Medical Negligence During Labor & Delivery, Birth Injuries & Brain Damage
Giving birth is one of the most joyous times in people’s lives. Sometimes, however, something may go wrong during labor and delivery, leaving a newborn baby with birth injuries, such as hypoxic ischemic encephalopathy (HIE), seizures, brain damage and cerebral palsy (CP). Birth injuries often occur when fetal distress is not recognized or appreciated and the medical team fails to quickly deliver the baby. The physician and staff are supposed to closely monitor the baby’s heart rate with a fetal heart monitor. If a complication causes a baby to be deprived of oxygen, called birth asphyxia, the distress will be evident on the monitor. When this occurs, the team must quickly deliver the baby to get her out of the oxygen depriving conditions and prevent brain injury.
Listed below are some common causes of fetal distress that require quick action by the medical team:
- Nuchal cord (cord wrapped around baby’s neck)
- Umbilical cord prolapse / compression
- Placental abruption
- Uterine rupture
- Placenta previa
- Vasa previa
- Oligohydramnios (low amniotic fluid)
- Infection in the mother that travels to the baby at birth
- Placental insufficiency
- Prolonged and arrested labor
- Premature rupture of the membranes (PROM)
- Misuse of Pitocin or Cytotec
- Improper use of an epidural
- Misuse of vacuum extractors and forceps and brain bleeds / hemorrhages
- Abnormal positions, such as breech presentation, face presentation, transverse lie (shoulder presentation), occipitoposterior (OP) position
Once a baby in distress is delivered, she may not be breathing properly and may need to be resuscitated. It is medical negligence if a resuscitation team isn’t immediately available to perform indicated resuscitation maneuvers and give appropriate medications to the baby.
Birth Injuries and Medical Malpractice: A Lack of Oxygen to the Baby’s Brain
As soon as a mother’s pregnancy is confirmed, her physician must take a thorough history and identify any problems that may make the pregnancy high risk. This will help determine how frequently prenatal testing should occur and whether the mother should be referred to a maternal-fetal specialist. There are certain pregnancy conditions that require very close monitoring and astute care, and some conditions require a planned, early delivery in order to prevent the baby from having birth injuries. Whether planned or unplanned, as soon as a mother and baby are admitted to the labor and delivery unit, the baby’s heart rate should be closely monitored and the medical team should also pay close attention to the mother’s heart rate, blood pressure and signs of any birth complications, such as a placental abruption.
Complications that can harm a baby during or near the time of delivery include brain bleeds, infections in the mother that travel to the baby at birth, failure to deliver a baby early when there are sub-optimal intrauterine conditions that can cause the baby to receive insufficient oxygen and/or nutrients, failure to deliver a baby by emergency C-section when she is in distress, failure to timely resuscitate a baby after birth, and failure to properly manage a baby’s breathing in the neonatal intensive care unit (NICU).
The most common cause of birth injuries is a lack of oxygen to the baby’s brain. When the brain experiences an oxygen-depriving insult, a cascade of events starts to occur that can cause permanent brain damage. Hypoxic ischemic encephalopathy (HIE) is a brain injury caused by insufficient oxygen getting to brain cells. Babies who experienced oxygen deprivation or birth asphyxia can have various types of brain injuries, depending on the severity of the birth asphyxia, fetal reserves, and how well the baby was medically managed.
Birth asphyxia is a common cause of birth injuries because there are several systems that work to deliver oxygen to the baby, and if something goes wrong with any one of the systems, the baby can be deprived of oxygen. The baby receives all her oxygen from nutrient and oxygen-rich blood being delivered to her from the mother. The blood travels from the mother through vessels of the uteroplacental circulation that run through the uterus and placenta. The umbilical cord arises from the placenta, and the oxygen-rich blood is carried to the baby through a vein in the cord. Problems with the uterus, placenta or umbilical cord can cause the baby to be deprived of sufficient oxygen. Maternal conditions that can affect blood flow to the baby include high or really low blood pressure, preeclampsia and gestational diabetes.
These problems should be recognized right away so that plans for an early delivery – and sometimes an immediate C-section delivery – can be made to prevent oxygen deprivation in the baby. Diagnosis of some of these conditions should be made during prenatal visits. Other conditions may not manifest until delivery. But if the staff is closely watching the fetal heart rate tracings, any condition that causes the baby to experience a lack of oxygen to her brain will show up as non-reassuring heart tracings (fetal distress).
Types of Birth Injuries
Described below are some of the most common birth injuries.
1. Neonatal encephalopathy (NE). Encephalopathy is essentially an umbrella term that includes any type of central nervous system (CNS) dysfunction caused by an insult to the brain. The CNS consists of the brain and spinal cord, and when a baby has neonatal encephalopathy, it means she has disturbed brain function during the earliest days of life.
2. Hypoxic ischemic encephalopathy (HIE). HIE is by far the most common type of neonatal encephalopathy, and it is caused by a lack of oxygen in the baby’s blood and reduced blood flow in the baby’s brain. HIE usually involves damage to the basal ganglia and watershed regions of the brain, but sometimes also includes periventricular leukomalacia (PVL). HIE and stroke often occur together, and HIE is the most common cause of seizures during the neonatal period.
3. Periventricular leukomalacia (PVL). PVL refers to white matter brain damage characterized by softening or death of white matter near the lateral ventricles, which are located in the top section of the brain and provide pathways for cerebral spinal fluid. When the white matter tissue softens and dies, cysts filled with fluid may be left behind. Lack of oxygen and too little blood to the brain are the main causes of PVL injuries. Although PVL can occur in term babies, it is most common in babies born preterm.
4. Hydrocephalus. A lack of oxygen in the baby’s brain and trauma can cause bleeding inside the brain’s ventricles, called an intraventricular hemorrhage (IVH). This can progress to significant swelling of the ventricles, called hydrocephalus. The swelling is caused by too much cerebral spinal fluid. Hydrocephalus can lead to damaged blood vessels and destruction of white matter in the brain, and the cerebral cortex may not develop properly.
5. Stroke. A stroke occurs when the blood supply to part of the brain is cut off. When brain tissue doesn’t receive adequate oxygen for more than three minutes, the process of cellular injury and death of the tissue begins. A hemorrhagic stroke is when brain vessels rupture from trauma, which can be caused by the use of forceps or vacuum extractors during delivery. An ischemic stroke occurs when brain arteries are blocked by a clot, which can also happen from the use of forceps and vacuum extractors.
6. Permanent brain damage. Birth asphyxia, brain bleeds, neonatal encephalopathy, HIE, PVL, hydrocephalus, stroke and seizures can all cause permanent brain damage in a baby. Brain damage can cause the baby to have lifelong disabilities, such as cerebral palsy. The type of long-term problems a child will have depend on the area(s) of the brain injured and the severity of the damage.
7. Seizures. Seizures are most commonly caused by HIE and are a sign of brain injury. Seizures can worsen existing brain injury and cause further brain damage, so it is important that they be recognized and treated right away. Seizures occur when there is uncontrolled electrical activity in the brain, and seizure activity causes brain disturbances, altered consciousness and sometimes convulsions.
8. Cerebral palsy. Cerebral palsy is a group of disorders that cause muscle dysfunction, which causes problems with movement, balance, posture and coordination. A child with cerebral palsy may have difficulty speaking, feeding and controlling bladder and bowels.
9. Developmental delays. Brain damage can cause a child to have trouble learning to walk, crawl or talk. Developmental delays often become evident when a child is not progressing the way she should in speech or thinking skills and has problems walking and reaching certain developmental milestones.
10. Intellectual disabilities. A permanent brain injury can cause a child to have intellectual disabilities, which means the child lacks certain cognitive abilities. A child with this condition may have a low IQ, limited communication and social skills, and may be unable to take care of herself.
11. Motor disorders. Motor disorders are disorders of the nervous system that cause abnormal and involuntary movements. These disorders are caused by damage to the motor system, often the basal ganglia. Cerebral palsy is an example of a motor disorder, and spastic cerebral palsy is by far the most common type of CP.
12. Microcephaly. A diagnosis of microcephaly (small head) in a baby can be an indication that the baby suffered hypoxic ischemic encephalopathy (HIE), and it also makes it more likely that the baby will have cerebral palsy. Problems with normal head growth may be the first indication that a baby has a brain injury.
12. Erb’s palsy. Erb’s palsy is a severe weakening or paralysis of the arm caused by stretched or torn nerves in the shoulder area, called the brachial plexus nerves. Brachial plexus injuries are often caused by the physician pulling too hard on the baby’s head when the baby’s shoulder gets stuck on the mother’s pelvis during delivery.
Treatments for Newborn Brain Injuries
There is a treatment for hypoxic ischemic encephalopathy (HIE) called hypothermia (brain cooling) treatment. Brain cooling must be initiated within 6 hours of the time the baby experienced an oxygen-depriving insult, which means most babies with HIE need the treatment within 6 hours of delivery. Brain cooling involves the baby wearing a cool cap or being placed on a cooling blanket for 72 hours. The baby’s core body temperature is cooled to a few degrees below normal during treatment.
Hypothermia treatment halts almost every injurious process that starts to occur when the brain experiences an oxygen-depriving insult. Research shows that hypothermia treatment can prevent a child with HIE from developing cerebral palsy or it can decrease the severity of the CP.
For any type of brain injury, the underlying cause must be treated, if possible, and proper management to maintain appropriate oxygenation and blood flow in the brain must take place. Seizures are typically treated with antiepileptic medications such as phenobarbital. Some babies who experienced a stroke may benefit from an anti-clotting medication called heparin. Hydrocephalus must be recognized and treated right away by draining the excess cerebral spinal fluid. This is often done with a shunt system. Failure to drain excess fluid can cause the brain damage to get significantly worse.
Underlying causes of brain damage that must be treated include brain bleeds and hemorrhages, hypoglycemia, hyperbilirubinemia (prolonged jaundice/abnormally high bilirubin), and infections such as sepsis and meningitis.
Award-Winning Infant Medical Malpractice Lawyers Helping Children with Birth Injuries
If you are seeking 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.