The Importance of Timely Cesarean Section (C-Section) Delivery
Michigan Cesarean Section (C-Section) Lawyers Helping Children with Hypoxic Ischemic Encephalopathy (HIE) & Cerebral Palsy
Two of the most important elements in preventing a birth injury are 1.) recognizing fetal distress or a condition that can cause significant distress, and 2.) performing a quick cesarean section (C-section) delivery when distress or impending distress are evident. Birth injuries can cause a baby to have brain bleeds, hypoxic ischemic encephalopathy (HIE), cerebral palsy, Erb’s palsy and other debilitating conditions.
It is the standard of care to continuously monitor the baby’s heart rate when the mother is admitted to the labor and delivery unit. Sometimes, the medical team monitoring the mother and baby are not properly trained in interpreting the fetal heart rate tracings. Other times, there is a breakdown in communication and the physician is not contacted quickly enough or the physician does not respond fast enough to communications regarding a baby’s distress.
When a baby is in distress, it almost always means she is suffering from a lack of oxygen in her brain, and this can cause permanent brain injury if prolonged. If a baby’s distress cannot be quickly remedied, the physician must deliver the baby right away, often by emergency cesarean (C-section) delivery. If the distress is severe and a baby cannot be vaginally delivered in a safe and timely fashion, a C-section must quickly be performed. Indeed, getting the baby out of the womb is the only way to directly help her and give her oxygen and other critical treatments, such as resuscitation maneuvers. When a baby is in distress, she almost always needs to be removed from the oxygen depriving conditions in the womb, and the best way to do this is usually by emergency C-section delivery.
Labor and Delivery Units Must Have the Ability to Quickly Perform Cesarean Section Deliveries
Indeed, it is against the standard of care for a hospital to hold itself out as a labor and delivery unit and then fail to have the capacity to quickly perform an emergency C-section. It is incredibly sad to see cases whereby distress was evident on the fetal monitor and the staff acted with no sense of urgency in getting the baby delivered by C-section. In so many cases, there are obvious signs of distress on the monitor with nobody recognizing it, or when the signs are recognized, the staff performs time consuming tests, leaving the baby in oxygen depriving conditions for far too long. Sometimes the staff slowly wheels the mother to another department that is far away and all the while, the baby is suffering in distress. Or the hospital is understaffed and the physician is busy with another patient and cannot help deliver the distressed baby.
Labor and delivery units must have the capacity to perform a C-section delivery right there, or the ability to get the mother to an area for a cesarean delivery within a couple of minutes. Most babies are born healthy and do not require emergency plans of action during delivery. But this does not mean the hospital can cut corners and take chances by being short staffed or not having proper C-section equipment in the labor and delivery unit. Babies can only be directly helped when they are out of the womb. Watching the fetal heart monitor for signs of distress and delivering a baby by emergency C-section are relatively simple procedures that can prevent a baby from being oxygen deprived and developing injuries that can cause the child to have lifelong, debilitating problems such as cerebral palsy, hypoxic ischemic encephalopathy (HIE), seizures, intellectual disabilities, and Erb’s palsy. Simple mistakes, such as failure to recognize and act on fetal distress, can cause an otherwise healthy child to have severe and permanent problems.
When Is a Cesarean Section Operation Safer Than Vaginal Delivery?
Another area of negligence we commonly see is when fetal distress is promptly recognized but the physician continuously attempts vaginal delivery instead of moving on to a C-section delivery. Prolonged labor and delivery is associated with oxygen deprivation in the baby. Often, when physicians know that a baby must be quickly delivered, they administer Pitocin or Cytotec to try and speed up delivery. These drugs are very risky; they can cause contractions to be so fast and strong that the baby becomes deprived (or further deprived) of oxygen. Even riskier are dangerous delivery devices, such as forceps and vacuum extractors. Instead of moving on to a C-section, physicians sometimes think it will be faster to try and deliver a baby with these instruments, which can cause brain trauma and brain bleeds and should only be used by very skilled physicians. Not only are Pitocin, Cytotec, forceps and vacuum extractors dangerous, but using these may prolong the delivery even more, worsening the oxygen deprivation and fetal distress.
C-sections are very common and the process is straightforward. Use of delivery drugs and instruments, on the other hand, is unpredictable. Physicians can’t predict how Pitocin and Cytotec will affect the mother and unborn baby. Forceps and vacuum extractors attach directly to the baby’s head and can cause trauma, especially when the physician is unskilled. Sometimes physicians are unaware that certain problems are present, such as shoulder dystocia (baby’s shoulder stuck on mother’s pelvis), cephalopelvic disproportion (CPD) or umbilical cord prolapse, and use of a delivery instrument may be contraindicated or extremely risky, causing major problems for the baby.
Certain conditions require a C-section delivery, such as placenta previa, cephalopelvic disproportion and (usually) and breech presentation. When other ominous pregnancy conditions occur, such as placental abruption, uterine rupture, and umbilical cord prolapse or compression, a C-section is also the safest way to deliver the baby, in most cases. When physicians fail to recognize these conditions and attempt a vaginal delivery, the baby can become seriously injured.
The three most common indications for a C-section delivery are failure of the baby to progress during labor, non-reassuring fetal heart tracings (fetal distress) and abnormal position of the baby, such as face or breech presentation.
Other conditions in which a C-section delivery is indicated include the following:
- Vasa previa: This is when the fetal blood vessels are crossing or running close to the inner opening of the womb (cervical os).
- Placenta accrete: This is when the placenta is deeply attached to the middle part of the uterine wall.
- Maternal infection, such as herpes simplex virus or HIV, that have the potential to spread to the baby during vaginal birth.
- Nuchal cord (cord wrapped around baby’s neck): This is an indication for cesarean section if accompanied by a non-reassuring fetal heart tracing.
- Maternal brain hemorrhage or aneurysm
- Short umbilical cord
- Umbilical cord knot (true knot)
Most of the indications for C-section delivery are emergencies. When required, an emergency C-section should be performed as quickly as possible, and many times it should be performed within 10 – 18 minutes or less.
When a baby is suffering from a lack of oxygen, the oxygen deprivation (hypoxia) can get progressively worse. Mere minutes can make a difference in how much damage hypoxia inflicts on the brain. Small amounts of time can make a difference when fetal distress and other complications are occurring, which is why it is crucial that hospitals be fully prepared to timely deliver a baby by C-section. This means that the facility must have proper anesthesia and surgical personnel to permit the start of C-section delivery well within 30 minutes of the decision to perform the procedure. Many experts state that in certain cases, a C-section must be performed in a matter of minutes, such as when the baby is high risk and has a non-reassuring heart rate.
Reiter & Walsh, P.C. | Legal Advocates for Birth Injured Children Since 1997
Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been advocating for children for decades. 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 Reiter 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, which typically includes therapy, treatment, medical devices, housing and education.
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 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.
Video: Cesarean Delivery, HIE and Birth Asphyxia
Watch Michigan lawyer Jesse Reiter discuss how a delayed cesarean section delivery can cause a lack of oxygen in the baby’s brain, brain injury, hypoxic ischemic encephalopathy (HIE) and cerebral palsy.