Michigan Medical Malpractice Lawyers | Negligence During Labor & Delivery can cause Hypoxic Ischemic Encephalopathy (HIE), Seizures, Brain Bleeds & other Birth Injuries
Michigan Medical Malpractice Lawyers Helping Children who have Hypoxic Ischemic Encephalopathy (HIE) & other Birth Injuries | Serving Michigan, Ohio, Washington, D.C. & All 50 States
When a mother is admitted to a labor and delivery unit, the obstetrician must properly evaluate her and the baby, enter a note and plan of action in her medical chart, and begin monitoring the baby with a fetal heart monitor right away. In the labor and delivery unit, medical negligence often occurs because the obstetrician doesn’t follow these steps, leaving the mother and baby with inadequate monitoring and care. In addition, nurses and other members of the medical team often fail to properly manage the mother and baby during this critical time. Improper monitoring can cause fetal distress and obstetrical emergencies to be missed, which can cause the baby to experience a lack of oxygen to her brain for too long (birth asphyxia). A delayed delivery when the baby is in distress and experiencing birth asphyxia can cause brain injury, hypoxic ischemic encephalopathy (HIE), seizures, developmental delays, cerebral palsy and other birth injuries.
In this article, we discuss how inattention during labor, lack of skill and a delayed delivery can cause permanent injury to a baby, and we also review steps mothers can take to help ensure a safe birth.
AWARD WINNING MICHIGAN MEDICAL MALPRACTICE LAWYERS HELPING CHILDREN FOR ALMOST 3 DECADES
The award winning birth injury attorneys at Reiter & Walsh ABC Law Centers have helped hundreds of children affected by birth injuries such as hypoxic ischemic encephalopathy (HIE). 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 one of the best medical malpractice law firms in the nation.
If your child experienced a birth injury and now has seizures, HIE, cerebral palsy, developmental delays or any other long-term condition, contact Reiter & Walsh today at 888-419-2229. Our award winning Michigan medical malpractice lawyers are available 24/7 to speak with you.
WERE YOU PROMPTLY & REGULARLY ASSESSED BY AN ACTUAL PHYSICIAN AFTER BEING ADMITTED TO THE LABOR & DELIVERY UNIT?
When a mother is admitted to the labor and delivery unit, it is common for a nurse to begin evaluating the mom and baby, and indeed, it is very important that fetal / maternal evaluation and continuous monitoring of the baby’s heart rate begin right after admission. Heart tracings that are “nonreassuring” mean a baby is experiencing oxygen deprivation. It is also critical that an obstetrician assess the mother and baby right away. It is the standard of care for an obstetrician to evaluate the mother and baby, enter a note with a plan of action in the mother’s chart, and write orders shortly after the mother is admitted. If the mother arrived with any signs or symptoms indicative of fetal distress or a risky pregnancy condition – or if the fetal monitor shows that the baby is in distress – the obstetrician must be promptly contacted for immediate evaluation and care of the mother and baby.
A patient is considered “low risk” if she is not in active labor and the following conditions are present:
- The baby is at 37–41 weeks of gestation
- The baby has an appropriate weight for gestational age
- The baby has a Category I electronic fetal monitoring strip (reassuring tracings) on admission (or a reassuring auscultation and a note written by the physician if the mother refuses electronic fetal monitoring)
- There is absence of moderate or thick meconium in the amniotic fluid
- The baby is in the normal, head-first position (vertex presentation)
- There are no medical or obstetrical complications
If the maternal and fetal conditions fall outside of these parameters or if the mother is in active labor, an obstetrician must assess the mother and baby right away and provide close and continuous monitoring. When conditions do not fall within the parameters listed above, maternal / fetal status is generally considered high risk.
At a minimum, the obstetrician’s initial assessment of the mother and baby should include the following:
- A review and summary of the pregnancy / prenatal course
- An evaluation of the status of labor, including a description of uterine activity, cervical dilation and effacement, and fetal station and presentation
- A physical exam (including an estimated fetal weight)
- An evaluation of fetal status, including interpretation of fetal heart monitoring strips
- The plan for delivery
During the first stage of labor, evaluations must occur at regular intervals, with high risk patients being evaluated much more frequently. Of course, continuous monitoring should occur for every mother admitted to the labor and delivery unit.
Evaluations during the first stage of labor should, at a minimum, include the following:
- Assessment of the mother’s status, including level of pain during labor
- Assessment of the fetal status
- Characterization of uterine activity
- A description of findings of the vaginal exam, if performed, including cervical dilation and effacement, fetal station, change in status of membranes, and progress since the last exam
- A summary of the mother and baby’s status
- The labor and delivery plan, including plans for or performance of medical interventions and pain management
Each evaluation must be documented in the mother’s chart.
During the second stage of labor, the following must be recorded at regular intervals:
- Maternal and fetal status
- Fetal station and position
- Presence of any swelling of the baby’s scalp / head and molding
- The delivery plan
The fetal heart tracings should be evaluated at least every 5 minutes, with alarms appropriately set. If nonreassuring heart tracings occur, the attending obstetrician should promptly evaluate the baby’s status and quickly initiate efforts to resolve the fetal distress. While attempts are being made to relieve the baby’s distress, preparations for an emergency C-section delivery should be started.
It is crucial for appropriate communication to occur among members of the medical team. Research shows that breakdown in communication is a common cause of medical negligence, including birth injury. Of course, there should be an obstetrician immediately available for every mother admitted to the labor and delivery unit, and conditions that are not low risk require continuous care by the obstetrician.
At a minimum of every hour – much more frequently in high risk situations – the obstetrician, along with nurses and other members of the mother’s medical team, should discuss the medical plan and document it in the mother’s chart.
PROPER ASSESSMENT, CONTINUOUS FETAL HEART MONITORING & TIMELY DELIVERY CAN PREVENT HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE), SEIZURES, CEREBRAL PALSY, DEVELOPMENTAL DELAYS & OTHER BIRTH INJURIES
Most babies are born healthy, with no birth injuries that can cause lifelong problems. However, when a baby starts to become deprived of oxygen (called fetal distress), it is very dangerous because there is no way to directly help the baby while she is still in the womb. Babies can show no signs of distress and appear perfectly healthy during labor. At any time, though, something can go wrong – such as a placental abruption or tight nuchal cord – that can cause the baby to experience oxygen deprivation. It is important that fetal distress be quickly recognized so the baby can be promptly delivered. Thus, continuous fetal heart monitoring and interpretation is very important during labor. It is also crucial for the labor and delivery unit to have the capacity to quickly deliver the baby by emergency C-section when necessary. This means that the unit must have enough obstetricians available to perform surgery on every mother admitted to the unit. There must also be adequate equipment, surgical suites and medical personnel to perform emergency C-sections. In addition, there should be enough “code” teams available in the event that both the mother and baby need emergency intervention right after delivery.
Failure to quickly deliver a baby in distress and failure to quickly resuscitate the baby after birth, if needed, can cause the baby to experience birth asphyxia, which can cause the following birth injuries:
- 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
Conditions that make a labor and delivery high risk, thereby requiring very close monitoring by the obstetrician (and preparation for an emergency C-section), include the following:
- History of a nonreassuing fetal heart tracing
- The baby in an abnormal presentation, such as breech position
- History of prior C-section delivery
- The mother is pregnant with twins, triplets or more
- There is significant maternal illness
- Pitocin or Cytotec were used to start or speed up labor
- There is abnormality of active or second stage labor
- The baby is experiencing a nonreassuring heart tracing
- There is thick meconium in the amniotic fluid
- There is heavy vaginal bleeding
Conditions that can cause birth asphyxia, thereby requiring prompt C-section delivery, include:
- Umbilical cord problems, such as a nuchal cord (cord wrapped around baby’s neck), umbilical cord prolapse, short umbilical cord and cord in a true knot
- Ruptured uterus
- Preeclampsia / eclampsia
- Placental abruption
- Placenta previa
- 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.
- 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 cephalopelvic disproportion (CPD), abnormal presentations (face or breech presentation), and shoulder dystocia also put a child at risk of having a brain bleed.
- Hyperstimulation caused by Pitocin and Cytotec can also cause oxygen deprivation that gets progressively worse.
- Fetal stroke
- Postmaturity syndrome, baby past due date
- Failure to quickly deliver a baby when fetal distress is evident on the fetal heart rate monitor (delayed emergency C-section)
WHAT CAN I DO TO HELP ENSURE A HEALTHY LABOR & DELIVERY?
Listed below are some questions a pregnant woman should ask prospective obstetricians to help determine which one to select for prenatal care and delivery:
- How many deliveries have you performed?
- Will my baby’s heart rate be continuously monitored as soon as I’m admitted to the labor and delivery unit?
- Are you skilled at interpreting fetal heart rate tracings?
- Will someone skilled in fetal heart rate interpretation be present at all times when I’m in labor?
- If my baby shows signs of distress and I cannot quickly deliver her, do you and the hospital have the capacity to quickly deliver my baby by C-section? Will I be in close proximity to a room where a C-section can quickly be performed?
- Will there be a second physician instantly available so that if both my baby and I are in distress, there is one physician focusing on me and one focusing on my baby?
- Will you please thoroughly explain the risks and benefits of – and alternatives to – any medications (such as Pitocin and Cytotec to induce or speed up labor) or delivery instruments you are going to use (such as vacuum extractors)? If an obstetrician decides to utilize drugs or delivery instruments, it is important to ask the obstetrician how much experience she has with using the drugs or vacuum extractors. This is especially true when it comes to delivery instruments, which are very risky. C-section risks and benefits must also be thoroughly discussed.
- If the obstetrician leaves the room during labor, the mother should not hesitate to ask the staff members present if they are skilled at fetal heart rate interpretation and if they have taken a proficiency exam. Research shows that a significant number of birth injuries occur when nonreassuring fetal heart tracings are not recognized, or if they are recognized, there is a breakdown in communication among the staff. An example would be when the staff fails to communicate abnormal heart tracings to the obstetrician, and then the baby is not quickly delivered.
AWARD WINNING MICHIGAN MEDICAL MALPRACTICE LAWYERS FOR BABIES
If your labor and delivery lacked proper attention from an obstetrician, your baby’s heart rate was not properly monitored and interpreted, or your delivery was delayed and your baby has a birth injury, call Reiter & Walsh ABC Law Centers. Reiter & Walsh 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 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 Michigan medical malpractice 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 Michigan medical malpractice lawyers are available 24 / 7 to speak with you.
VIDEO: MICHIGAN MEDICAL MALPRACTICE LAWYERS DISCUSS BIRTH ASPHYXIA
Watch a video of Michigan medical malpractice lawyers Jesse Reiter and Rebecca Walsh discussing how birth asphyxia can cause hypoxic ischemic encephalopathy (HIE), cerebral palsy, seizures and other birth injuries.