An obstetrician in Ontario is no longer permitted to deliver babies after severely injuring two newborns during delivery. The College of Physicians and Surgeons of Ontario released a decision made in June by its discipline committee, which ruled that the physician, Dr. Padamjit Singh, was incompetent.
The first infant that was injured suffered from a crushed skull due to improper vacuum extractor use. During labor, there was a loss of the baby’s heart rate on the fetal monitor and the baby needed to be delivered by emergency C-section. Singh, however, failed to act with any sense of urgency, and in fact, she told the anesthesiologist that she had time to start an elective epidural in another patient. The anesthesiologist described Singh as a “deer in headlights.” Singh attempted a vaginal delivery, but was having difficulty delivering the head. She decided to use a vacuum extractor, which is a delivery instrument placed on a baby’s head to help facilitate delivery. After delivery, the baby was found to have multiple skull fractures and hematomas, which are areas of brain bleeds and blood pooling.
In addition, the baby suffered brain damage as a result of oxygen deprivation (asphyxia) caused by the delayed delivery. The baby was in distress in the womb and needed to be delivered immediately so she could be out of the stressful conditions and breathing, and so physicians could resuscitate her if necessary. All of these critical measures were delayed due to failure to perform an emergency C-section, prolongation of a vaginal delivery, and improper use of a vacuum extractor.
In the second negligent delivery, delivery was so prolonged that the baby suffered severe asphyxia that caused a permanent brain injury known as hypoxic ischemic encephalopathy (HIE). In this case, Singh failed to properly examine and monitor the mother and baby. The baby was malpositioned (not in a normal, head-first position), but Singh failed to notice this. Again, an emergency C-section was not timely performed and the baby was left in distress for too long. When Singh finally decided to perform a C-section, she made an improper incision and extracted the baby from the womb in a dangerous fashion, using excessive force while simultaneously pulling the baby’s arm and leg.
These very tragic cases emphasize the importance of properly monitoring a mother and baby during labor and delivery, which means the baby’s heart tracings on the fetal heart monitor must be closely watched and accurately interpreted. If there are any signs of distress, a baby should be delivered immediately, usually by emergency C-section. Physicians must appreciate signs of distress and should never be dismissive of an abnormal tracing or a tracing that could be a sign of distress. If a baby’s fetal heart tracing is abnormal, or the monitor appears not to be picking up the baby’s heart rate, physicians should err on the side of caution and should never gamble that a baby will be fine inside the womb. There is no excuse for failure to properly monitor a baby or failure to pay attention to a baby that is in distress. If vaginal delivery cannot quickly occur, the baby should be delivered by emergency C-section.
BIRTH ASPHYXIA AND HIE
Birth asphyxia or intrauterine hypoxia (oxygen deprivation in the womb) occurs when an infant does not receive an adequate supply of oxygen before, during, or immediately following birth. HIE is defined as permanent brain damage caused by insufficient oxygen or blood flow to the brain near the time of birth. A baby’s brain can be deprived of oxygen when there is not enough oxygen in the blood (hypoxia) and / or when there is insufficient flow of blood in the brain (ischemia). When a baby is deprived of oxygen for too long, brain cells start to die and HIE can result.
There are many complications during and after pregnancy, labor and delivery that can cause HIE. These include:
- Trauma to the baby’s head and hemorrhages (bleeds) during delivery, which can be caused by use of forceps or vacuum extractors during delivery
- Failure to properly resuscitate the baby after birth
- Umbilical cord injuries, such as a prolapsed cord (cord exits before the baby and gets impinged upon) or nuchal cord (cord is wrapped around the baby’s neck)
- Improper use of Pitocin or Cytotec that causes hyperstimulation of the uterus (strong and frequent contractions that deprive the baby of oxygen)
- Problems with the placenta or uterus, such as placental abruption (part of the placenta tears away from the uterus), plancenta previa (placenta partially or completely covers the opening to the birth canal), and a ruptured uterus
- Complications related to the baby’s size or position, such as cephalopelvic disproportion (baby is too big to fit through the mother’s pelvis), breech birth and face presentation
- Delayed delivery of the baby and failure to perform an emergency C-section when the baby is in distress
- Undiagnosed or improperly treated conditions in the mother, such as high blood pressure (preeclampsia) or infections, such as chorioamnionitis and villitis, Group B Strep (GBS) and herpes simplex virus (HSV)
- Meconium aspiration (baby breathes in a mixture of amniotic fluid and stool)
- Oligohydramnios (low fluid in the womb)
- Prolonged labor
- Hydrocephalus (fluid in the brain)
- Post-term pregnancy
IMPROPER USE OF A VACUUM EXTRACTOR
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 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 must move on to a C-section delivery. Vacuum extractors are a high-risk instrument, and incorrect use can result in severe injuries, such as skull fractures, brain hemorrhages and hematomas, brachial plexus injuries / Erb’s palsy, cerebral palsy and seizures.
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.
FAILURE TO RECOGNIZE A MALPOSITIONED FETUS
It is an obstetrician’s job to know the position of the baby because the position has very significant implications for delivery; certain positions greatly increase the risk for serious birth complications, such as umbilical cord prolapse, nuchal cord and head trauma. In addition, the position of the fetus is one of the factors that dictates exactly how the baby should be delivered. Sometimes, an abnormal position can be detected when the physician performs a digital exam, and the position can be confirmed by an ultrasound. Other times, routine ultrasounds detect the baby’s position. Many times, a baby who is malpositioned maneuvers to a normal, head first position prior to delivery. Thus, the baby’s position must be properly assessed at the time of birth.
Since abnormal positions such as breech and face presentation increase the risk of fetal distress, it is imperative that physicians closely assess and monitor the mother and baby during labor and delivery. A fetal heart monitor must be properly used so that the heart tracings are accurate. The physician must be very skilled in handling malposition, and a C-section delivery is often the safest method of delivery.
FAILURE TO TIMELY RESUSCITATE A NEWBORN
When a fetus is in a high-risk situation, a resuscitation team should be in the delivery room at birth. Otherwise, a team should be instantly available for any newborn who may be in distress at birth. Prompt resuscitation is important; resuscitation maneuvers are used to help a baby breathe or start breathing, help her heart beat faster or better, and/or to help improve her circulation and blood pressure. Delay in correcting any of these problems can cause oxygen deprivation and brain damage in a newborn. These maneuvers cannot be implemented until the baby is out of the womb. Thus, when a baby is in distress, quick delivery is crucial.
NEGLIGENCE DURING LABOR AND DELIVERY
The instances of negligence in this Canadian hospital highlight the importance of having only skilled obstetricians perform deliveries. Deliveries can get complex at any moment. It is the duty of all hospitals to perform performance reviews to assess the skill of their physicians. If a physician lacks the skills necessary to be able to safely handle the numerous situations that can arise during delivery, the physician should not be handling deliveries. Knowing when and how to quickly deliver a baby by emergency C-section is critical, and swift resuscitation must take place at birth if indicated. If a hospital lacks the staff or equipment to properly carry out these procedures, the hospital should not perform deliveries.
Listed below are some behaviors that constitute negligence:
- Failure to closely monitor a mother and baby during pregnancy and delivery, and failure to detect fetal malposition
- Failure to obtain adequate informed consent, which includes advising the mother of the risks and alternatives of delivery methods, such as vaginal birth versus C-section and expectant management
- Failure to obtain adequate informed consent, which includes advising the mother of the risks and alternatives of the use of delivery instruments, such as vacuum extractors
- Failure to properly and timely deliver the baby and follow standards of care when performing a C-section or vaginal delivery, and when utilizing delivery instruments
When a baby suffers from permanent brain damage, it is devastating. When negligence on the part of trusted medical personnel causes the damage, it is especially tragic.
Failure to properly assess and monitor a baby during labor and delivery and improper use of delivery instruments constitute negligence. Failure to recognize distress and perform a timely C-section when one is indicated is also negligence. When this negligence causes injury in the baby, it is medical malpractice.
HELP FOR FAMILIES WHOSE CHILD HAS HIE, CEREBRAL PALSY OR OTHER BIRTH INJURIES
Due to the complex nature of birth injury cases, it is imperative to have skilled and experienced attorneys such as the nationally recognized attorneys at Reiter & Walsh ABC Law Centers. Our attorneys will research your case, find the cause of injury and determine if negligence occurred. For decades, we have been helping families in Michigan and throughout the nation, and we have numerous multi-million dollar verdicts that attest to our success. We will fight to obtain the compensation you and your family deserve for lifelong care, treatment and therapy of your child, and you never pay any money until we win your case. Call us at 888-419-2229.