Approximately four million babies are born every year, and 97% of these births take place in the hospital. This means that close to 120,000 births take place outside of a hospital every year, and this number is on the rise. A birth is something that parents never forget and nobody can deny the importance of the birthing environment. However, a home birth, outside of an institution with the capacity to quickly perform a C-section delivery if necessary, greatly increases the baby’s risk of suffering permanent brain damage, birth injuries, hypoxic ischemic encephalopathy (HIE), cerebral palsy and seizures.
Listed below are factors to consider when choosing a birthing facility, as well as important questions to ask potential obstetricians in order to help ensure a safe and healthy delivery.
Hospitals Have The Ability To Closely Monitor Your Baby And Perform An Emergency C-Section
Of course, not all hospitals are equal. Expecting parents should thoroughly research potential obstetricians and hospitals before deciding on a birthing facility. But one thing is absolutely certain: the facility should have the ability to quickly perform an emergency C-section if the baby gets in trouble. Most babies born in the U.S. have healthy births. But this is no reason to take the chance that your baby will have an uneventful and safe birth. A seemingly small action–such as not delivering a baby fast enough when she is in distress–can cause the baby to be permanently crippled with cerebral palsy or other lifelong conditions.
There are many conditions that can occur during or near the time of delivery that can cause a baby to be deprived of oxygen. In a hospital, the standard of care is to monitor the baby’s heart beat with a fetal heart rate monitor. If a baby starts to suffer from a lack of oxygen to her brain, this will show up as a non-reassuring heart tracing on the monitor, called fetal distress. When a baby is in distress, she should be delivered immediately, in most cases. If a baby cannot be safely and quickly delivered by a vaginal delivery, a C-section should be performed to get the baby out of the oxygen depriving conditions and allow physicians to help her if she needs it. Failure to quickly deliver a baby when she is experiencing a lack of oxygen to her brain can cause a permanent brain injury called hypoxic ischemic encephalopathy (HIE), which often leads to cerebral palsy and other conditions, such as hydrocephalus, periventricular leukomalacia (PVL), seizure disorders and intellectual disabilities.
Conditions that can cause a baby to suffer a lack of oxygen to her brain during or near the time of delivery include the following:
- Umbilical cord problems (cord wrapped around the baby’s neck (nuchal cord), umbilical cord prolapse, short cord and cord in a true knot)
- Placental abruption
- Uterine rupture
- Placenta previa
- Shoulder dystocia (baby’s shoulder is stuck on the mother’s pelvis, thereby halting the process of delivery)
- Prolonged and arrested labor
- The baby is in an abnormal position, such as a breech or face presentation
- The mother has preeclampsia, which can turn into eclampsia
- The mother has cephalopelvic disproportion (CPD), which makes a vaginal birth impossible
The likelihood of a serious event occurring during delivery is small. Nonetheless, it is critical to have C-section delivery quickly available because should an oxygen-depriving or traumatic event occur, a quick delivery can not only prevent permanent disability such as cerebral palsy, it can save the baby’s life. Having the capacity to perform an emergency C-section must be coupled with close monitoring of the baby’s heart rate because the fetal heart tracings are often the only sign that a baby is in distress.
Ten Reasons To Give Birth In A Hospital
1. It is the mother’s first pregnancy and she is over the age of 35. Research indicates that these mothers are at a higher risk of having delivery complications, including excessive bleeding and placental complications. They are also more likely to have prolonged and arrested labor.
2. The mother has uterine fibroids. These mothers are more likely to have a baby in breech position, preterm labor, arrested labor, and the mothers are more likely to require a C-section delivery.
3. The mother is expecting twins, triplets or more. Being pregnant with multiple babies makes a delivery high risk due to the numerous complications that can arise, which include premature birth.
4. The mother has gestational diabetes. Gestational diabetes increases the likelihood that the baby will be macrosomic (large) which can make delivery difficult and traumatic for the baby. When macrosomia is present, the baby often won’t fit through the birth canal (CPD), making C-section a requirement. Furthermore, these babies should be born in a hospital setting because their blood sugars often plummet within the first 24 hours after birth, putting them at great risk of neonatal hypoglycemia and resultant cerebral palsy if not properly managed. Obesity increases the mother’s chances of developing diabetes during pregnancy and having a macrosomic baby.
5. The mother has placenta problems. Placenta accrete, placenta previa and placental abruption are all very serious problems that can cause severe hemorrhaging in the mother and oxygen deprivation in the baby. In many instances, these conditions require a planned C-section delivery. Placental abruption may be mild and a mother may not know she has it. But a mild abruption can turn severe very quickly, which is why it is crucial for the baby’s heart rate to be closely monitored during labor and delivery. If an abruption gets worse and it affects the baby, this will manifest as a non-reassuring heart rate on the fetal monitor, thereby alerting the medical staff that the baby should be delivered immediately.
6. The mother has had problems with pregnancies in the past. If a woman had a difficult or high risk pregnancy or delivery in the past, it increases the likelihood that her current pregnancy will be high risk.
7. The mother has had a lot of babies. The ability of the uterus to shrink after giving birth decreases for mothers who have had more than four children. This is called uterine atony, and it can cause the mother to have a lot of blood loss.
8. The baby is in a breech presentation. Babies in breech position are at a high risk of having their arm or head trapped, delaying delivery and causing the baby to suffer from a lack of oxygen. The placenta may start to detach as the uterus quickly shrinks (because most of the baby is out) and strongly contracts in an effort to expel the baby.
9. The mother has preeclampsia. This increases the risk of placental abruption. In addition, preeclampsia can become eclampsia, which is a condition in which the mother has a seizure. This can cause death in both the mother and baby.
10. The mother lives far away from a hospital. If a woman does not live near a hospital, it is important to plan to deliver at a hospital. Giving birth at home without the ability to have a C-section quickly performed is risky enough. But if the hospital is a far drive, it may be impossible to get help in time if an emergency arises during labor and delivery.
Choosing An Obstetricians And Birthing Facility
Natural births can occur in a hospital. Many hospitals now offer medication-free, midwife deliveries. Some provide water therapy, birthing balls and a wide variety of environments from which the mother can choose. The advantage is that the baby’s heart rate can be closely monitored and a C-section can quickly take place if the baby starts to suffer from oxygen deprivation/fetal distress. Even when a C-section delivery is required, relaxing therapies such as hypno-birthing, foot massage and music therapy are often offered.
The physician and midwife must give the mother informed consent, which means the risks, benefits and alternatives for all procedures must be thoroughly explained.
Listed below are some questions a pregnant woman should ask her prospective obstetricians to help determine which one to select for prenatal care and delivery:
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 during my labor and delivery?
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? When I’m in labor, 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 (e.g., Pitocin / Cytotec to induce or speed up labor) or delivery instruments you are going to use (e.g., forceps or vacuum extractors)?
8. If an obstetrician decides to use drugs or delivery instruments, it is important to ask the obstetrician how much experience she has with using the drugs and instruments.
9. 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 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 hypoxic ischemic encephalopathy and cerebral palsy.
Reiter & Walsh: Advocates For Babies And Children For Almost 3 Decades
If you are seeking the help of a lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children for almost 3 decades.
Cerebral palsy lawyer Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over 28 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Jesse is currently recognized as one of the best medical malpractice lawyers in America by U.S. News and World Report 2014, which also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation. The lawyers 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, periventricular leukomalacia (PVL), a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award winning lawyers 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. Our award winning lawyers are available 24/7 to speak with you.