What are some emergencies that can happen during labor and delivery?

Michigan Birth Trauma Attorneys & Cerebral Palsy Lawyers Helping Children With Birth Injuries

Most babies are born healthy, with no major complications.  But it is very frightening for parents when something unexpected occurs during labor and delivery that puts the baby at risk of having a birth injuryBirth trauma and birth injuries are permanent conditions – usually involving brain damage – that are caused by injuries that happen to the baby during or near the time of delivery.  Often, birth injuries are caused by a lack of oxygen to the baby’s brain due to problems with the placenta, uterus (womb), or umbilical cord, such as the cord being wrapped around the baby’s neck.  Birth trauma is usually caused by too much force on baby’s head.  This can occur when physicians use the labor drugs Pitocin or Cytotec, or when instrument are used to assist in vaginal birth (forceps and vacuum extractors).  Birth trauma can also occur when the baby is in an abnormal position and physicians attempt vaginal delivery for too long or don’t properly deliver the baby.  A C-section is usually the safest method of delivery when the baby is in an abnormal position.  Another common cause of birth trauma is when the baby’s shoulder gets stuck on the mother’s pelvis and physicians pull too hard on the baby’s head, causing nerves in the shoulder to tear, which results in partial or full paralysis of the baby’s arm.  This type of arm paralysis is called Erb’s palsy.

Some common birth injuries are:

AWARD WINNING BIRTH TRAUMA / BIRTH INJURY LAWYERS AVAILABLE 24 / 7

The firm of Reiter & Walsh ABC Law Centers has been helping children who have hypoxic ischemic encephalopathy (HIE), seizures, Erb’s palsy and cerebral palsy for almost 3 decades.  The firm’s award winning birth injury attorneys focus solely on birth injury cases and the firm is recognized as being one of the top birth injury law firms in the U.S.  The firm’s president, Jesse Reiter, was named one of the best medical malpractice lawyers in America by U.S. News and World Report 2014.

Email or call Reiter & Walsh today if you need legal help for your child.  Our firm’s attorneys are available 24 / 7 to speak with you, and we give personal attention to each child and family we help.  No fees are ever paid to our firm until we win your case.

EMERGENCIES DURING LABOR AND DELIVERY THAT CAN CAUSE BIRTH TRAUMA / BIRTH INJURIES

Emergencies that occur during or near the time of labor and delivery are very frightening because the parents and medical team cannot actually see the baby and tell that she’s okay.  However, with monitoring devices, such as a fetal heart rate monitor and ultrasound technology, the medical team will be able to recognize if the baby is in distress.  In many cases, impending distress can even be recognized.  The key is for the medical team to initiate continuous fetal heart monitoring as soon as the mother arrives at the hospital in labor, and to pay close attention to the fetal heart rate tracings.  In fact, this is the standard of care.  In addition, if the mother has a high risk pregnancy or the physician suspects any abnormal position or problems, ultrasound tests – which can show various images of the baby, womb, placenta and umbilical cord – can be performed to help diagnose complications that may be present.  Fetal distress almost always means the baby is suffering from a lack of oxygen.  If this occurs, there may be no time for tests because the baby should be quickly delivered by emergency C-section, in most cases.

In short, obstetrical complications are not as dangerous as they may seem, as long as the medical team continuously monitors the baby’s heart rate and closely and skillfully interprets the heart tracings AND has the capability to quickly perform a C-section if the baby shows signs of distress.  If a hospital holds itself out as a labor and delivery unit, it is required to have the capacity to perform a timely emergency C-section delivery.

Listed below are some complications that can cause birth injuries and trauma.

Brain Bleeds and Hemorrhages

Brain bleeds and hemorrhages can be very dangerous for a baby.  Bleeds in the brain can cause permanent brain damage by several mechanisms.  For example, a bleed can cause so much blood to be lost that there is an inadequate flow of oxygen-rich blood to certain parts of the brain, causing brain cells to be starved of oxygen (and glucose).  This can cause a cascade of damaging events to occur within the brain.

There are a number of things that can cause brain bleeds during labor and delivery. They include:

One of the most dangerous types of bleeds is called a subgaleal hemorrhage.  This is a significant risk factor when vacuum extractors are used to help deliver the baby.  A vacuum extractor is especially dangerous for the baby because the cup attaches directly to the baby’s head.  Suction is applied to help ease the baby out of the birth canal.  If too much suction is used, suction is used for too long, the cup is not placed in the correct spot, or too many attempts are made with the vacuum extractor, the vessels in the baby’s head can rupture.  A subgaleal hemorrhage occurs when a vein (or veins) located between the scalp and the skull ruptures.  Almost half of the baby’s blood volume can go into the subgaleal space, which can cause the baby’s blood pressure to drop to a dangerously low level.

When a brain bleed occurs, the baby should be promptly delivered, usually by C-section.  When a bleed is serious enough, it will cause the baby to have fetal distress, which will manifest on the heart monitor.  Bleeds must be promptly recognized and treated.  Brain bleeds and hemorrhages can cause permanent brain damage, hypoxic ischemic encephalopathy (HIE), cerebral palsy and seizures.

Umbilical Cord Problems

The umbilical cord is the baby’s lifeline.  Blood travels from the mother through vessels in the uterus and placenta, and then on to the baby through the umbilical cord.  The umbilical cord arises from the placenta.  If the umbilical cord becomes compressed, thereby restricting blood flow to the baby, the baby can be severely deprived of oxygen.  If there is total compression of the cord, the baby may even be completely cut off from her supply of oxygen-rich blood.  Complications that can cause cord compression include umbilical cord prolapse, nuchal cord (cord is wrapped around baby’s neck), a short umbilical cord and the cord being in a true knot.

Conditions that place a baby at risk of having a cord prolapse, which is when the cord exits in front of the baby in the birth canal, include shoulder dystocia, oligohydramnios, premature rupture of the membranes (PROM), premature delivery, delivery of twins or more, an abnormally long cord and breech presentation.

Umbilical cord problems can cause the baby to have HIE, cerebral palsy, seizure disorders and other birth injuries.  They are obstetrical emergencies that almost always mandate a prompt C-section delivery.

Uterus and Placental Problems

A ruptured uterus is a very serious condition in which all the layers of the uterus are torn.  This is life threatening for both the mother and baby.  So much blood can be lost by the mother, that there can be a severe shortage of oxygen-rich blood being delivered to the baby.  If the uterus tears at a spot that is significantly involved in circulation between the uterus and placenta, the baby could also be severely deprived of oxygen.  The tear may also cause the baby to spill out of the womb and into the mother’s abdomen.

A placental abruption is when the placenta tears away from the uterus, either partially or completely.  If a complete abruption occurs or the abruption is at the place where the umbilical cord arises, the baby will be completely cut off from her supply of oxygen-rich blood.  A minor abruption is also serious because it can turn severe very quickly.  If a baby is at term, the standard of care is to deliver her right away even if a minor abruption is present.  If the baby is not at term, the mother should be admitted to the hospital and closely monitored.  Depending on the severity of the abruption, the baby may need to be delivered prematurely.  Regardless of any other factors, if an abruption is causing fetal distress, the baby should be delivered immediately.

Placental previa occurs when the placenta grows so close to the opening of the uterus that it partially or completely blocks the cervix (cervical os), which is the opening to the birth canal.  If there is complete or total previa at the time of delivery, a C-section is required.  Attempting vaginal delivery in this case will be impossible and can cause severe hemorrhaging in the mother, which can lead to significant oxygen deprivation in the baby and fetal distress. 

Preeclampsia is when a mother is diagnosed with high blood pressure during pregnancy.  Through a number of mechanisms, preeclampsia can cause problems with blood flow in the placenta, which can cause the baby to be deprived of sufficient oxygen and nutrients long term.  This can cause the baby to suffer from intrauterine growth restriction (IUGR), which can lead to a number of other problems with the baby.  Preeclampsia increases the risk of placental abruption and the baby having hypoglycemia at birth.  In addition, preeclampsia can progress to eclampsia, which is when the mother has a seizure.  This is life-threatening for both the mother and baby.

When a mother has placental insufficiency, it means there is a lack of adequate blood flow to the baby, which can cause the baby to have IUGR, oligohydramnios, and nutrient and oxygen deprivation.  Placental insufficiency can also cause preeclampsia, and it is the most frequent cause of IUGR.

Problems with the uterus and placenta can cause HIE, cerebral palsy, seizures and other birth injures if the baby is not promptly delivered either before fetal distress occurs or as soon as it is recognized on the fetal heart monitor.

Size and Positional Problems

Macrosomia (large baby) and cephalopelvic disproportion (CPD) greatly increase a baby’s risk of having a traumatic delivery.  When a baby is macrosomic, it is more likely that the physician will use forceps or vacuum extractors.  Trauma can cause hemorrhages / brain bleeds, which can cause a lack of oxygen in the brain.  In addition, the prolonged labor that can occur with macrosomia and CPD also increases the chance of oxygen deprivation.  If a mother has gestational diabetes, she has an increased chance of having a macrosomic baby.

When a baby is in a breech presentation, either the feet or buttocks are positioned to descend the birth canal first.  It is the physician’s responsibility to identify a breech baby, make appropriate attempts at turning the child, if possible, and safely deliver the baby, usually by C-section.

There are three types of breech presentations:

Frank breech. This position resembles a pike position where the baby’s buttocks are pointed toward the birth canal and the knees are extended.

Complete breech. This position is similar to a cannonball position where the baby’s buttocks are pointed down toward the birth canal and the legs are folded at the knees.

Incomplete or footling breech. This is where a foot presents first and one or both of the baby’s hips are extended.

A complete breech and incomplete or footling breech require a C-section delivery.  Physicians may attempt a vaginal birth if the baby is in the frank breech position, but most experts recommend a C-section for all breech positions because it is the safest way to deliver the baby.

Shoulder Dystocia

Shoulder dystocia occurs when the baby’s shoulder becomes stuck on the mother’s pelvis during delivery.  When this occurs, physicians often pull too hard on the baby’s head when trying to deliver her.  This excessive force can cause the nerves in the shoulder area to become severely stretched or torn.  These damaged nerves can cause partial or complete paralysis of the baby’s arm, leaving the arm hanging limply at the baby’s side.

Sometimes forceps and vacuum extractors are used during a shoulder dystocia situation, and this can place the baby at an even larger risk of having a birth injury, such as a brain bleed.

Hyperstimulation Caused by Pitocin and Cytotec

Hyperstimulation of the uterus (also called tachysystole) occurs when contractions are excessive.  Hyperstimulation is a complication of Pitocin and Cytotec, and it can seriously impede the flow of blood through the umbilical cord, thereby causing oxygen deprivation in the baby. Hyperstimulation can have a significant impact on the placenta.  When the uterus contracts, the flow of oxygen in or out of the placenta slows or stops.  Between contractions, the placenta is “at rest” and oxygen flows freely.  For the placenta to function properly, there must be sufficient time between contractions for the placenta to recharge with a fresh supply of oxygen.  When hyperstimulation occurs, there often isn’t enough time for adequate oxygen replenishment.  Hyperstimulation induced by Pitocin or Cytotec can cause contractions to occur less than 2-3 minutes apart, thereby hindering replenishment.  With each contraction, the oxygen saturation in the baby’s blood can become progressively worse.

Hyperstimulation can have a significant impact on the placenta.  When the uterus contracts, the flow of oxygen in or out of the placenta slows or stops.  Between contractions, the placenta is “at rest” and oxygen flows freely.  For the placenta to function properly, there must be sufficient time between contractions for the placenta to recharge with a fresh supply of oxygen.  When hyperstimulation occurs, there often isn’t enough time for adequate oxygen replenishment.  Hyperstimulation induced by Pitocin or Cytotec can cause contractions to occur less than 2-3 minutes apart, thereby hindering replenishment.  With each contraction, the oxygen saturation in the baby’s blood can become progressively worse.

When oxygen saturation in the baby’s blood drops, there often isn’t sufficient oxygen reaching the baby’s brain, which will cause fetal distress.  The physician must then stop the administration of Pitocin.  Cytotec, on the other hand, cannot readily be discontinued because the pill is absorbed by vessels in the mother’s vagina.  Both drugs are risky because there is no way to predict how a woman will tolerate them.  The effects of any given dose vary widely, and there are no precise methods of measuring the effects of Pitocin and Cytotec on the uterus.

When fetal distress occurs, the baby should be delivered immediately by an emergency C-section, in most cases.  Failure to promptly deliver a baby when hyperstimulation and fetal distress occur can cause hypoxic ischemic encephalopathy, cerebral palsy, seizures and other birth injuries.

Hyperstimulation can cause uterine rupture.  Uterine rupture happens when excessive contractions associated with hyperstimulation cause the uterus to tear, either partially or completely.  This is an emergency and it requires an emergency C-section to avoid HIE and other birth injuries.

BIRTH TRAUMA & HIE ATTORNEYS HELPING CHILDREN WHO HAVE BIRTH INJURIES & CEREBRAL PALSY FOR ALMOST 3 DECADES

As discussed above, although labor and delivery complications are very frightening, permanent injury to the baby can be avoided if physicians follow standards of care and promptly deliver the baby as soon as fetal distress is evident on the monitor.  Brain bleeds must be promptly recognized and treated right after birth.

Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been advocating for children for decades.  Jesse Reiter, president of the firm, has been focusing solely on birth injury and birth trauma cases for over 28 years.  He is currently recognized as one of the best medical malpractice attorneys in America by U.S. News and World Report 2014, which also recognized ABC Law Centers as one of the best law firms in the country.  The attorneys 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).

Jesse and his team are passionate about helping children obtain all the support, therapy and treatment they need so they have a good quality of life and a secure future.  The team at ABC Law Centers will carefully review all medical records to determine if negligence occurred.  Once the attorneys see medical malpractice, they aggressively fight to obtain compensation for lifelong care and support of the child.

If your child was diagnosed with a permanent disability, such as cerebral palsy, hypoxic ischemic encephalopathy (HIE), periventricular leukomalacia (PVL), intellectual disabilities or developmental delays, the award winning birth injury attorneys at ABC Law Centers can help.   We help children in Michigan, Ohio, Washington, D.C. and throughout the country, and we give personal attention to each child and family we represent.  Our nationally recognized 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.  An attorney from our firm is available to answer questions 24 / 7.