A mother arrived at the hospital a few hours before midnight on a Friday because she was having contractions. Her labor had come 5 weeks before the due date. At the hospital, no obstetrician came to evaluate or treat her for almost 16 hours. Instead, nurses communicated with the attending obstetrician by phone throughout the night and next morning. When the obstetrician finally arrived at the hospital, he decided to deliver the baby using a vacuum extractor. At birth, the baby was blue and had low Apgar scores, which are scores that help assess the likelihood that a newborn will need medical intervention. The premature baby had trouble breathing and had to spend many weeks in the neonatal intensive care unit (NICU). Shortly after arriving in the NICU, the medical team noticed that the baby had an intracranial hemorrhage (brain bleed). The baby was soon diagnosed with cerebral palsy. Later, she was also diagnosed with intellectual disabilities.
MEDICAL NEGLIGENCE CAUSED THE LITTLE GIRL TO HAVE A BRAIN HEMORRHAGE, CEREBRAL PALSY & INTELLECTUAL DISABILITIES
The care of this little girl involved multiple areas of medical negligence. First of all, it is against the standard of care for a woman admitted to a labor and delivery unit to not have a physical examination and assessment performed by a physician. It is the policy of most hospitals to have a physician evaluate the mother, enter a note, and provide orders shortly after the mother arrives at the hospital. When there are signs of a dangerous condition at admission, such as vaginal bleeding and abdominal pain (which are signs of placental abruption), a physician should assess the mother right away. When a dangerous condition does exist, the physician should provide continuous care and monitoring and be prepared to quickly deliver the baby by emergency C-section, when necessary.
The mother in this case should have been evaluated by a physician soon after arriving at the hospital. In addition, a physician should have been present throughout labor and delivery since she had preterm labor. The birth of a premature baby requires special care since premature babies are more susceptible to brain bleeds than term babies. The circulation changes that occur during labor are not tolerated well. Furthermore, many babies about to be born prematurely need drugs that are given in-utero, such as magnesium sulfate, which helps protect the baby’s fragile brain from injury, and steroids, which helps with the maturity of lungs and other tissues.
Prolonged labor is dangerous for all babies. It increases a baby’s risk of experiencing birth injuries such as birth asphyxia and brain bleeds / hemorrhages. Labor is considered prolonged when it lasts over 20 hours in a first pregnancy and 14 hours in a woman who has previously given birth. Prolonged labor can be especially risky for premature babies since they are already at an increased risk of having a brain bleed. The mother in this case should have been evaluated by a physician for risks of prolonged labor and other conditions that could make her labor and delivery risky; this is one of the reasons it is important to have a physician do an evaluation soon after admission to a labor and delivery unit. When the mother’s labor became prolonged, a physician should have been there to discuss the risks of allowing the labor to continue, as well as the alternatives, such as a C-section delivery.
Physicians also need to be present to interpret fetal heart tracings on the heart monitor. The baby’s heart rate is supposed to be continuously monitored and properly interpreted throughout labor and delivery. If the heart tracings become nonreassuring, the baby must be promptly delivered, usually by emergency C-section. If no physician is present, nonreassuring heart tracings may be missed and a C-section certainly cannot be quickly performed. Nonreassuring heart tracings mean a baby is experiencing oxygen deprivation; if a physician has to be called in to perform one, too much time can elapse, leaving the baby starved of adequate oxygen for too long. In addition, at least 2 physicians should be present at every birth in case both the mother and baby need critical attention. The medical records showed that this baby had several episodes of nonreassuring heart tracings during labor and delivery. No actions were taken – such as a quick C-section delivery – in response to this baby’s oxygen deprivation.
Indeed, the mother in this case should have had her premature baby delivered a lot sooner – she should have been given the option of a C-section delivery and informed of the risk of continuing labor when her baby had nonreassuring heart tracings. Furthermore, the physician should have discussed the risks of a vacuum extraction delivery, including the risk of a brain bleed / hemorrhage, and she should have been informed that her premature baby was already at risk of having a brain bleed. A vacuum extraction delivery is so dangerous for a premature baby that it is contraindicated in babies less than 34 weeks of gestation due to the risk of an intraventricular hemorrhage (IVH).
Informed consent requires that the risks, benefits and alternatives of all procedures be thoroughly explained to the patient, and they must be explained by the provider performing the potential procedure. A C-section should have been offered to this mother multiple times, and since nurses cannot perform C-sections, the physician should have been there to discuss a C-section delivery with the mother.
A VACUUM EXTRACTION DELIVERY CAN CAUSE BRAIN BLEEDS, CEREBRAL PALSY, INTELLECTUAL DISABILITIES & OTHER BIRTH INJURIES
A vacuum extractor is an instrument used to help deliver a baby. It consists of a soft cup that attaches to the baby’s head. The physician can control the amount of suction of the vacuum extractor. This device is very risky since it involves direct force on the baby’s head. Only very skilled physicians should use these devices. If the cup is not attached to a precise spot on the baby’s head, too much force is applied to the head, the force is applied for too long, or too many attempts are made at trying to pull the baby out of the birth canal with the vacuum extractor, the baby may experience head trauma. Trauma to the head can cause blood clots, strokes, brain bleeds, permanent brain damage and lifelong conditions such as cerebral palsy.
Listed below are types of brain bleeds that can occur with a vacuum extraction delivery.
INFANT INTRACRANIAL HEMORRHAGES (BRAIN BLEEDS) CAN CAUSE BRAIN DAMAGE & CEREBRAL PALSY
An intracranial hemorrhage is sudden, rapid bleeding that occurs within the skull. Listed below are common types of intracranial hemorrhages.
Subarachnoid hemorrhage (SAH) and subdural hemorrhage (SDH). SAH is the second most common brain bleed in a newborn. It is caused by rupture of veins in a space or spaces near the skull. Hydrocephalus (fluid in the brain) can develop after SAH because the bleeding causes too much cerebral spinal fluid (CSF) to build up in the brain’s ventricles, which can cause brain and head swelling. SAH can also cause oxygen to be cut off in certain parts of the brain (ischemia), which can cause brain tissue to die.
SDH, or subdural hemorrhage / hematoma, is the most common type of brain bleed in a newborn. SDH occurs when there is rupture of the blood vessels in the area between the surface of the brain and the thin layer of tissue that separates the brain from the skull. Sometimes SDH causes an increase in pressure inside the brain, which can cause an increase in head size, apnea (periods of not breathing) and bradycardia (slow heart rate).
Signs and symptoms of SAH and SDH include shallow breathing, difficulty breathing, apnea, seizures, irritability and altered tone and level of consciousness. Subarachnoid hemorrhages and subdural hemorrhages are indeed very dangerous. These brain bleeds can cause permanent brain damage and conditions such as cerebral palsy and intellectual disabilities.
Intraventricular hemorrhage (IVH). The brain has four ventricles in the middle of it. IVH is bleeding inside the brain’s ventricles, and it is most common in premature babies, although term babies can develop IVH as well. Premature babies are more susceptible to IVH because their blood vessels are fragile.
Very close monitoring of infants with IVH is crucial due to the potential for the bleeding to extend into the tissue around it and cause hydrocephalus.
Signs and symptoms of IVH include irritability, seizures, apnea and a bulging fontanelle (soft spot). Intraventricular hemorrhages can lead to the development of permanent brain damage and conditions such as cerebral palsy, developmental delays and intellectual disabilities.
INFANT EXTRACRANIAL HEMORRHAGES CAN CAUSE BRAIN INJURY, SEIZURES & CONDTIONS SUCH AS CEREBRAL PALSY & INTELLECTUAL DISABILITIES
An extracranial hemorrhage is a brain bleed that occurs just outside the skull. Listed below are two common types of extracranial hemorrhages.
Cephalohematoma (cephalhematoma) . This is a collection of blood between the skull and its covering caused by ruptured vessels. Cephalohematoma (cephalhematoma) can be caused by any type of trauma to the baby’s head, but it is most commonly associated with forceps and vacuum extraction delivery. The swelling does not cross suture lines, which are bands of tissue that connect the bones of the skull. Discoloration may or may not be present, and there typically isn’t significant blood loss when a baby has a cephalohematoma. However, if this condition is left unresolved, calcification of the hematoma can occur, which will cause a bony swelling that can last for months. Untreated cephalohematoma can also cause severe infection in the baby, which can lead to pus-filled formations and death of parts of the skull. The infection can also cause the baby to develop meningitis. Cephalohematomas must be promptly recognized and treated because they can cause permanent brain damage, seizures, intellectual disabilities and other birth injuries.
Subgaleal hemorrhage. This is a potentially deadly type of bleed that is strongly associated with trauma from a vacuum extraction delivery. In fact, subgaleal hemorrhages are almost exclusive to vacuum extractor deliveries. A subgaleal hemorrhage is caused by rupture of veins that are very close to the scalp. When these veins rupture, blood builds up just beneath the scalp, and the baby will have swelling of the head and evidence of shock, which is severely low blood volume and blood pressure. Almost half of a baby’s blood volume can go into the subgaleal space, which is what makes this type of brain bleed so dangerous. Prompt and aggressive treatment is critical. Subgaleal hemorrhages can lead to epilepsy, cerebral palsy, intellectual disabilities and developmental delays.
PROLONGED LABOR INCREASES A BABY’S RISK OF BRAIN BLEEDS, BRAIN DAMAGE & CEREBRAL PALSY
Prolonged labor can be very traumatic for a baby, especially when the baby is premature or has intrauterine growth restriction (IUGR). Prolonged labor can occur when a baby is very large, when the baby is not in the normal position in the birth canal (e.g., breech or face presentation), when the mother’s pelvis is too small for the baby, and when the mother has problems with uterine contractions or was given too much anesthesia. Many conditions can cause prolonged labor, and oftentimes, the physician fails to move on to C-section delivery when it is medically necessary. During the extended vaginal labor and attempted delivery, the physician may use Pitocin or Cytotec to try and speed up delivery, or vacuum extractors may be used to try and facilitate delivery. All of these actions can cause a traumatic injury to the head with resultant brain bleeding.
AWARD WINNING BIRTH INJURY LAWYERS HELPING CHILDREN WHO HAVE CEREBRAL PALSY, INTELLECTUAL DISABILITIES & OTHER BIRTH INJURIES
If your baby has a birth injury and you need 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 being two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as being 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 lawyers are available 24 / 7 to speak with you.