Bronagh Colhoun had an uneventful pregnancy, and went into labor on September 27th, 2008. That afternoon, the physician gave her the drug syntocinon (Oxytocin) to induce labor. An hour and a half after administration, the electronic fetal monitor showed that the baby was in distress. The physician recommended discontinuation of the drug, but it was started again approximately 1 – 2 hours later. The distress continued, but despite this, the rate of Oxytocin was further increased.
When the baby still had not been delivered by midnight, the physician decided to facilitate delivery using another risky technique, vacuum extraction. A vacuum extractor uses a small, soft cup and suction to help pull the baby out of the birth canal. The vacuum extraction lasted for 39 minutes, and different cups had to be reapplied. This is against the recommended standard of care, which is that pulling should last for no more than 10 – 15 minutes. Further standards of care were violated when an urgent C-section was not performed once it was realized that the vacuum extraction was taking longer than recommended.
Bronagh’s baby, Sarah, was deprived of oxygen while excessive Oxytocin was administered and standards of care for vacuum extraction were not followed. Within a year, Sarah was diagnosed with periventricular leukomalacia (PVL) and cerebral palsy that affects all of her body, with no movement on her right side. The hospital eventually admitted liability for the negligence and injuries, and a settlement of close to $1.8 million was awarded for Sarah’s care.
Oxytocin, Hyperstimulation and Fetal Oxygen Deprivation
Anything that interferes with delivery of oxygen to a baby can start a cycle of injury. This includes any problems with the mother’s ability to supply oxygen to the placenta. The placenta is a remarkably efficient organ that generally has a large capacity to handle problems that develop naturally in its functioning. A common threat to this proper functioning can be the impatience of the physician during labor and delivery. Inappropriate use of Oxytocin is dangerous and can seriously hinder the ability of the placenta to deliver oxygen to the baby. Oxytocin is given to increase both the frequency and strength of contractions, and if too much is used or it is used improperly, it can cause hyperstimulation of the uterus, which can deprive a baby of oxygen.
Hyperstimulation can have a major effect on the placenta. The placenta is embedded in the wall of the uterus. It consists of a network of the mother’s blood vessels lying next to vessels on the baby’s side of the circulation, across which oxygen flows. When the uterus contracts, the flow of oxygen in or out of the placenta slows or stops. Between contractions, the placenta is “at rest” and oxygen flows freely. During a contraction, flow stops or is slowed. For the placenta to work properly, there must be sufficient time between contractions for the placenta to recharge with a fresh supply of oxygen.
Excessive Oxytocin can cause contractions to occur less than 2 –3 minutes apart, thereby reducing the ability of the placenta to replenish its oxygen supply. Excessive frequency of contractions is called tachysystole, or hyperstimulation. When hyperstimulation occurs, the physician must stop the Oxytocin. Failure to do so can lead to brain damage or loss of the baby.
When Sarah showed signs of distress on the fetal monitor, the Oxytocin should have immediately been stopped. Research shows that Oxytocin induced hyperstimulation can cause the baby’s oxygen saturation to progressively decrease. When a baby is deprived of oxygen, it is called hypoxia, and a condition called hypoxic-ischemic encephalopathy (HIE) can result, which can lead to PVL and cerebral palsy.
Vacuum Extraction, Delayed Delivery and Oxygen Deprivation
A vacuum extractor uses a cup that is 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 gentle traction to the baby’s head while suction from the vacuum assists in pulling the baby’s head out of the birth canal. Problems can occur if the suction cup of the vacuum extractor is not placed correctly. The physician’s technique to pull the baby out is equally important – there should be no twisting of the head or neck, no excessive pulling, and no pulling for more than 10 to 15 minutes. Also, if the vacuum extractor comes off 3 times during use, or if 3 consecutive pulls do not result in delivery of the baby, the physician should move on to a C-section delivery. Incorrect use of a vacuum extractor can result in skull fractures, retinal hemorrhages, brachial plexus injuries / Erb’s palsy, brain hemorrhages, cerebral palsy and seizures.
Furthermore, when a baby shows signs of distress on the fetal monitor, it is almost always a sign that the baby is not receiving enough oxygen. When this occurs, it is crucial for the baby to be delivered immediately. A delay in performing an emergency C-section prolongs the oxygen deprivation, thereby increasing the likelihood of HIE and permanent damage to the baby’s brain.
Sarah was showing signs of distress, and when the vacuum extraction clearly was not working, the physician should have moved on to an emergency C-section so that Sarah could be out of the oxygen depriving conditions. The claim that the Colhouns made against the hospital stated that there was excessive administration of Oxytocin and failure to recognize hyperstimulation. It further claimed that there was failure to properly deliver the baby at the earliest possible opportunity and failure to perform a C-section.