Birth Injury Prevention

The following are some of the most important aspects of birth injury prevention:

1. Providing proper prenatal care

Doctors should perform prenatal tests and monitoring to assess the health of both the mother and baby and to determine which pregnancies are at higher risk. Prenatal testing can provide information about maternal conditions such as:

• Gestational diabetes: a health condition involving high blood sugar that can occur during pregnancy. It can put your baby at risk of harm if it’s not identified and managed properly.
• Gestational hypertension: high blood pressure during pregnancy which can increase the risk of harm.  
• Preeclampsia: occurs when a mom  develops high blood pressure and signs of organ damage. It typically occurs after 20 weeks of pregnancy.
• Infections: like group B strep, UTIs, and BV that can be passed down from the mother to the baby if doctors do not identify them in time and treat them.

Prenatal tests can also help medical professionals recognize many fetal issues that place the baby at risk for harm, such as:

• Intrauterine growth restriction: when the baby is small and not growing properly.
• Abnormal Fetal Positions: the baby is not in the ideal position for birth (e.g. breech, or legs first).
• Umbilical cord problems: including umbilical cord knots or issues that compress the cord and decrease the oxygen and blood flow to the baby during labor and delivery.
• Heart rate abnormalities: like bradycardia (a slow heartbeat) or tachycardia (a fast heartbeat) which can suggest that a baby may not be getting enough oxygen.
• Low amniotic fluid: when the fluid surrounding the baby is low, increasing the risk of umbilical cord compression and less oxygen to the baby.

These complications make a pregnancy high-risk. Women with high-risk pregnancies should be monitored more carefully. Many times, a high-risk maternal-fetal specialist is consulted. Diagnosing and appropriately managing these complications and high-risk pregnancies help to prevent birth injuries.  

2. Detecting and addressing signs of fetal distress

Throughout pregnancy and during labor and delivery, medical professionals should monitor the mother and baby for signs of fetal distress. When a baby is in distress, it likely means they are not receiving enough oxygen. Signs of distress include:

• Decreased fetal movement
• Abnormal fetal heart rate, which can be seen via fetal monitoring, a nonstress test, or a contraction stress test
• Abnormal amniotic fluid volume (fluid surrounding the baby in the womb)
• Abnormal biophysical profile (BPP)
• Abnormal Doppler flow study (testing that checks blood flow)
• Vaginal bleeding
• Maternal cramping
• Too little or too much maternal weight gain

It is especially important to watch for signs of fetal distress during delivery. This means medical staff must continuously monitor the baby’s heart rate using an external or internal fetal monitor. For most pregnancies, it is necessary to have continuous heart rate monitoring.

3. Preventing premature birth, and minimizing risks if it’s inevitable

Premature babies often have underdeveloped organs, weak immune systems, and low birth weights. These factors increase their risk of birth injury. Fortunately, doctors are often able to prevent premature birth by recognizing and decreasing risk factors. Three common interventions are:

• Cervical cerclage: a temporary stitch that helps keep the cervix closed until the baby is ready to be born
• Progesterone: a hormone that helps women to maintain pregnancy and prevent premature uterine contractions from happening
• Magnesium sulfate: an inorganic salt that can prevent or delay preterm labor

In some cases, premature birth can’t be prevented. It may also be medically necessary, especially if another pregnancy complication outweighs the risks associated with premature birth. Doctors may recommend an early C-section or induce labor to prevent serious health risks and injury.

If this is the case, there are certain measures that can be taken to decrease the risk of injury  while the baby is still in the womb. These include an antenatal steroid called betamethasone, which can help the baby’s lungs develop faster. Magnesium sulfate may also be given to the mother. In addition to suppressing preterm labor, magnesium sulfate can protect the baby’s brain.

4. Recognizing when vaginal birth may be dangerous or impossible

A C-section delivery is recommended or necessary in certain situations in order to prevent birth injury. Reasons for C-section delivery include:

• Prolonged and arrested labor: when labor takes too long or can’t progress
• Macrosomia: when the fetus is too large for their age
• Cephalopelvic disproportion (CPD): a size mismatch between the fetus and the mother’s pelvis
• Placental abruption: when the placenta separates from the uterus, limiting oxygen to the baby
• Placenta previa: condition in which the placenta lies very low in the uterus and can block the baby’s path out of the womb, resulting in excessive blood loss
• Uterine rupture: a tear in the uterus that can potentially expel the baby into the mother’s stomach, limiting oxygen to the baby
• Umbilical cord compression:  can be caused by a variety of issues and stop the flow of blood to the baby 
• Maternal infection
• Fetal distress: when a baby isn’t tolerating labor well and likely isn’t getting enough oxygen 

In some cases, doctors attempt to deliver the baby vaginally using less invasive interventions first. However, this can lengthen the amount of time that a baby is exposed to risky conditions and decrease oxygen to the baby. Medical staff must weigh the risks and benefits of such actions carefully.

5. Properly caring for babies in the NICU

Babies who are premature, suffer a birth injury such as HIE, or have other health issues will typically spend time in the neonatal intensive care unit (NICU). NICU babies are fragile, so it is critical that they receive the best possible care. Medical mistakes in the NICU can have serious consequences. Examples of mistakes may include:

• Resuscitation or breathing assistance errors
• Failure to diagnose hypoxic-ischemic encephalopathy (HIE) and quickly provide therapeutic hypothermia (cooling therapy)
• Failure to quickly diagnose and treat infections
• Other errors, including medication mix-ups and problems with tubes, IVs, and central lines.

6. Patient-centered care

Proper and consistent communication with patients is an often undervalued part of birth injury prevention. Medical staff should share any changes or issues during labor, delivery, and NICU care. They should also address and answer their patient’s questions and concerns. If there are any changes in the patient’s condition, their medical team should make note and intervene in case there are any risks for birth injury.

Informed consent is another important aspect of patient care and communication. Pregnant mothers should have full knowledge of the risks, consequences and alternative treatment plans and options. This means explaining the risks, benefits, and possible alternatives of certain treatments and interventions.

Even in cases where a patient gives their informed consent to a treatment, it does not mean that doctors have the right to provide negligent care.