severe preeclampsia, other conditions may also occur, including low amniotic fluid levels (oligohydramnios), intrauterine growth restriction (IUGR) and placental abruption.
Prudent management of preeclampsia is critical in achieving good health outcomes. Physicians managing mothers with preeclampsia must conduct thorough maternal evaluations, including blood and urine lab tests, to continually assess the mother’s and baby’s health. Prenatal tests include weekly nonstress tests (NSTs), biophysical profiles (BPPs) and ultrasound (US) examinations to assess amniotic fluid levels and to monitor fetal growth. Because of the risks associated with even mild to moderate preeclampsia, many physicians deliver the babies prior to term. It is essential that physicians refer mothers with preeclampsia to maternal-fetal specialists (MFMs), who specialize in helping mothers through high-risk pregnancies.
A uterine rupture is an obstetric emergency that can occur when uterine contractions cause the uterus to shear or tear, necessitating rapid diagnosis and emergency C-section. Prompt intervention is critical. In a uterine rupture, the unborn baby may spill into the mother’s abdomen. This, paired with hemorrhage and resulting low blood pressure, can cause severe outcomes if not promptly treated. If the rupture occurs where the placenta attaches to the uterus, the baby may have a severely restricted oxygen supply.
The most common cause of uterine rupture is the separation of a previous C-section scar during labor. Vaginal birth after Cesarean section (VBACs) are significantly associated with increased uterine rupture risk, especially if mothers are given Pitocin, Cytotec, or prostaglandin agents like Cervidil for induction or augmentation.
Because of the serious risks to the mother and baby associated with uterine rupture, physicians should closely monitor the labor of any mom who has increased risk factors for uterine rupture. If uterine rupture occurs, maternal hemorrhage must be promptly controlled and the baby must be delivered as quickly as possible to prevent birth asphyxia, hypoxic-ischemic encephalopathy and cerebral palsy.
VBAC (Vaginal Birth After Cesarean)
VBAC carries a number of risks, many of which are not fully explained or discussed with the mother. These risks include uterine rupture.
Because of these substantial risks, many physicians have questioned whether VBAC is an appropriate and safe mode of delivery for mothers who have had prior C-section deliveries. Unfortunately, perhaps as a result of inexperience or institutional pressures, many physicians encourage their patients to undergo VBAC deliveries and fail to adequately inform them of the risks and alternatives, including repeat C-section delivery.
Forceps and Vacuum Extractors
- Brain bleeds
- Cerebral contusions
- Stretching and tearing of blood vessels and brain tissue
- Cerebral compression
- Skull fractures
When a baby is in distress during vaginal delivery, forceps (which resemble large tongs) are placed on either side of the baby’s head. As each contraction occurs, the physician uses traction on the baby’s head to guide it downward and out of the birth canal.
A vacuum extractor uses a soft cup applied to the top and back of the baby’s head. A tube runs from the cup to a vacuum pump that provides suction. During a contraction, the physician pulls or applies traction to the baby’s head while suction from the vacuum assists in pulling the head out of the birth canal.
If forceps and vacuum extractors are used improperly, the damage can be extensive and permanent. If these tools are applied unevenly or improperly placed, the strain could cause cerebral compression and the compromise of the delicate vasculature that provides blood, oxygen and nutrients to brain cells.
Other potential problems with delivery instruments include:
- Facial bone distortions
- Brain swelling
- Brain damage, which can generate secondary issues such as seizures, epilepsy and cerebral palsy.
The physician’s technique for pulling the baby out during an instrument-assisted birth is critical – there should be no twisting of the head or neck, no excessive pulling, and no pulling for more than 10 to 15 minutes. In addition, if a vacuum extractor comes off 3 times during use, the physician should move on to a C-section. Incorrect use of vacuum extractors can result in skull fractures, retinal hemorrhages, brain hemorrhages or bleeds, and seizures.
Trauma from forceps and vacuum extractors can also cause the formation of blood clots inside blood vessels, leading to strokes, hypoxic ischemic encephalopathy, and cerebral palsy
Brain Bleeds and Intracranial Hemorrhages
Sometimes during labor and delivery, trauma to the baby’s head occurs, causing hemorrhages (brain bleeds). Sometimes, the hemorrhages are very serious and result in permanent brain damage, cerebral palsy, and even death.
Many brain bleeds are the result of mismanaged labor and delivery. Listed below are some of the types of brain bleeds that can occur around the time of birth:
Intracranial hemorrhages (brain bleeds): Intracranial hemorrhage refers to any bleeding within the skull or brain. Listed below are types of intracranial hemorrhages.
- Cerebral hemorrhage: A form of stroke in which bleeding occurs within the brain.
- Subarachnoid hemorrhage: This occurs when there is bleeding in the subarachnoid space, the area between the innermost two membranes that cover the brain. This usually occurs in full-term babies and produces seizure activity, lethargy and apnea.
- Intraventricular hemorrhage: This is bleeding into the brain’s ventricular system, where spinal fluid is produced. This is the most serious type of intracranial bleeding and is usually seen in premature infants and infants with low birth weight. This is because blood vessels in the brain of premature infants are not fully developed.
- Subdural hemorrhage or subdural hematoma: This occurs when there is a rupture of one or more blood vessels that are in the subdural space – the area between the surface of the brain and the thin layer of tissue that separates the brain from the skull. These ruptures are usually caused by difficult deliveries. Seizures, high levels of bilirubin in the blood, rapidly enlarging head, a poor Moro reflex, or extensive retinal hemorrhages (bleeding of the vessels in the retina) sometimes occur with these kinds of hemorrhages.
Extracranial hemorrhages: These are brain bleeds that occur just outside the skull, and they can be life threatening.
- Cephalohematoma: This is bleeding that occurs between the skull and its covering, starting as a raised bump on the baby’s head. It occurs a few hours after birth and lasts anywhere from 2 weeks to a few months.
- Subgaleal hemorrhage: This occurs when a vein or veins rupture and then the vein bleeds into the space between the scalp and the skull. This is life threatening for the baby and can cause severe oxygen deprivation. If the bleed is not properly managed, almost half of the baby’s blood volume can end up in the subgaleal space. A vacuum extraction delivery puts a baby at a high risk of sustaining this type of hemorrhage.
Causes of Brain Bleeds
There are a number of things that can cause brain bleeds during labor and delivery. They include:
- Misuse of vacuum extractors and forceps
- Mismanaged delivery of a baby in breech position
- Mismanaged delivery of a baby who is large for gestational age (macrosomic)
- Mismanaged cephalopelvic disproportion (CPD). CPD occurs when the baby is too large to fit through the mother’s pelvis
- Trauma from prolonged labor
- Abnormal changes in blood pressure
- Blood disorders (such as vitamin K deficiency, hemophilia)
- Hypoxic-ischemic encephalopathy (HIE; birth asphyxia)
In these cases, the physician must closely monitor the baby for fetal distress and give the mother the option for a C-section. Informed consent is imperative. If fetal distress occurs and normal methods of delivery are unsuccessful, an emergency C-section is required to minimize the risk of hemorrhage and cerebral palsy.
As discussed above, severe head and brain trauma to newborns can occur from medical intervention during labor and delivery. Improper use of delivery instruments, such as forceps and vacuum extractors, are well-documented as causes of intracranial and extracranial bleeding. In addition, improper delivery techniques (excessive twisting or pulling of the infant’s head) can cause severe hemorrhages.
Labor Augmentation with Pitocin and Cytotec
In cases where babies are very large (macrosomic) or there is a mismatch between the size of the baby’s head and the mother’s pelvis (cephalopelvic disproportion, or CPD), labor can sometimes stall. In cases where this occurs, medical staff may sometimes try to use Pitocin or Cytotec to augment contractions to avoid a C-section. However, if there is a size mismatch that makes delivery extremely difficult or impossible, this augmentation does not speed up delivery. Instead, it can cause trauma to the baby’s head as prolonged contractions and pushing cumulatively cause head trauma, compression and brain bleeds. Both of these drugs have substantial risks, including:
- Umbilical cord compression
- Uterine rupture
- Amniotic fluid embolism (where amniotic fluid enters the mother’s bloodstream, causing cardiovascular collapse).
Excessive labor augmentation can cause strong contractions to occur less than 2-3 minutes apart in a condition called hyperstimulation. Hyperstimulation reduces the placenta’s ability to replenish its oxygen supply, therefore reducing oxygen supply to the baby. There are no precise methods of measuring the effect of Pitocin or Cytotec on a given person. The effects of any given dose vary widely; they can range from excessive and severe contractions and fetal oxygen deprivation / asphyxia to absolutely no discernible effect on uterine contractility.
Unlike Pitocin (which can be quickly discontinued), Cytotec is a vaginally-inserted tablet typically cut into quarters, with one quarter inserted every four hours. If the mother or baby has an adverse reaction, it cannot be rapidly discontinued because the drug has already been absorbed. In recent years, there have been concerns over the number of birth injuries that have occurred in cases where Cytotec was used.
Uterine rupture occurs when the excessive contractions associated with hyperstimulation cause the uterus to tear partially or completely. The baby must be delivered via emergency C-section to prevent birth asphyxia, hypoxic ischemic encephalopathy and cerebral palsy.
Breech Presentation (Breech Births)
A breech birth is when the baby enters the birth canal buttocks- or feet- first. Breech presentation presents some hazards to the baby, including the mode of delivery (vaginal versus C-section). Though labor and vaginal birth are sometimes possible for breech babies, certain fetal and maternal factors influence the safety of vaginal breech birth. Most breech babies are delivered by C-section.
At the beginning of labor, the baby is generally facing either the right or left side of the mother’s back. Delay in descent is a sign of problems with the delivery of the head. Umbilical cord prolapse may occur, particularly in the complete, footling, or kneeling breech position. This is caused by the lowermost parts of the baby not completely filling the space of the dilated cervix. When the water breaks, it is possible for the cord to drop down and become compressed. When this occurs, the baby must be delivered immediately (usually by emergency C-section).
Because the umbilical cord is significantly compressed while the head is in the pelvis during a breech birth, it is important that the delivery of the fetal head not be delayed. Oxygen deprivation may occur from either cord prolapse or prolonged compression of the cord during birth, as in head entrapment. If this oxygen deprivation is prolonged, it may cause permanent brain damage and cerebral palsy or death. Injury to the brain and skull may occur due to the rapid passage of the baby’s head through the mother’s pelvis. Positioning the baby incorrectly while using forceps to deliver the head can damage the brain, spine or spinal cord, which often results in cerebral palsy.
When a baby remains in the womb beyond the due date, usually beyond 41 or 42 weeks, there is great potential for birth injuries. In general, the longer a pregnancy continues after 40 weeks, the more risks there are to the baby, including cerebral palsy. Research suggests that due to the increase in fetal death and injury at 42 weeks and beyond, it is much safer to induce labor by about 40 or 41 weeks than to allow the pregnancy to continue.
A baby can face numerous problems if a pregnancy continues beyond the normal gestation period. While some problems resolve on their own, others are more serious and result in irreversible and lifelong disabilities. This includes:
Postmaturity Syndrome: Occurring in 20% of postdate pregnancies, this syndrome develops due to uteroplacental insufficiency which causes chronic stress, trauma and oxygen deprivation in the baby. The baby has a unique appearance when born, including overgrown fingernails and hair, a long body with little fat, and wrinkled or dry, parchment-like skin. Postmaturity syndrome features a number of disorders:
- Uteroplacental insufficiency: The major risk to the baby comes from the fact that the placenta reaches its maximum size and surface area around 37 weeks. After 37 weeks, its surface area and function gradually deteriorate. This means that the placenta is less able to supply sufficient oxygen-rich blood to the baby.
- Fetal Distress: In post-term pregnancies, there is increased risk of fetal distress and trauma due to the higher incidence of cord compression. It is crucial that physicians pay close attention to the fetal heart rate monitor.
- Meconium aspiration: Sometimes fetal stress and an older gestational age induce a bowel movement by the baby while in the womb. In some cases, the baby will inhale amniotic fluid and fecal matter into their lungs. This can cause trauma to the airway, irritation, airway obstruction, infection, problems with normal lung expansion and HIE.
- Oligohydramnios: The volume of amniotic fluid increases during pregnancy and reaches its peak at around 34 weeks. When there is an unexpected decrease in the amount of amniotic fluid, it is called oligohydramnios. Oligohydramnios can cause cord compression and oxygen deprivation.
- Umbilical cord compression: When oligohydramnios occurs, there is a serious risk of cord compression. This is because the baby and umbilical cord no longer float in the fluid. Instead, the baby’s movements can put direct pressure on the cord, which can decrease or totally cut off the supply of oxygen-rich blood going to the baby.
- Macrosomia: A baby can become very large when a pregnancy is post-term. This can make it traumatic to deliver vaginally. This may prompt the physician to use forceps or a vacuum extractor, which increases the likelihood of birth trauma to the baby, such as brain bleeds. Macrosomia also increases the chances for shoulder dystocia (the baby’s shoulder is stuck on the mother’s pelvis) and cephalopelvic disproportion (CPD). CPD requires C-section delivery, and when macrosomia is present, a C-section delivery is usually the safest way to deliver the baby in order to prevent Erb’s palsy.
Cephalopelvic disproportion (CPD) injuries occur when the baby’s head or body is too large to pass through the mother’s pelvis and instead of delivering the baby by C-section, the physician makes prolonged attempts at vaginal delivery. Initially, physicians should have information about the mother’s pelvis type and size from x-ray and examination. Ultrasounds also give the physician an idea of the baby’s head measurements. Another important factor is how the baby’s head is positioned in the pelvis – some parts of the head can mold to conform to the mother’s pelvis.
Except for macrosomia, physicians will usually not assume CPD based on measurements alone, although measurements are one piece of information that should be considered when deciding whether to deliver vaginally or by C-section. One indication of CPD is failure to progress, meaning that labor either ceases or does not move as quickly as it should. Physicians should identify any risk factors for CPD before the start of labor. Risk factors include:
- Small or abnormal pelvis
- Large head measurement of baby
- Mother with diabetes or gestational diabetes
- Post-term pregnancy
- Mother over age 35
When CPD is identified during pregnancy, it may be necessary to plan to deliver the baby early.
If physicians fail to diagnose CPD prior to labor, they must identify the condition right away during labor and delivery and move on to a C-section. The treatment for CPD is C-section delivery. When CPD is present, attempts to deliver the baby vaginally will cause trauma, which can lead to permanent injuries such as cerebral palsy.
When CPD is present, some mistakes that can cause trauma include the following:
- Pitocin/Oxytocin: Physicians may react to CPD by administering Pitocin, which can cause excessive contractions, leading to oxygen deprivation and HIE.
- Continued Labor: Physicians may allow labor to progress for too long. Labor can be stressful and traumatic for babies, and when prolonged, it can cause oxygen deprivation and HIE.
- Prolapsed Umbilical Cord: When there is less room in the uterus, a prolapsed umbilical cord is more likely, which puts the baby at risk for HIE.
- Shoulder Dystocia: When CPD is a problem, babies are more likely to have shoulder dystocia injuries, including Erb’s Palsy.
Premature Rupture of Membranes (PROM)
Premature rupture of the fetal membranes (PROM) is a dangerous condition that can lead to early labor, fetal distress and other complications before labor or near the end of the third trimester. Without protective amniotic fluid and membranes, an unborn baby is prone to infections, loss of nutrients, premature birth and other traumatic complications. Complications from PROM can include:
- Prolapsed umbilical cord
- Inflammation and infection of the fetal membranes (chorioamnionitis)
- Infections such as GBS, UTI and BV, and HSV
- Premature birth and hypoxia
Prolapsed umbilical cord, premature birth, hypoxia and infection in the baby all may lead to hypoxic-ischemic encephalopathy (HIE), cerebral palsy and other serious conditions.
Maternal Infections, Sepsis and Meningitis
Certain infections in a mother can be passed on to the baby at birth, which is why it is crucial for physicians to recognize and properly treat them. These infections include:
- Group B streptococcus (GBS)
- Herpes simplex virus (HSV)
- E Coli
- Staphylococcus (staph) infections.
When these infections are passed on to the baby via contact with the mother’s tissues, the baby can get a systemic bloodstream infection called sepsis, which can damage the brain either by direct central nervous system infection or by causing brain inflammation (encephalitis). Sepsis can also cause meningitis, which is inflammation of the membranes around the brain and spinal cord. The most common source of meningitis is GBS.
Sepsis can also cause the baby to go into septic shock, which causes a severe reduction in blood flow and blood pressure. When blood pressure drops, the baby’s brain can become deprived of oxygen, which can cause hypoxic ischemic encephalopathy (HIE), permanent brain damage and cerebral palsy.
Gestational diabetes is when a woman is diagnosed with diabetes for the first time during pregnancy. This is one of the most common medical conditions that occurs during pregnancy. Gestational diabetes usually begins midway through pregnancy and it occurs when the body cannot make and use as much insulin as it needs. Insulin is needed to convert glucose (blood sugar) into energy.
Babies born to mothers who have gestational diabetes – especially poorly managed diabetes – are likely to be macrosomic (very large), which puts them at risk for a number of health problems. This also increases a baby’s chances of experiencing a traumatic birth. In addition, at birth, these babies (who previously had a high supply of glucose from maternal circulation) must now obtain glucose on their own. This, paired with existing high insulin production, makes these babies susceptible to hypoglycemia (low blood sugar levels). Hypoglycemia can lead to brain damage and cerebral palsy if not promptly recognized and treated.
Neonatal Ventilator (Breathing Machine) Injuries
If a baby is on a breathing machine (ventilator) after birth, they are susceptible to certain injuries if not closely monitored or if the ventilator settings are mismanaged. One cause of injury is hypocarbia. Hypocarbia is when the baby’s carbon dioxide level is below normal for too long. This can cause blood vessel constriction in the brain, which causes reduced blood flow and oxygen deprivation. These conditions often cause cerebral palsy and a brain injury known as periventricular leukomalacia (PVL), where certain portions of the brain around the ventricles soften and die.
Another type of injury is a pneumothorax, which is when there is a hole (or holes) in the lungs, causing air to leak into the space just outside the lung. This puts pressure on the lung and causes that lung to have difficulty expanding properly. This can cause severe oxygen deprivation, lung collapse and respiratory failure.
Jaundice and Kernicterus
When a baby has jaundice, it means the body isn’t breaking down and getting rid of excess bilirubin, causing the skin and eyes to turn yellow. This is somewhat normal for newborns, but if too much bilirubin is allowed to build up in the baby’s blood, the bilirubin can enter the brain tissue. Bilirubin is toxic to brain tissue, and it can cause a permanent form of brain damage called kernicterus, which often causes cerebral palsy.
High bilirubin levels are very easy to treat using phototherapy (placement of the baby under a specific kind of blue light) and babies should have their bilirubin levels frequently checked.
Delayed C-Section Delivery
As discussed earlier, when delivery complications occur, a baby will usually be unharmed if the physician quickly and properly delivers via C-section to allow medical staff to administer interventions to the baby directly.
Certain conditions require a C-section delivery, such as placenta previa, cephalopelvic disproportion and certain types of breech presentation. When other ominous pregnancy conditions occur, such as placental abruption, uterine rupture, and umbilical cord prolapse or compression, a C-section is also the safest way to deliver the baby in most cases. When physicians fail to recognize these conditions and attempt a vaginal delivery, the baby can become permanently injured.
When required, an emergency C-section should be performed as quickly as possible, and many times it should be performed within 10 – 18 minutes or less.
When a baby is is oxygen-deprived, the oxygen deprivation can get progressively worse. Mere minutes can make a difference in injury severity. Indeed, small amounts of time can make a difference when fetal distress and other complications are occurring, which is why it is critical – and the standard of care – for a labor and delivery facility to be fully prepared to timely deliver a baby by C-section. This means that the facility must have proper anesthesia and surgical personnel to permit the start of C-section delivery well within 30 minutes of the decision to perform the procedure. Many experts state that in certain cases, a C-section must be performed in just a few minutes, such as when there is a complete placental abruption or umbilical cord occlusion. These and other conditions that cause oxygen deprivation will manifest as a non-reassuring heart rate on the fetal heart monitor.
A common birth injury that does not involve the brain is called a brachial plexus injury or Erb’s palsy. This occurs when the baby’s shoulder gets caught on the mother’s pelvis during delivery and the doctor applies too much force to the baby’s head in an attempt to deliver. Excessive force can cause the baby’s nerves to stretch or tear, resulting in extreme weakness or paralysis of the affected arm. Sometimes the baby is stuck for too long in the birth canal, causing head trauma, brain bleeds and / or oxygen deprivation and HIE.
Cerebral palsy can often be one of the consequences of oxygen deprivation to a baby’s brain. If a baby is diagnosed with cerebral palsy, this means that they have a motor disorder stemming from damage to the part of the brain involved in controlling motor function. As a result, children may have either too much or too little muscle tone, tremors, repetitive motion, and difficulty with fine motor coordination. There are different types of cerebral palsy: spastic cerebral palsy, athetoid cerebral palsy, and ataxic cerebral palsy. The diagnosis is further subdivided by the number and type of limbs affected.
Michigan Birth Injury Attorneys Serving all Michigan Cities
The birth injury attorneys at Reiter & Walsh ABC Law Centers have dedicated themselves to ensuring that families from all across Michigan have access to legal representation for their child. We want to make sure that Michigan families from West Branch to Detroit to Sault St. Marie can secure the resources they need to make sure their child is taken care of – no matter what. We would be happy to travel to you to speak about your case – and our consultation is free. Call us if you’re in one of these cities, or anywhere in between:
- Ann Arbor
- Auburn Hills
- Battle Creek
- Bay City
- Clinton Township
- Farmington Hills
- Garden City
- Grand Rapids
- Grosse Pointe
- Lincoln Park
- Mt. Clemens
- Mt. Pleasant
- Oakland County
- Port Huron
- Rochester Hills
- Sault St. Marie
- South Lyon
- St. Clair Shores
- Sterling Heights
- Traverse City
- Wayne County
- West Branch
Reiter & Walsh, P.C. | Michigan Birth Injury Attorneys Representing Injured Children
The award-winning birth injury attorneys at Reiter & Walsh ABC Law Centers have been helping children with birth injuries and cerebral palsy throughout the nation since the firm’s inception in 1997. Jesse Reiter, the firm’s president, has been focusing on birth injury cases his entire career. Jesse and his team help children all over the country, and when they take a case, they spend a lot of time getting to know the child and family they are helping so they can fully understand the child’s needs.
Birth injury is a difficult area of law to pursue due to the complex nature of the medical records. The award-winning Michigan birth injury attorneys at Reiter & Walsh have decades of experience with birth injury, hypoxic ischemic encephalopathy and cerebral palsy cases. To find out if you have a case, contact our firm to speak with one of our attorneys. We have numerous multi-million dollar verdicts and settlements that attest to our success, and no fees are ever paid to our firm until we win your case. Email or call us at 888-419-2229. We give personal attention to each child and family we help and our Michigan birth injury attorneys are available 24/7 to speak with you.
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