Emergency C-Section Protects Baby from HIE and Neonatal Brain Damage
In our blogs, we usually write about babies experiencing hypoxic ischemic encephalopathy (HIE), brain damage and conditions such as cerebral palsy caused by the delay of a necessary C-section when a baby is experiencing a lack of oxygen to her brain. We’ve also written about babies having brain injuries because the medical team delayed resuscitation efforts when the newborns were in distress. Today, however, we are writing about an amazing delivery in which the medical team acted quickly and skillfully to save a mother and baby, with miraculous results.
Rapid C-Section Delivery and Resuscitation Prevent Brain Injury and Hypoxic Ischemic Encephalopathy (HIE)
Ruby experienced a potentially deadly complication during labor and delivery: she had an amniotic fluid embolism, which is a condition in which amniotic fluid, fetal cells or other debris enter the mother’s blood stream and trigger an allergic reaction that causes cardiorespiratory collapse in the mother, which then causes rapid deterioration of the baby.
When Ruby and her baby started to deteriorate, the medical team acted quickly and promptly delivered the little girl by C-section. The newborn appeared perfectly healthy at birth, but Ruby lost consciousness and went into cardiopulmonary arrest. Within seconds, a code was called and a resuscitation team began performing critical maneuvers such as giving Ruby a breathing tube and performing chest compressions to help maintain perfusion (blood flow) in Ruby’s brain and get her heart beating.
The resuscitation effort lasted for 3 hours. When Ruby had no heart rate for 45 minutes, the medical team lost hope and called the family into the room to say goodbye. But as the family walked in, a miracle occurred. A sudden, tiny bleep sounded on the heart monitor. The family and medical team stared in disbelief as Ruby’s heart began beating in perfect rhythm. Everyone in the room began crying.
Physicians say they have never seen anything like this, and they have no explanation. The physician who led the effort to resuscitate Ruby said, “To keep it simple I believe this is truly a miracle.”
In spite of not breathing on her own for 3 hours and having no heart beat for 45 minutes, Ruby has no known brain damage and has been giving numerous interviews about her incredible experience. She has posed for dozens of pictures with her beautiful and healthy baby girl, Taily.
Ruby’s extraordinary story is an important reminder of just how important it is for labor and delivery units to have adequate staff and equipment available for emergency C-sections and code situations, especially in the event that both the mother and baby need to be resuscitated at the same time.
The Benefits of Prompt Emergency C-Section Delivery
Some of the most important actions that can be taken to prevent a birth injury are 1.) recognizing fetal distress on the fetal heart monitor or a condition that can cause significant distress, and 2.) performing a quick C-section delivery when distress or impending distress are evident. Birth injuries can cause a baby to have debilitating conditions such as the following:
- Cerebral palsy
- Brain bleeds
- Hypoxic ischemic encephalopathy (HIE)
- Seizure disorders
- Intellectual disabilities
- Developmental delays
- Periventricular leukomalacia (PVL – usually seen in premature babies)
It is the standard of care to continuously monitor the baby’s heart rate when the mother is admitted to the labor and delivery unit. When a baby is in distress, it almost always means she is suffering from a lack of oxygen in her brain (birth asphyxia), and this can cause permanent brain injury if prolonged. If a baby’s distress cannot be quickly remedied, the physician must deliver her right away, often by emergency C-section delivery. Indeed, getting the baby out of the womb is the only way to directly help her and give her oxygen and other critical treatments, such as resuscitation maneuvers. When a baby is in distress, she needs to be removed from the oxygen depriving conditions in the womb, and the best way to do this is usually by emergency C-section delivery.
It is against the standard of care for a hospital to hold itself out as a labor and delivery unit and then lack the capacity to promptly perform an emergency C-section. It is very sad to see cases in which distress was evident on the fetal monitor and the staff acted with no sense of urgency in delivering the baby by C-section. In many cases, there are obvious signs of distress on the monitor with nobody recognizing it, or when the signs are recognized, the staff performs time consuming tests, leaving the baby in oxygen depriving conditions for far too long. Often, the hospital is understaffed and the physician is busy with another patient and cannot help deliver the distressed baby.
Labor and delivery units must have the ability to perform a C-section delivery right there, or the ability to get the mother to an area for a C-section within a couple of minutes. Babies can only be directly helped when they are out of the womb. Watching the fetal heart monitor for signs of distress and delivering a baby by emergency C-section are relatively simple procedures that can prevent a baby from being oxygen deprived and developing injuries that can cause the child to have lifelong problems such as cerebral palsy, hypoxic ischemic encephalopathy (HIE), seizures and developmental delays. Simple mistakes, such as failure to recognize and act on fetal distress, can cause an otherwise healthy child to have severe and permanent problems.
When Is a C-Section Delivery Required to Prevent Birth Injury?
Another area of negligence commonly seen is when fetal distress is promptly recognized but the physician continuously attempts vaginal delivery instead of moving on to a C-section. Prolonged labor and delivery is associated with oxygen deprivation in the baby. Often, when physicians know that a baby must be quickly delivered, they administer Pitocin or Cytotec to try and speed up delivery. These drugs are very risky; they can cause contractions to be so fast and strong that the baby becomes deprived (or further deprived) of oxygen.
Even riskier are dangerous delivery devices, such as forceps and vacuum extractors. Instead of moving on to a C-section, physicians sometimes think it will be faster to try and deliver a baby with these instruments, which can cause brain trauma and brain bleeds and should only be used by very skilled physicians. Not only are Pitocin, Cytotec, forceps and vacuum extractors dangerous, but using these may prolong the delivery even more, worsening the oxygen deprivation and fetal distress.
C-sections are very common and the surgery is straightforward. Use of delivery drugs and instruments, on the other hand, is unpredictable. Physicians can’t predict how Pitocin and Cytotec will affect the mother and unborn baby. Forceps and vacuum extractors attach directly to the baby’s head and can cause brain bleeds, especially when the physician is unskilled. Sometimes physicians are unaware that certain problems are present, such as shoulder dystocia (baby’s shoulder stuck on mother’s pelvis), cephalopelvic disproportion (CPD) or umbilical cord problems, and use of a delivery instrument may be contraindicated or extremely risky, causing major problems for the baby.
Certain conditions require a C-section delivery, such as placenta previa, cephalopelvic disproportion and (usually) and breech presentation. When other dangerous pregnancy conditions occur, such as placental abruption, uterine rupture or umbilical cord prolapse, a C-section is also the safest way to deliver the baby, in most cases. When physicians fail to recognize these conditions and attempt a vaginal delivery, the baby can experience birth asphyxia and become permanently brain damaged.
The three most common indications for a C-section delivery are failure of the baby to progress during labor, non-reassuring fetal heart tracings (fetal distress) and abnormal position of the baby, such as face or breech presentation.
Most of the indications for C-section delivery are emergencies. When required, an emergency C-section should be performed as quickly as possible, and many times it should be performed within 10 – 18 minutes or less.
When a baby is suffering from a lack of oxygen, the oxygen deprivation (hypoxia) can get progressively worse. Mere minutes can make a difference in how much damage the lack of oxygen inflicts on the brain, which is why it is crucial that hospitals be fully prepared to timely deliver a baby by C-section. This means that the facility must have proper anesthesia and surgical personnel to permit the start of C-section delivery well within 30 minutes of the decision to perform the procedure. Many experts state that in certain cases, a C-section must be performed in a matter of minutes, such as when the baby is high risk and has a non-reassuring heart rate.
Delayed Resuscitation of a Newborn Can Cause Brain Damage
Sometimes babies need to be resuscitated right after delivery because they are not breathing or are having heart and respiratory problems. This can occur after a difficult delivery, and all labor and delivery units must have proper resuscitation equipment available at the bedside. In addition, a resuscitation team must be readily available to care for both the mother and baby in the event that both experience medical emergencies.
Prompt resuscitation is crucial because a delay in performing resuscitative maneuvers can cause the baby to be deprived of oxygen and adequate blood flow. This can cause damage to the baby’s organs, including the heart and brain. A lack of oxygen to the baby’s brain – including decreased blood flow to the brain – can cause hypoxic ischemic encephalopathy (HIE), periventricular leukomalacia (PVL), cerebral palsy, an intraventricular hemorrhage (IVH), hydrocephalus, seizure disorders and other debilitating conditions.
Indeed, failure to quickly resuscitate a baby who is in respiratory distress can cause the baby to experience a cardiopulmonary arrest, meaning the baby’s heart and breathing stops. This is called a “code.” A cardiopulmonary arrest causes even more oxygen deprivation in the baby’s brain because blood flow is further reduced and is even stopped if chest compressions are not performed. This can cause severe oxygen deprivation and even death of the baby.
Babies may need resuscitation right after birth if they experience a difficult labor and delivery. Signs that a baby may need resuscitation must not be missed. Resuscitation typically involves use of medication, chest compressions, help breathing via a breathing tube attached to a bag (the bag is squeezed by someone on the medical team) or ventilator, IV fluids and a defibrillator (rarely used on babies).
In Ruby’s case, her baby did not need resuscitation, but there was a team in place to promptly begin performing resuscitation maneuvers on her. The fact that the team acted quickly to start giving her chest compressions and start breathing for her likely prevented her from having permanent brain damage. Indeed, research shows that maintaining adequate perfusion in the brain by performing chest compressions is one of the most critical factors in preventing or minimizing brain damage.
Reiter & Walsh ABC Law Centers | Trusted Birth Injury Attorneys
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 with birth injuries for almost 3 decades.
Birth injury 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. Partners Jesse Reiter and Rebecca Walsh are currently recognized as two of the best medical malpractice lawyers in America by U.S. News and World Report, 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 birth injury, such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award winning birth injury 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 birth injury 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 award winning birth injury lawyers are available 24 / 7 to speak with you.