Preventing Hypoxic Ischemic Encephalopathy (HIE) and Cerebral Palsy by Avoiding Prolonged Labor
A prolonged or arrested (stalled) labor is associated with a lack of oxygen to the baby’s brain, hypoxic ischemic encephalopathy (HIE), and permanent conditions, such as cerebral palsy and seizures. Therefore, it is critical that medical personnel do everything possible to prevent hypoxic ischemic encephalopathy (HIE) and cerebral palsy by avoiding prolonged, arrested, or stalled labor and delivery situations. Prolonged labor is more common in a first pregnancy and in women over 35 years of age. Labor is considered prolonged when the first and second stage of labor combined is greater than 20 hours for a first and greater than 14 hours for mothers who have had prior births. Some experts consider labor to be prolonged after 18 – 24 hours. During active labor (cervix is dilated more than 4 cm), the cervix should dilate at a rate of at least 1.2 cm per hour for first babies and 1.5 cm per hour for subsequent babies.
Prolonged and arrested labor have two basic causes: inadequate contractions and mechanical impediments. Mechanical impediments include malpresentation, such as breech position, face presentation, deflexed position of the baby’s head, and asynclitism (baby’s head is presenting first and is tilted to the shoulder). Cephalopelvic disproportion (CPD) is also a major mechanical impediment. In fact, CPD means the baby’s size or position and/or the size of the mother’s pelvis makes it impossible for the baby to fit through the birth canal. Macrosomia often is a cause of CPD. This is when the baby grows very large, often due to gestational diabetes. CPD requires a C-section delivery.
Inadequate uterine (womb) contractions are the most common cause of prolonged and arrested labor during the first stage of labor. This means that uterine activity is not sufficiently strong or is not appropriately coordinated to dilate the cervix and expel the baby.
Inadequate contractions are treated with uterine stimulation, which is generally accomplished with Cytotec or Pitocin. Sometimes these drugs can cause frequent and strong contractions (hyperstimulation), which can injure the baby. When hyperstimulation occurs, the baby often has to be delivered immediately by C-section.
Use of painkillers or anesthesia can cause inefficient uterine action and may prevent voluntary effort by the mother to deliver the baby during the second stage of labor. Research shows that anesthesia can increase the length of the second stage of labor, and that it increases the use of Pitocin, as well as the frequency of delivery involving vacuum extractors and forceps.
Indeed, use of Pitocin, Cytotec, vacuum extractors and forceps is more common when labor is prolonged or arrested. These drugs and delivery instruments are very risky for the baby. Hyperstimulation caused by Pitocin and Cytotec can cause oxygen deprivation in the baby that gets progressively worse. Vacuum extractors and forceps place a baby at in increased risk of suffering head trauma, brain bleeds and hemorrhages. Informed consent is important during any medical procedure. When these drugs or delivery devices are being considered, the mother must be informed of the risks and alternatives. An alternative to these drugs and devices is a C-section delivery. In many instances, a C-section is the safer alternative, and a C-section is required when CPD is present or the baby is in certain malpresentations. A baby’s heart rate should be monitored throughout labor and delivery, and if the baby has a non-reassuring heart tracing, she should be delivered right away by C-section, in most cases. A non-reassuring heart tracing means that the baby is experiencing a lack of oxygen to her brain, which is called fetal distress.
PROLONGED AND ARRESTED LABOR INCREASES THE BABY’S RISK OF HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE)
There are multiple ways in which a long or stalled labor can cause the baby to have a brain injury such as hypoxic ischemic encephalopathy (HIE). HIE is caused by a lack of oxygen in the baby’s blood (hypoxemia/hypoxia) and/or a restriction of blood flow in the baby’s brain. HIE often leads to cerebral palsy, seizure disorders, periventricular leukomalacia (PVL) and intellectual disabilities. Listed below are some risks associated with prolonged and arrested labor.
- Fetal distress due to decreased oxygen going to the baby. Labor is traumatic for a baby. A long labor increases the risk that the baby will be oxygen deprived. Research shows that babies who experience a prolonged latent phase of labor are more likely to have thick meconium (a sign of fetal distress), low five minute Apgar scores (a sign of overall health of the baby), and an increased likelihood of requiring admission to the neonatal intensive care unit. These factors are all associated with hypoxic ischemic encephalopathy (HIE)
- Increased chances of operative delivery with forceps or vacuum extractors, and increased likelihood that Pitocin or Cytotec will be used.
- Intracranial hemorrhage or bleeding inside the baby’s head. The mere act of labor–contractions causing repeated pressure on the baby’s head– can cause a baby to have brain bleeds. Usually, these bleeds do not cause permanent damage to the baby. However, when labor is prolonged, there is an increased chance of the bleeds being more serious. Use of Pitocin and Cytotec can not only cause oxygen deprivation due to decreased time for the placenta to recharge with a fresh supply of oxygen-rich blood for the baby, but hyperstimulation caused by the drugs can increase the pressure on the baby’s head, with an increased risk of brain bleeds and hemorrhages.
- Vacuum extractors and forceps place a baby at in increased risk of having serious brain bleeds and hemorrhages because the devices attach directly to the baby’s head. A subgaleal hemorrhage is a very serious bleed that can occur with these instruments, especially when vacuum extractors are used. A subgaleal hemorrhage or hematoma can cause almost half the baby’s blood volume to be in the subgaleal space, which is the space between the scalp and the skull. Blood in this space is not involved in the baby’s circulation, and this can cause the baby to be severely deprived of oxygen, which can cause hypoxic ischemic encephalopathy (HIE), cerebral palsy, seizure disorders and even death of the baby.
If a woman is at risk of having any type of abnormal labor, intensive clinical monitoring should be done. This includes recording the pulse, blood pressure and fetal heart tracings at least every hour, and dilation of the cervix at intervals of at least two hours. Fetal heart rate strips should be continuously interpreted. If labor fails to accelerate and fetal distress develops, an emergency C-section should be performed. Of course, an emergency C-section should be performed whenever a baby is in distress and a vaginal delivery cannot quickly and safely occur.
REITER & WALSH: ADVOCATES FOR CHILDREN WITH HIE & CEREBRAL PALSY 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.
Birth injury lawyer Jesse Reiter, president of the Reiter & Walsh 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.