In a recent study published in May in The Lancet, researchers found that the U.S. has increasing rates of death and trauma caused by complications that occur during pregnancy and delivery. In fact, the U.S. is becoming a less safe place to have a baby, dropping from being the 4th safest country in which to give birth to number 31. Reasons for the increase in death and trauma during delivery is largely due to mismanaged problems associated with obesity and diabetes. Obesity, diabetes and gestational diabetes (diabetes that begins during pregnancy) are all risk factors for high blood pressure and preeclampsia. In 2013, a Norwegian study found that obesity increases the chances that the physician will use forceps or vacuum extractors to assist with a vaginal delivery. These delivery devices place a baby at an increased risk of suffering head trauma, brain bleeds, hemorrhages and cerebral palsy.
Indeed, the increasing incidence of death and trauma during pregnancy and birth impacts both the mother and child. The U.S. has the highest rate of first-day neonatal death of any country in the developed world. Babies who experience traumatic births and survive are often left with lifelong disabilities, such as hypoxic ischemic encephalopathy (HIE), seizures and cerebral palsy.
In 2012, the Centers for Disease Control (CDC) published alarming results of a study that examined deliveries in the U.S. Investigators found that emergencies during delivery increased by 75% in the previous decade (ending in 2009). Severe complications affected approximately 52,000 births annually. A significant cause of the 75% increase in emergencies during delivery is due to the increase in the number of mothers who are obese, older, or have long-term conditions, such as diabetes. However, healthy women can also experience major complications during pregnancy, and the research indicates that hemorrhage is one of the most common complications in previously healthy women. Hemorrhages during delivery can be caused by placental abruption and uterine (womb) rupture.
The principal investigator of the CDC study stated that his research should prompt a major call to address the issue of complications that occur during pregnancy and delivery. He said that when things go wrong during this time period, they can go south very fast, which means it is crucial to have an astute obstetrics team trained to respond to fetal and maternal distress when there is a crisis.
OBESITY AND BIRTH INJURIES
The World Health Organization (WHO) has stated that obesity is a global health crisis. Women with a pre-pregnancy BMI (body mass index) of 40 or more (indicative of obesity) have the strongest risk of vacuum extraction delivery. Women who gain 35 pounds or more while pregnant have a significantly increased risk of having a forceps or vacuum extraction delivery. This finding is independent of BMI prior to pregnancy. Research shows that obese women have significantly lower gestational weight gain, but their babies tended to be larger (macrosomic).
Indeed, being overweight during pregnancy can be responsible for a number of complications, including gestational diabetes, a macrosomic baby, premature birth, pregnancy-induced hypertension, a longer labor, and vacuum or forceps-assisted delivery. It is imperative for physicians to pay attention to a pregnant woman’s weight and weight gain during pregnancy. Physicians should work with overweight women to create a diet and exercise program so that weight and weight gain will be as healthy as possible, thereby minimizing the risks associated with obesity. Physicians must be aware of the complications associated with overweight pregnant women, and they must carefully monitor the mothers during pregnancy and delivery. Most obese women are considered to have a high risk pregnancy, and all women with gestational diabetes and preeclampsia are considered high risk. A high risk pregnancy requires more frequent prenatal testing as well as referral to a maternal-fetal specialist.
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, high blood pressure and preeclampsia, obesity, being pregnant with twins, triplets or more, and being pregnant for the first time after age 35.
Diabetes, gestational diabetes, high blood pressure and preeclampsia 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 also put a baby at risk of experiencing complications during delivery. It also is very serious when there are complications affecting the placenta or umbilical cord, which are responsible for transferring oxygen-rich blood to the baby from the mother. These problems include uterine rupture, placental abruption, umbilical cord prolapse and nuchal cord. If a mother has placenta previa, which is when the placenta covers the opening of the birth canal, the baby is also at risk of having serious complications 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 immediately. Often, this must occur by emergency C-section delivery. Failure to do this when a baby is in distress can cause severe oxygen deprivation and permanent brain damage that results in cerebral palsy, hypoxic ischemic encephalopathy (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 performed in which the baby required time in the neonatal intensive care unit (NICU), or where the baby had HIE.
REITER & WALSH: ADVOCATES FOR CHILDREN FOR OVER 28 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 28 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. Our firm’s attorneys are available to speak with you 24 / 7.