Delayed Post-Term Delivery Results in Birth Asphyxia with Infant Brain Damage, Seizures, HIE and Cerebral Palsy
A new mother was 15 days past her due date when her obstetrician finally decided to induce labor. During labor, the baby’s heart rate dropped dangerously low, but nobody on the medical team recognized the non-reassuring heart tracing, which was a sign the baby was experiencing a lack of oxygen to her brain. This birth asphyxia lasted for too long, causing the infant to be born with hypoxic ischemic encephalopathy (HIE). Soon after birth, the newborn, named Cassie, began having seizures and was diagnosed with severe brain damage and cerebral palsy. Cassie will be entirely dependent on her parents.
Preventing Infant Brain Damage, HIE and Cerebral Palsy: Planning Early Deliveries for Post-Term Pregnancies
A normal timing of the onset of labor and delivery is an important determinant of the health of the baby. Just as premature birth increases a baby’s risk of experiencing birth asphyxia, breathing problems and brain damage, so does the delivery of a baby who is past her due date. Being born post-term increases a baby’s risk of the following:
- Macrosomia and brain bleeds / hemorrhages
- Prolonged labor
- Uterine rupture
- Cephalopelvic disproportion (CPD)
- Shoulder dystocia and Erb’s palsy
- Fetal growth restriction (FGR) / intrauterine growth restriction (IUGR)
- Fetal dysmaturity (postmaturity) syndrome
- Being small for gestational age (SGA)
- Umbilical cord compression
- Placental insufficiency
- Meconium aspiration syndrome
- Intrauterine infection
- Neonatal hypoglycemia
- Intellectual disabilities
- Birth asphyxia
- Brain damage
- Hypoxic ischemic encephalopathy (HIE)
- Cerebral palsy
- Seizure disorders
In general, the longer a pregnancy continues after 40 weeks, the more risks there are to the baby. Due to the increased risk of injury at 42 weeks and beyond, it is much safer to induce labor by week 40 or 41 than to allow the pregnancy to continue. Babies who are born post-term can become really large (macrosomic) or they may have poor growth, a condition called intrauterine (fetal) growth restriction.
Macrosomia, Traumatic Birth Injuries, and Birth Asphyxia
Macrosomia results from the baby’s extended time in the womb since babies continue to grow from week 39 – week 43. Other than their large size, macrosomic babies appear normal at birth. Their large size, however, puts them at risk of experiencing birth injuries caused by trauma during an attempted vaginal delivery as well as umbilical cord compression and birth asphyxia.
When a baby is very large, a vaginal delivery becomes more difficult. Sometimes a macrosomic baby is too large to fit through the mother’s birth canal, which is a condition called cephalopelvic disproportion (CPD). CPD requires a C-section delivery. A baby with macrosomia is also risk of her shoulder becoming stuck on the mother’s pelvis during delivery, which is called shoulder dystocia. When this occurs, physicians often pull too hard on the baby’s head, causing the nerves in the neck and shoulder area to become stretched and torn. When these nerves, called the brachial plexus nerves, become injured, that baby may have severe weakness or paralysis of the arm, which is called Erb’s palsy. One of the most serious complications associated with shoulder dystocia is umbilical cord compression, which occurs when something in the birth canal puts pressure on the cord, thereby decreasing or completely cutting off the flow of oxygen-rich blood to the baby. Cord compression during shoulder dystocia often occurs when the cord is trapped between the baby and the mother’s pelvic bone. Compression of the umbilical cord requires a prompt emergency C-section delivery to minimize the effects of birth asphyxia and prevent hypoxic ischemic encephalopathy and brain damage.
When a baby is macrosomic, she is at risk of the physician attempting to deliver her using forceps or a vacuum extractor during a vaginal delivery. These risky delivery devices attach directly to the baby’s head, and the physician uses them to apply traction to help pull the baby out of the birth canal. Sometimes the traction is too much and this excessive force causes brachial plexus injuries and Erb’s palsy. Forceps and vacuum extractors can also cause brain bleeds and hemorrhages in the baby, which can cause the baby to have brain damage and lifelong conditions such as seizures and cerebral palsy. Vacuum extractors are more commonly used than forceps, and due to lack of use, physicians usually lack skill in forceps use.
Macrosomic babies are also at risk of experiencing a ruptured uterus (womb), which is when there is a complete tear through all layers of the uterus. A uterine rupture can cause the baby to be deprived of oxygen in multiple ways. When a rupture occurs, the mother usually loses so much blood that there is a severe reduction in oxygen-rich blood being delivered to the baby, which can cause the baby to have birth asphyxia. A ruptured uterus is an obstetrical emergency that requires the baby to be delivered right away by emergency C-section to prevent birth asphyxia and brain damage.
A prolonged or arrested labor is another risk to which macrosomic babies are susceptible. When the second stage of labor is prolonged or arrested, the baby is at an increased risk of getting an infection that travels from the mother to the baby at birth, and the infant also has an increased chance that the physician will use forceps or vacuum extractors to assist in delivery. An infection that a baby contracts during delivery can cause the baby to have sepsis, meningitis, hypoxic ischemic encephalopathy, seizures and cerebral palsy.
Intrauterine Growth Restriction (IUGR) and Hypoxic Ischemic Encephalopathy (HIE)
Intrauterine (fetal) growth restriction is used to describe a condition in which the baby is smaller than she should be because she is not growing at a normal rate inside the mother’s womb. IUGR is thought to be caused by a degenerating or poorly functioning placenta that is unable to provide sufficient nutrition and oxygen to the baby, which is a condition called placental insufficiency. The placenta reaches its maximum size and surface area around 37 weeks. After week 37, its surface area and function gradually deteriorate. Thus, the longer a baby is inside the womb after week 37, the more likely it is that she is not getting enough oxygen and nutrients. When a baby experiences a lack of oxygen to her brain caused by placental insufficiency, she can develop hypoxic ischemic encephalopathy and brain damage.
Another reason post-term babies with IUGR are at risk of birth asphyxia and HIE is due to an associated condition called oligohydramnios, which means there is an abnormally low level of amniotic fluid in the womb. Oligohydramnios may predispose a baby to umbilical cord compression.
IUGR in a post-term pregnancy causes the baby to be long, thin and small for gestational age. The baby is malnourished, has meconium staining, and has skin that is dry and peeling. These characteristics are referred to as postmaturity or dysmaturity syndrome.
Whether the baby is macrosomic or has IUGR, a lack of oxygen to her brain can cause her to have a bowel movement while in the womb. Amniotic fluid mixed with stool is called meconium, and if a baby inhales this mixture during delivery, it can cause serious breathing problems, such as respiratory distress syndrome (RDS) and pneumonia. These conditions can cause the baby to experience a lack of oxygen to her brain. In addition, babies with meconium aspiration syndrome, RDS and pneumonia often need assistance of a breathing machine (ventilator). If the medical team doesn’t properly manage the settings on the baby’s ventilator, the baby is at risk of having overventilation injuries and a hole in her lungs, called a pneumothorax. These injuries can cause the baby to have birth injuries such as cerebral palsy.
Post-Date Pregnancy & the Importance of Timely Delivery: Fetal Distress and Emergency C-Sections
Due to the risks that a post-term pregnancy place on a baby, the mother’s physician should make sure that she does not go past 41 weeks of gestation. As with any pregnancy, close fetal monitoring should be ongoing, with the size and health of the baby being regularly assessed. If there are any risky pregnancy conditions, such as oligohydramnios and intrauterine (fetal) growth restriction, a scheduled delivery may need to take place prior to term to prevent hypoxic ischemic encephalopathy (HIE) and conditions such as seizures and cerebral palsy.
When a mother with a post-term pregnancy is in labor, the baby must be delivered immediately at the first signs of distress. A C-section delivery is often the safest and fastest way to deliver a post-dates baby. When a baby is in distress, this will manifest on the fetal heart monitor as a nonreassuring heart tracing. Fetal distress means the baby’s brain is receiving insufficient oxygen. Babies who have IUGR or other problems related to insufficient oxygen are more susceptible to birth asphyxia if complications, such as a uterine rupture, occur during delivery.
The physician caring for Cassie and her mother should not have let the pregnancy continue for so long after the due date. And during labor, the little girl should have been delivered at the first signs of distress. Failure to plan a timely delivery of Cassie and failure to deliver her when she was in distress during labor caused her to experience birth asphyxia, hypoxic ischemic encephalopathy (HIE), brain damage, seizures and cerebral palsy.
Michigan Birth Injury Lawyers Representing Children with Brain Injuries, HIE and Cerebral Palsy
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 lawyers are available 24 / 7 to speak with you