Delayed C-section and nuchal cord cause hypoxic ischemic encephalopathy (HIE)

Nuchal Cord and HIE

nuchal cord; umbilical cord; fetal oxygen deprivation; hypoxia; hypoxic ischemic encephalopathy; birth asphyxia


Hypoxic-ischemic encephalopathy (HIE) is brain damage caused by oxygen deprivation in the brain. This deprivation can be caused by a lack of oxygen in the blood (hypoxemia / hypoxia) or a lack of blood flow in the brain (ischemia).

A nuchal cord is when the baby’s umbilical cord is wrapped around the baby’s neck. Sometimes the cord ends up in a true knot and cannot be undone. Nuchal cords can form at any time. Sometimes they form and disentangle, and sometimes they stay in a knot. In some cases, a nuchal cord may not affect the pregnancy. But in many cases, a nuchal cord causes restriction of blood flow, depriving the baby’s delicate brain of oxygen-rich blood (1).

The methods by which a nuchal cord (or cords) can cause hypoxia, ischemia and HIE are:

  • There is restriction of carotid (neck) artery blood flow because the cord is wrapped tightly around the baby’s neck.
  • There is severe congestion of venous blood flow – the blood flow gets backed up and doesn’t circulate properly.
  • There is compression of the umbilical cord vessels themselves when the cord becomes tightly compressed against itself or the baby’s neck. In other words, the umbilical  cord is impinged upon so blood cannot easily flow through the cord to the baby.

Improper Fetal Monitoring and HIE

internal fetal monitoring; fetus; pregnancy

Internal fetal monitoring is critical in detecting fetal oxygen deprivation

Knowing when a baby is in distress during pregnancy, labor, and delivery is very important because fetal distress represents a lack of oxygen in the baby (2).  When a fetus is deprived of oxygen, it is very serious because physicians do not have instant access to the baby when oxygen deprivation and fetal distress occur. Instead, the process of delivery – often by an urgent C-section – has to take place before physicians are able to directly help the baby with oxygenation and circulation. In many cases, simply delivering the baby so she can breathe on her own is the main action that needs to occur because it removes her from oxygen-depriving conditions, such as a nuchal cord. However, physicians and nurses may not be aware that a baby is in distress if the baby is not being carefully monitored with a fetal heart monitor, or if data on the fetal monitor is being ignored or misinterpreted. If a baby’s hypoxia and distress are not recognized, HIE and other permanent brain injuries can result.

Research has shown that one of the causes of birth injuries is failure to react appropriately to nonreassuring fetal heart tracings, and this failure is often due to a lack of knowledge in interpreting fetal heart tracings, as well as a failure of communication among the members of the medical team. The hospital must ensure that the staff members who are monitoring mothers and babies during labor and delivery are skilled in interpreting fetal heart tracings, so that even subtle changes on the fetal heart monitor are noticed. The medical team must recognize abnormal tracings before they become very serious. In addition, data on the heart monitor must be communicated to members of the team taking care of the mother and baby. If a physician is out of the room and cannot be quickly reached, this constitutes a breakdown in communication.  Furthermore, when a mother is in labor, the medical team must have the capacity to quickly perform an emergency C-section. Medical personnel involved in labor and delivery should be aware of the fact that there are many dangerous conditions that can occur during labor and delivery that can cause the baby to be severely oxygen-deprived. Thus, the ability to quickly react to this situation means that 1.) a fetal heart rate monitor must be appropriately placed, and staff that are very skilled in heart tracing interpretation must be present; and 2.) communication among staff members must occur, and the physician must be present and ready to quickly deliver the baby by emergency C-section, should the need arise (2).

Legal help for children with HIE and seizure disorders

Reiter & Walsh, Best Lawyers, 2015

Failure to properly monitor and treat the mother and baby during pregnancy, labor and delivery is negligence. Failure to diagnose and treat problems such as HIE and seizures in a baby after birth is also negligent. If this negligence leads to injury of the baby, it is medical malpractice.

The nationally-recognized lawyers at ABC Law Centers (Reiter & Walsh, P.C.) have decades of experience in birth injury cases, including HIE, seizure, and nuchal cord cases. If you experienced complications during pregnancy and your child developed an injury such as a seizure disorder or HIE, we can help you. Our award-winning attorneys will work tirelessly to obtain compensation for treatment, therapy and a secure future for your child. Email or call us at 866-933-3015 for a free consultation. Should we take your case, you would pay no fee unless we win.


  1. HIE: Cord Wrapped Around Baby’s Neck (Nuchal Cord). (n.d.). Retrieved September 18, 2020, from
  2. Reiter, J. (2014, November 14). Signs of Fetal Distress and Oxygen Deprivation: FAQs. Retrieved September 18, 2020, from

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  1. Reiter & Walsh, P.C. says:

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