The Relationship between Delayed Emergency C-Sections, Hypoxic Ischemic Encephalopathy (HIE) and Cerebral Palsy
A child has brain damage and cerebral palsy caused by a hospital’s failure to treat his fetal distress as an emergency situation. When the unborn baby boy was being deprived of oxygen, causing birth asphyxia and distress, the hospital delayed his delivery for over 2 hours. In fact, the medical team failed to note his fetal heart tracings as being nonreassuing, which is an indication of fetal distress and birth asphyxia. Indeed, the heart tracings were pathologically bad, according to an expert. Despite this, the attending physician was never notified of the emergent situation. When a decision was finally made to deliver the boy by C-section, the operating room was, according to experts, exceedingly far from the labor and delivery unit, making a quick delivery impossible. Sadly, the baby’s brain was deprived of oxygen for too long. Shortly after birth he had seizures and was diagnosed with hypoxic ischemic encephalopathy (HIE). Later, he received the tragic diagnosis of mixed dyskinetic spastic cerebral palsy.
How Do Delayed C-Sections Cause Hypoxic Ischemic Encephalopathy (HIE) and Cerebral Palsy?
When a hospital has a unit called a “labor and delivery unit,” it must have the capacity to continuously monitor and properly interpret the baby’s heart rate. In addition, the hospital must also have the capacity to quickly perform an emergency C-section delivery when the baby is not getting enough oxygen and experiencing fetal distress. This means the hospital must be properly staffed with adequate personnel to perform the C-section and to perform resuscitation maneuvers on both the mother and baby, if needed, right after birth. Indeed, it is against standards of care for hospitals to lack appropriate equipment and staff to properly monitor the mother and baby and deliver the baby by emergency C-section when necessary. There should be no impediments to being able to perform a quick C-section delivery; this means the operating room or surgical suite must not be located far from the labor and delivery unit.
When a baby is experiencing oxygen deprivation (which causes fetal distress) it will affect the heart rate, which will cause the heart tracings to become nonreassuring (abnormal). When nonreassuring heart tracings occur, the baby should be delivered right away, in most cases. A C-section delivery is usually the fastest and safest way to deliver a baby in distress. Most experts agree that when nonreassuring heart tracings first appear and indicate that the baby must be delivered immediately, a C-section delivery must occur within 30 minutes, and in many cases, the C-section should occur within 18 minutes. In some cases, such as when the mother experiences cardiac arrest, or there is complete umbilical cord occlusion, complete placental abruption, massive blood loss or fixed fetal bradycardia (slow heart rate), the baby should be delivered within 5 minutes – and delivery taking longer than 15 minutes could cause severe brain damage and death of the baby.
Listed below are some conditions that can cause a lack of oxygen to the baby’s brain, birth asphyxia and hypoxic ischemic encephalopathy (HIE) if the baby is not quickly delivered:
- Umbilical cord problems, such as a nuchal cord (cord wrapped around baby’s neck), umbilical cord prolapse and compression, short umbilical cord and cord in a true knot
- Ruptured uterus
- Placental abruption
- Vasa previa
- Placenta previa
- Preeclampsia / eclampsia
- Anesthesia mistakes, which can cause blood pressure problems in the mother, including a hypotensive crisis. This can greatly decreases the supply of oxygen-rich blood going to the baby, causing birth asphyxia.
- Oligohydramnios (low amniotic fluid)
- Premature rupture of the membranes (PROM) / premature birth
- Prolonged and arrested labor
- Intracranial hemorrhages (brain bleeds), which can be caused by a traumatic delivery. Forceps and vacuum extractors can cause brain bleeds. Sometimes intense contractions (hyperstimulation) caused by labor induction drugs (Pitocin and Cytotec) can cause head trauma. Mismanagement of macrosomia, cephalopelvic disproportion (CPD), abnormal presentations (e.g., face or breech presentation), and shoulder dystocia also put the baby at risk of experiencing birth trauma and birth asphyxia.
- Hyperstimulation caused by Pitocin and Cytotec can cause oxygen deprivation that gets progressively worse.
- Fetal stroke
- Postmaturity syndrome
- Placental insufficiency and intrauterine growth restriction (IUGR). Babies with IUGR often do not tolerate labor well.
The Relationship Between Infant Brain Damage, Hypoxic Ischemic Encephalopathy (HIE) and Cerebral Palsy
Hypoxic ischemic encephalopathy (HIE) is a brain injury caused by oxygen deprivation in the baby (hypoxia) and decreased blood flow in the baby’s brain (ischemia). The severity HIE in a baby depends upon the following:
- The severity of the birth asphyxia. For example, whether the birth asphyxia was sudden and severe, lasting for a short duration; sudden, severe and prolonged; mild or moderate and lasting for a long time; mild or moderate and lasting for a short time. The faster the delivery of an oxygen-deprived baby, the better.
- The condition of the baby at the time of the oxygen-depriving insult. If the baby had good fetal reserves (good oxygen level in bloodstream, placenta and intravillous space).
- Treatment of the baby right after birth. Medical management of a baby who experienced birth asphyxia is crucial. If the baby needs to be resuscitated at birth, this must occur right away, with all steps being performed appropriately and in a timely manner. If the baby lost a lot of blood, blood products and other blood volume enhancers that are indicated must be given right away. In short, the medical team must ensure adequate oxygenation, ventilation and blood flow to the baby’s brain.
There is a groundbreaking treatment for HIE called hypothermia (brain cooling) treatment, and it must be given within 6 hours of the time the baby experienced the oxygen-depriving insult. This usually means that the treatment must be given within 6 hours of delivery. Indeed, it is crucial that babies who qualify for hypothermia treatment get it right away. The more severe the birth asphyxia, the sooner the treatment should be initiated. Research shows that hypothermia treatment halts almost every injurious process that starts to occur when a baby sustains an oxygen-depriving insult. Hypothermia treatment can help prevent a child with HIE from developing cerebral palsy (CP) or the treatment can reduce the severity of the CP.
HIE typically occurs in term babies, although premature infants can also develop HIE. When premature babies experience birth asphyxia, they often develop periventricular leukomalacia (PVL). HIE usually involves damage to the basal ganglia, cerebral cortex or watershed regions of the brain, but it sometimes includes periventricular leukomalacia (PVL).
Listed below are some conditions that can be caused by HIE and PVL:
- Seizure disorders
- Cerebral palsy (CP)
- Intellectual disabilities
- Developmental delays
- Learning Disabilities
- Motor disorders
Award-Winning Michigan Birth Injury Attorneys Helping Children with Hypoxic Ischemic Encephalopathy (HIE) and Cerebral Palsy
If you are seeking the help of a birth injury 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 over 3 decades.
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 hypoxic ischemic encephalopathy lawyers are available 24 / 7 to speak with you.