New Research: Increase in Delivery Risks

Henry Ford has an award winning hospital for women in Dearborn, Michigan called Women’s Health Services.  Over 3,000 babies are born every year at this hospital, and Henry Ford Health System has consistently provided a strong voice for women’s health issues.  In December of 2012, the hospital published an article warning women that giving birth has gotten riskier.  Risky deliveries increase a woman’s chance of having a baby who sustains a brain injury during birth, which can cause conditions such as cerebral palsy, hypoxic ischemic encephalopathy (HIE), and intellectual and developmental disabilities.

In 2012, the Centers for Disease Control (CDC) published results of a shocking study about deliveries.  Researchers found that emergencies during delivery increased by 75% in the decade ending in 2009.  Researchers also found that in the days following delivery, severe complications in mothers more than doubled.

More than 4 million babies are born every year in the U.S., and many of these births are affected by some type of complication.  Approximately 52,000 deliveries are affected by severe complications each year.  A major cause of the 75% increase in emergencies during delivery is due to the large increase in the number of expecting mothers who are obese, older, or have long-term conditions, such as diabetes and kidney disease.  However, healthy women can also experience major complications during pregnancy, such as a hemorrhage, which can be caused by placental abruption or uterine (womb) rupture.

The lead author of the CDC study, William Callaghan, said that this research should prompt a major call to address the issue of pregnancy and delivery complications.  He said that when things go wrong during pregnancy and delivery, they can go south very fast, which means it is crucial to have an astute team trained to respond when there is a crisis.

Thanks to this research, hospitals have been implementing programs and borrowing strategies from the military to train staff in emergency care protocols that have been proven to decrease trauma, injuries and deaths.  A Minnesota surgeon recalls an incident that happened during a delivery, when a mother started hemorrhaging and losing major amounts of blood.  The surgeon, Peter Johnson, tried to stop the bleeding with medication and other treatments, and when this failed, the medical team followed a massive transfusion protocol, which helped to rapidly replace the mother’s blood.  At the same time, an additional surgeon was called in to perform an emergency hysterectomy.  The mother and her baby both survived, with no permanent injuries.  Johnson says that prior to implementing the emergency protocols, the staff might have been panicking and running around in different directions.  However, since the team had learned and practiced these emergency drills, everyone was calm, reasoned and efficient.

Complications that occur during pregnancy and delivery cost hospitals billions of dollars every year, according to Premier, Inc., a program that helps hospitals train their medical team by simulating emergencies and performing drills, and by helping the hospitals develop protocols.

The shocking numbers – that there is a 75% increase in delivery emergencies and that birth complications cost billions of dollars a year – should alert women to the importance of taking care of their health prior to and during pregnancy, as well as finding a very skilled and competent physician who practices in a hospital that is prepared for emergencies.

WHAT ARE SOME OF THE COMPLICATIONS THAT CAN OCCUR DURING PREGNANCY AND DELIVERY?

There are many conditions that can cause a pregnancy to be high risk, such as diabetes, gestational diabetes (diabetes that starts during pregnancy), high blood pressure, obesity, being pregnant with twins, triplets or more, and being pregnant for the first time after age 35.  A high risk pregnancy means that the mother and baby are more likely to have complications during the pregnancy and delivery and therefore must be very closely monitored and have prenatal testing performed more frequently.

Complications can involve diabetes and high blood pressure / preeclampsia, both of which can cause a decrease in the transfer of nutrients and oxygen-rich blood to the baby.  The position or size of the baby, such as breech or face presentation, cephalopelvic disproportion (CPD) or macrosomia, can put the baby at risk.  It also is very serious when there are complications affecting the placenta or umbilical cord, which are both responsible for transferring oxygen-rich blood and nutrients to the baby from the mother.  These problems include placental abruption, umbilical cord prolapse and nuchal cord.  A uterine rupture also can severely deprive a baby of oxygen.  If a mother has placenta previa, which is when the placenta covers the opening of the birth canal, the baby can also be in serious trouble during delivery.

These are just a few of the many complications of which physicians must be aware.  With close monitoring and proper management, a baby in a complicated pregnancy and delivery can usually be born healthy.  However, if physicians fail to perform proper prenatal tests, or don’t properly monitor the mother and baby during labor and delivery, the baby is much more likely to suffer a birth injury.  Birth injuries frequently occur when physicians don’t pay close attention to the data on the fetal heart rate monitor (or they lack skill in interpreting the data), and a baby’s distress goes unnoticed.  When a baby is showing signs of distress, it means she is being deprived of oxygen and must be delivered in a timely fashion.  Often, the baby has to be quickly delivered by an emergency C-section.  Failure to do this when a baby is in distress can cause severe oxygen deprivation and permanent brain damage that results in cerebral palsy, HIE, periventricular leukomalacia, seizure disorders, hydrocephalus, and intellectual and developmental disabilities.

WHAT CAN I DO TO HELP PREVENT PREGNANCY AND DELIVERY COMPLICATIONS?

It is important to talk to your physician prior to becoming pregnant so that a plan can be made to make sure that you have good health at the start of your pregnancy.  Once pregnant, your physician should take a thorough history of you to help determine a healthy routine for you to follow.  In addition, a history will help your physician determine if you have a high risk pregnancy.  Appointments for prenatal visits should be made, and a plan for prenatal care should be developed by you and your physician.

It is critical that you find a very skilled physician or physicians to care for you during your pregnancy and delivery.  We have written extensively about how to find a good obstetrician, and listed below are some questions to ask prospective obstetricians.

Questions for prospective obstetricians:

1.) Will you be continuously monitoring my baby’s heart rate when I go into labor?

2.) How many deliveries have you performed?

3.) Are you skilled at interpreting fetal heart rate tracings?

4.) Will someone skilled in fetal heart rate interpretation be present at all times when I’m in labor?

5.) If my baby shows signs of distress and I cannot quickly deliver her, do you and the hospital have the capability to quickly deliver my baby by C-section?  Will I be in or next to a room where a C-section can quickly be performed?

6.) Will there be a second physician instantly available so that if both my baby and I are in distress, there is one physician focusing on me and one focusing on my baby?

7.) Will you please thoroughly explain the risks and benefits of – and alternatives to – any medications (such as Pitocin / Cytotec to induce or speed up labor) or delivery instruments you are going to use (such as forceps or vacuum extractors)?   If an obstetrician decides to utilize drugs or delivery instruments, it is important to ask the obstetrician how much experience she has with using the drugs or forceps / vacuum extractors.  This is especially true when it comes to delivery instruments, which are very risky.  C-section risks and benefits must also be thoroughly discussed.

8.) If the obstetrician leaves the room during labor, the mother should not hesitate to ask the staff members present if they are skilled at fetal heart rate interpretation and if they have taken a proficiency exam.  Research shows that a lot of malpractice occurs when abnormal (non-reassuring) fetal heart tracings are not recognized, or if they are recognized, there is a breakdown in communication among the staff.  An example would be when the staff fails to communicate abnormal heart tracings to the obstetrician, and then the baby is not quickly delivered and is instead left in oxygen depriving conditions, which can cause brain damage.

An expecting mother should also ask the obstetrician how many deliveries she’s been involved in where the baby required time in the neonatal intensive care unit (NICU), or where the baby had HIE.

REITER & WALSH: ADVOCATES FOR CHILDREN FOR OVER 25 YEARS

Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping and advocating for children for decades.  Jesse Reiter, the co-founder of the firm, has been focusing solely on birth injury cases for over 25 years.  He is currently recognized as one of the best medical malpractice attorneys in America by U.S. News and World Report 2014, which also recognized ABC Law Centers as one of the best law firms in the country.  The attorneys at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).

 

If your child was diagnosed with a permanent disability, such as cerebral palsy, HIE, PVL, intellectual disabilities or developmental delays, the award winning attorneys at ABC Law Centers can help.   We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent.  Our nationally recognized firm has 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 Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation.

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