Lawyers Win $7.8 Million Case for Boy with Cerebral Palsy and Brachial Plexus Lawyers
A Scottish boy received 5.25 million pounds ($7.8 million) because the physician failed to promptly deliver him by C-section when his shoulder become stuck on the mother’s pelvis and he began experiencing birth asphyxia. Failure to perform a C-section caused brain damage, cerebral palsy and brachial plexus injuries in the little boy, whose name is Sam. Lawyers for Sam say this is the “most significant medical negligence judgment in 30 years.”
Sam’s mother, Nadine Montgomery, claimed the physician failed to advise her of the risks of vaginal delivery and the potential benefits of delivering her baby by C-section. During prenatal visits, physicians failed to advise her of the benefits of a planned C-section delivery, and during delivery, when her baby’s shoulder became stuck and he experienced birth asphyxia, the medical team failed to inform her of the benefits of an emergency C-section. In their written opinion, the Supreme Court Justices emphasized the fact that it was not in dispute that had baby Sam been born by C-section, he would have been born unharmed. Nadine told the court that if she had been informed of the risks of vaginal delivery, she would have chosen to have a C-section.
Indeed, it is medical negligence when physicians fail to thoroughly inform their patients of the risks, benefits and alternatives to potential procedures. When it comes to labor and delivery, this includes giving the mother all relevant information – including the risks – of different delivery methods, including vaginal birth versus a C-section delivery, use of the labor drugs Pitocin and Cytotec, and use of forceps and vacuum extractors to facilitate delivery.
Vaginal Birth Put the Baby at Risk of Birth Asphyxia, Cerebral Palsy and Brachial Plexus Injuries (Erb’s Palsy)
Nadine is a very small-framed woman whose height is just over five feet tall. She has type 1 diabetes, which can cause the baby to grow very large, a condition called macrosomia. Macrosomia and being below 5’3” are both risk factors for cephalopelvic disproportion (CPD) which means the baby is too large to fit through the mother’s pelvis. CPD places the baby at risk of experiencing shoulder dystocia during delivery, which increases the baby’s risk of umbilical cord compression, birth asphyxia and brachial plexus injuries when a vaginal birth is attempted. In fact, when the mother has CPD, a C-section delivery is required. Even without a diagnosis of CPD, a vaginal delivery when the baby is macrosomic increases the baby’s risk of cord compression, asphyxia, shoulder dystocia and Erb’s palsy. Nadine had a right to be informed of these risks so that she could have chosen a C-section delivery.
Nadine had a difficult delivery. When Sam’s head became stuck on her pelvis (shoulder dystocia), he became deprived of oxygen. This is usually caused by the umbilical cord being compressed between the baby’s body and the birth canal, a common complication of shoulder dystocia. When umbilical cord compression occurs, the baby can be severely – even completely – cut off from oxygen-rich blood that is supplied to him through the umbilical cord. Umbilical cord compression requires a prompt emergency C-section delivery, in most cases.
When Sam’s shoulder got stuck and he began experiencing birth asphyxia, the physician did not perform an emergency C-section. Instead, the physician spent time trying to maneuver Sam and deliver him vaginally. Finally, a lot of traction was applied to Sam’s head, causing the nerves in his shoulder and neck to become stretched and torn. The network of nerves in the shoulder and neck is called the brachial plexus. When the brachial plexus becomes injured, the baby’s arm can become fully or partially paralyzed, resulting in Erb’s palsy. Erb’s palsy causes a baby’s arm to hang limply at his side.
Prolonged birth asphyxia caused Sam to have permanent brain damage and he was diagnosed with cerebral palsy shortly after birth. In addition, the little boy was diagnosed with brachial plexus injuries.
Informed Consent Errors and Birth Injury Cases
This very sad and public case out of Scotland highlights important issues pertaining to informed consent, C-section deliveries and birth asphyxia. Mothers have a right to be informed of risks associated with their medical conditions. Even if the risks are small, mothers should be told of the risks and alternatives so they can make informed decisions. Nadine was never informed of the risks associated with having Type 1 diabetes during pregnancy and delivering vaginally.
The judge who delivered the Supreme Court’s opinion stated, “An adult person of sound mind is entitled to decide which, if any, of the available forms of treatment to undergo, and her consent must be obtained before treatment interfering with her bodily integrity is undertaken.”
Nadine’s claim was rejected twice by Scotland’s highest court, but the Supreme Court overturned the ruling, which will hopefully change medical practices in Scotland.
Preventing Birth Asphyxia and Cerebral Palsy with C-Section Deliveries
There are many labor and delivery conditions that can cause a baby to experience a lack of oxygen to his brain and birth asphyxia. Problems with the placenta, uterus and umbilical cord as well as maternal blood pressure problems are common causes of birth asphyxia. This is because the baby gets all her oxygen from oxygen-rich blood delivered to her from her mother. Blood from the mother diffuses through vessels in the uterus and placenta and is then carried to the baby through the umbilical cord. The placenta acts like a lung; gas exchange takes place here.
Common causes of oxygen deprivation and birth asphyxia include the following:
- Placental abruption. This is where the placenta separates from the wall of the uterus. Abruption can cause severe bleeding and birth asphyxia.
- Uterine rupture. This occurs when there is a tear through all the layers of the womb. A ruptured uterus can cause severe hemorrhaging in the mother and the baby can spill out of the womb and into the mother’s abdomen. The bleeding can cause the mother to lose so much blood that there is a decreased flow of blood to the baby, causing birth asphyxia.
- Umbilical cord problems, such as a prolapsed umbilical cord, the cord being wrapped around the baby’s neck (nuchal cord), a short umbilical cord, and the cord being in a true knot can all cause birth asphyxia in the baby due to cord compression. A short umbilical cord is dangerous because any movement of the baby can pull on the cord’s insertion point on the placenta, causing the placenta to tear away from the womb (placental abruption). Short cords are also at risk of rupturing.
- Uteroplacental insufficiency / placental insufficiency. When vessels in the uteroplacental circulation are abnormal or compromised, the baby may experience long-term oxygen deprivation. Uteroplacental insufficiency can cause intrauterine growth restriction (IUGR) / fetal growth restriction (FGR). Babies with IUGR don’t tolerate labor well, making them more susceptible to birth asphyxia.
- Preeclampsia. This is when the mother has high blood pressure diagnosed during pregnancy, which can cause a decreased flow of blood to the baby and other serious problems, including eclampsia. Preeclampsia can cause the baby to be deprived of oxygen long-term, thereby often necessitating an early, scheduled delivery.
- Placenta previa. This is when the placenta grows close to the opening of the uterus, which can partially or completely block the mother’s cervix, which is the opening to the birth canal. An attempted vaginal delivery when the mother has placenta previa can cause severe hemorrhaging and birth asphyxia.
- Stroke. A fetal stroke occurs when blood vessels in the baby’s brain become blocked or restricted. Forceps and vacuum extractors can cause the baby to have a stroke, which can cause severe oxygen deprivation. Hypoxic ischemic encephalopathy (HIE) and stroke often occur together.
- Premature rupture of the membranes (PROM). PROM occurs when the water breaks before the mother goes into labor. PROM can cause umbilical cord compression, premature birth and being born before the lungs are fully developed, which can cause birth asphyxia and HIE.
- Prolonged and arrested labor. Contractions during labor are traumatic for the baby, and when labor is prolonged, there may be a lack of oxygen to the baby’s brain that gets progressively worse, especially if Pitocin or Cytotec are used.
- Oligohydramnios (low amniotic fluid). This is a condition in which the mother has low amniotic fluid. Oligohydramnios puts the baby at significant risk of having a prolapsed or compressed umbilical cord, which can cause birth asphyxia. Oligohydramnios can also lead to meconium aspiration, which can cause respiratory distress and oxygenation problems.
- Anesthesia mistakes, which can cause blood pressure problems – especially low blood pressure – in the mother, including a hypotensive crisis. When a mother’s blood pressure drops too low, the baby can experience severe birth asphyxia.
- Mismanagement of cephalopelvic disproportion (CPD), abnormal presentations (face or breech presentation), and shoulder dystocia increase a baby’s risk of birth trauma and birth asphyxia.
- Abnormal presentations. When a baby is not in the normal, head first position at the time of delivery, she is at risk of suffering head trauma, brain bleeds and umbilical cord problems if the doctor attempts vaginal delivery. Breech presentation, transverse lie position and face presentation are some of the abnormal positions that increase a baby’s risk of suffering bleeds, cord problems and birth asphyxia.
- Type 1, Type 2 and gestational diabetes sometimes cause decreased blood flow to the baby, which can cause long-term oxygen deprivation. Diabetes can also cause the baby to be macrosomic, which increases the baby’s risk of shoulder dystocia, umbilical cord compression, birth trauma and birth asphyxia.
- Failure to quickly deliver the baby when birth asphyxia (fetal distress) occurs (delayed emergency C-section).
Many of the conditions listed above, such as preeclampsia, cause long-term oxygen deprivation, requiring the baby to have a scheduled, early delivery. Other conditions, such as breech presentation and macrosmia increase a baby’s risk of experiencing birth trauma and birth asphyxia during delivery, thereby making C-section delivery a safer alternative. In certain cases of macrosomia and breech presentation, a C-section is required.
Some conditions occur during or near the time of delivery and cause severe birth asphyxia, requiring a prompt emergency C-section delivery to prevent brain damage, hypoxic ischemic encephalopathy and cerebral palsy. Hospitals should be prepared for these emergencies. It is the standard of care to start monitoring a baby’s heart rate as soon as the mother is admitted to the labor and delivery unit. When a baby begins to experience birth asphyxia, the heart monitor will show nonreassuring heart tracings. When these tracings occur, maneuvers must be performed try and alleviate the birth asphyxia. This often includes giving the mother IV fluids and/or oxygen. While these maneuvers are being performed, preparations for a C-section delivery should occur. Certain conditions, such as complete placental abruption or uterine rupture require a baby to be delivered within a matter of minutes.
Delayed delivery when a baby is experiencing birth asphyxia can cause the following conditions:
- Hypoxic ischemic encephalopathy (HIE). HIE usually involves damage to the basal ganglia, cerebral cortex or watershed regions of the brain, but it sometimes includes periventricular leukomalacia (PVL)
- Neonatal encephalopathy
- Permanent brain damage
- Seizure disorders
- Cerebral palsy (CP)
- Intellectual disabilities
- Developmental delays
- Learning Disabilities
- Motor disorders
- Periventricular leukomalacia (PVL)
VIDEO: CEREBRAL PALSY LAWYERS DISCUSS BIRTH ASPHYXIA CAUSED BY FAILURE TO PERFORM A TIMELY C-SECTION
Watch a video of cerebral palsy lawyers Jesse Reiter and Rebecca Walsh discussing the importance of a prompt C-section delivery to prevent prolonged birth asphyxia and cerebral palsy.