Birth Injury Prevention
The term “birth injury” can be used to refer to any type of harm to a baby just before, during, or shortly after the birthing process. This includes oxygen deprivation (birth asphyxia), traumatic birth injuries (caused by mechanical force), neonatal infections, and more. Birth injuries can have lifelong impacts, as they often result in permanent disabilities such as hypoxic-ischemic encephalopathy (HIE), cerebral palsy (CP), periventricular leukomalacia (PVL), intellectual impairments, and seizure disorders. However, birth injuries and associated disabilities are often preventable.
Medical professionals can prevent birth injuries by carefully monitoring the health of a mother and baby and promptly intervening if necessary. This includes care throughout pregnancy, childbirth, and the neonatal period. If a medical professional fails to follow standards of care, or if a hospital provides inadequate care due to staffing issues, this is negligence. If negligence results in birth injury to the baby, or harm to the expectant mother, it constitutes medical malpractice.
The following are some of the most important aspects of birth injury prevention:
1. Providing proper prenatal care
Doctors should recommend a variety of prenatal tests, which are done to assess the health of both the mother and baby (which are in many ways interdependent). Prenatal testing can provide information about maternal conditions such as gestational diabetes, preeclampsia, and infections. These tests can also help medical professionals recognize a wide variety of fetal issues, such as intrauterine growth restriction (in which the baby is not growing properly), suboptimal positions (e.g. breech), umbilical cord problems, and heart rate abnormalities. If these complications are caught early and properly managed, it is often possible to avoid serious birth injuries. It is important that doctors recognize factors that make a pregnancy high-risk; women with high-risk pregnancies should be referred to a maternal-fetal specialist and receive more extensive prenatal care and monitoring.
2. Detecting and addressing signs of fetal distress
Throughout pregnancy and during delivery, medical professionals should monitor the mother and baby for signs of fetal distress, which indicate that the baby is likely being deprived of oxygen. Fetal distress signs include:
- Decreased fetal movement
- Abnormal fetal heart rate (as indicated by fetal monitoring, a nonstress test, or a contraction stress test)
- Abnormal amniotic fluid volume
- Abnormal biophysical profile (BPP)
- Abnormal Doppler flow study
- Vaginal bleeding
- Insufficient or excessive maternal weight gain
It is especially important to watch for signs of distress during delivery. Among other things, this means monitoring the fetal heart rate. This can be accomplished through an external or internal fetal monitor. For most pregnancies, it is often necessary to have continuous heart rate monitoring.
3. Preventing premature birth, and minimizing risks if it is inevitable
Infants who are born prematurely often have underdeveloped organs, weak immune systems, and low birth weights. These factors increase their susceptibility to birth injuries and subsequent neonatal brain damage/disabilities. Fortunately, doctors are often able to prevent premature birth. This entails recognizing and mitigating risk factors, such as incompetent cervix/cervical insufficiency. Three relatively 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 is important to the maintenance of pregnancy
- Magnesium sulfate: an inorganic salt that can suppress preterm labor
In some cases, premature birth may be inevitable, or even medically necessarily (if another pregnancy complication outweighs the risks associated with premature birth, doctors may recommend an early C-section or labor induction).
If this is the case, there are certain measures that can be taken – while the baby is still in utero – to minimize the chance of harm. These include an antenatal steroid called betamethasone (which can accelerate lung development) and magnesium sulfate (in addition to suppressing preterm labor, this can protect the brain of a baby about to be born prematurely).
4. Recognizing when vaginal birth may be dangerous or impossible
There are certain circumstances under which C-section deliveries are recommended or necessary. Among others, possible indications for C-section delivery include:
- Prolonged and arrested labor
- Cephalopelvic disproportion (CPD)
- Placental abruption
- Placenta previa
- Uterine rupture
- Umbilical cord compression (which can be caused by a variety of issues, including a cord prolapse)
- Maternal infection
- Fetal distress
In some cases, doctors attempt to get the baby out using less invasive interventions first. However, this can lengthen the amount of time that a baby is exposed to risky conditions, so the pros and cons of such actions should be weighed carefully.
Two of the most common interventions – contraction-enhancing drugs and birth-assisting tools – come with additional dangers.
Contraction-enhancing drugs (Pitocin and Cytotec) can cause uterine tachysystole/hyperstimulation, which may deprive the baby of oxygen. Birth-assisting tools (forceps and vacuum extractors) increase the risk of birth trauma.
In some cases, these drugs and tools are very helpful, but medical professionals must use them with great caution. Moreover, they should be prepared to perform an emergency C-section if serious complications arise.
5. Properly caring for babies in the NICU
Babies who are premature, have sustained birth injuries, or have other health issues will typically spend time in the neonatal intensive care unit (NICU). NICU babies are fragile, so it is very important that they receive the best possible care. Unfortunately, medical professionals sometimes make mistakes in the NICU, which can have serious consequences. Among others, these mistakes include:
- Resuscitation or breathing assistance errors
- Failure to diagnose hypoxic-ischemic encephalopathy (HIE) and quickly provide therapeutic hypothermia
- Failure to quickly diagnose and treat conditions such as infections, intracranial hemorrhages, neonatal seizures, hypoglycemia, anemia, and jaundice
- Other errors, including medication mix-ups and problems with tubes, IVs, and central lines.
Birth injury prevention and medical malpractice
It’s critical that medical professionals follow standards of care when managing pregnancy, birth, and infant health problems. Moreover, medical professionals must obtain informed consent from the mother when making medical decisions regarding pregnancy or birth, and informed permission from one or both parents when making a decision regarding an infant’s health. This means explaining the risks, benefits, and possible alternatives of certain courses of action.
If a doctor, nurse, or hospital fails to do these things, and it results in harm to the mother and/or baby, this constitutes medical malpractice.
Sometimes, parents choose to sue if medical malpractice has caused their child’s birth injury. This can help to ensure that medical professionals and organizations are held accountable and learn from their mistakes. Moreover, pursuing a lawsuit can help families obtain the financial means to afford high-quality care and support for a child with a disability/serious health issue.
If you are interested in pursuing a case, the attorneys at Reiter & Walsh ABC Law Centers may be able to help. We focus exclusively on birth injury, and have the legal and medical expertise necessary to effectively advocate for our clients. Please reach out today for a free case review. In fact, you pay nothing throughout the entire legal process unless we win or favorably settle your case.
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