Anesthesia Errors and Birth Injuries
Spinal epidurals and spinal blocks are two types of anesthesia commonly given to expectant mothers. Epidurals can provide pain relief during vaginal delivery; spinal blocks are more often used in Cesarean deliveries (C-sections). Spinal epidurals and spinal blocks both come with risk factors; medical professionals are required to explain these risk factors to mothers and obtain informed consent before administering the anesthesia. Epidurals can interfere with the second stage of labor, increasing the likelihood that physicians will use forceps and vacuum extractors. Improper use of these instruments can result in birth injuries such as infant brain bleeds. Additional health risks associated with anesthesia include heart problems in the mother, postpartum hemorrhage, abnormal uterine activity, maternal hypotension, fetal oxygen deprivation, and acidosis. Infants may also develop permanent disabilities such as hypoxic-ischemic encephalopathy (HIE) and cerebral palsy (CP).
In the context of childbirth, the term “regional analgesia” refers to the inhibition of labor pain. The term “regional anesthesia” refers to a greater concentration of local anesthetic, which removes all sensation in a specific area of the body. Local anesthetic is typically used to facilitate instrumental (use of forceps or vacuum extractor) or C-section delivery. However, the two terms are sometimes used interchangeably.
Analgesics may be administered via an epidural, a spinal block, or a combination of both routes. Epidural anesthesia takes longer to go into effect than the spinal approach, in which drugs are deposited directly into the cerebral spinal fluid (CSF).
Drugs for regional anesthesia during labor and delivery include:
Complications Associated with Anesthesia and Analgesia Use During Childbirth
Maternal hypotension (sometimes referred to as a hypotensive crisis) is a labor and delivery complication in which a mother’s blood pressure drops very low. Anesthesia use during labor and delivery can trigger maternal hypotension. Women under anesthesia/analgesia often lie flat on their backs, which can create pressure-related issues. Prolonged maternal hypotension frequently causes nausea and vomiting in the mother, and can also be harmful to the fetus. Even brief episodes of maternal hypotension can result in fetal acidosis and lower Apgar scores. Maternal hypotension is associated with an increased risk of stillbirth, as well as pregnancy complications such as preterm birth, intrauterine growth restriction (IUGR), meconium stained fluid , and postpartum hemorrhage.
If a mother has spinal anesthesia, her doctor must be vigilant for signs of hypotension. If promptly addressed, hypotension can often be improved by repositioning the mother or using a vasopressor. Physicians must also record the baby’s heart rate with a fetal heart rate monitor. This can show signs of fetal distress, which are indications that a baby is being deprived of oxygen. A baby in distress is in need of immediate medical attention and delivery.
The use of anesthesia during childbirth can also cause a maternal hypertensive crisis. A hypertensive crisis is defined as a persistently high blood pressure or a precipitous increase in blood pressure, such as a slightly high blood pressure suddenly becoming extremely high. As with a hypotensive crisis, hypertensive crises can compromise the baby’s health. Spikes in maternal blood pressure can decrease the flow of oxygen-rich blood reaching the fetus. In a hypertensive crisis, blood pressure must be lowered safely. Too swift or too dramatic a reduction in blood pressure can harm both the mother and baby; the mother could have a heart attack or stroke, and the baby may experience sudden fetal distress.
During a hypertensive crisis, the mother should be in a delivery unit with critical care capabilities. Continuous fetal heart rate monitoring is critical. Under such extreme circumstances, it is often not possible to prolong a pregnancy that is remote from term. Delivery decisions will need to balance prematurity risks against maternal risks, and oftentimes, an emergency C-section must be performed.
Abnormal Uterine Contractions and Anesthesia Errors
Uterine contractions can become weaker and less frequent during analgesia/anesthesia epidural use. Doctors may the prescribe Pitocin (a synthetic version of the hormone oxytocin) to increase contractions. This is a risky drug, which can cause a complication known as uterine tachysystole. Also known as hyperstimulation and hypertonus, uterine tachysystole involves contractions that are too strong, frequent, or long. This can result in the baby going into distress from lack of oxygen. Moreover, when tachysystole is severe, the uterus can rupture. The epidural can mask the strength of the uterine contractions so that no one knows how strong they are, making uterine rupture more possible. Uterine rupture is very dangerous for babies, and sometimes results in hypoxic-ischemic encephalopathy (HIE) or death. It can also cause serious symptoms in the mother, such as postpartum hemorrhage.
Heart Problems and Anesthesia Errors
During anesthesia/analgesia usage, mothers can experience bradycardia (an abnormally slow heart rate), heart block in which the electrical activity of the chambers of the heart become dissociated, and sometimes even cardiac arrest.
Respiratory Arrests and Anesthesia Errors
Mothers can go into respiratory arrest (stop breathing) or experience other breathing difficulties when anesthesia/analgesia is used during childbirth.
Anesthesia Complications During the Second Stage of Labor
With large doses of anesthesia/analgesia, the mother may lose the ability and instinct to bear down and push. When this happens, medical professionals are more likely to use forceps and vacuum extractors during delivery. Forceps and vacuum extractors put a baby at risk for head trauma and brain bleeds, which can cause permanent brain damage. Prolonged labor also has risks, such as oxygen deprivation and brain bleeds.
Anesthesia Use During C-Sections
Operative anesthesia requires a more intense block because the pain and stimulation from surgery is different and more intense than the pain of labor. While motor block should be avoided in vaginal deliveries because it interferes with pushing, it is desirable for C-section delivery to obtain abdominal muscle relaxation. This block is achieved by administering a high concentration of local anesthetic.
Scheduled Vs Emergency C-Sections
For scheduled C-section, the rapidity of anesthetic induction is less of a concern, so all anesthetic options are available. For more urgent C-sections (e.g., in instances of fetal distress), a faster anesthetic technique is preferable. If the C-section is a true emergency, the time required to achieve anesthesia and facilitate a rapid delivery may be of critical importance to the well-being of the baby and/or mother. This is one of the main reasons it is critical to have a skilled team readily available at all deliveries, and it is crucial that all team members – especially the obstetrician and anesthesiologist – communicate effectively when a C-section is about to take place.
Fetal Monitoring During C-Sections
For low-risk mothers and babies undergoing scheduled C-section delivery, the presence of a normal fetal heart rate should be ascertained and documented before administration of anesthesia. When an emergency C-section is about to occur, continuous fetal heart rate monitoring should be maintained until the abdominal sterile preparation has begun, at which time the external monitor may be removed. If an internal monitor is being used, it may be removed when the abdominal sterile preparation is complete.
The introduction of a sterile field does not necessitate discontinuation of fetal heart rate monitoring. Indeed, there are certain instances in which monitoring should continue until the baby is delivered. Sterilizable probes are available for use with certain Doppler monitors. If a hospital does not have these types of probes, a condom can be placed over the probe to allow for fetal heart rate monitoring during a C-section.
Other Complications Associated with Anesthesia Use
- Motor Block: Epidural anesthesia/analgesia can cause motor block, resulting in temporary paralysis, even of respiratory muscles.
- Accidental Spinal Anesthesia: When an epidural accidentally turns into a spinal anesthetic, many complications can occur:
- Postspinal headaches
- Dysfunction of the bladder (this is frequent)
- Numbness and tingling of the lower limbs and abdomen (this is more occasional)
- Unilateral footdrop (paralysis of the muscle that lifts the foot) has occurred
- Permanent nerve damage (conditions called chronic, progressive adhesive arachnoiditis or transverse myelitis) can occur. These lead to paralysis of the lower parts of the body.
- Deaths have been reported
- Difficult breathing
- Increased incidence of forceps deliveries
- Medication interactions: A hidden danger of epidural anesthesia/analgesia is its interaction with medications commonly used to soften the cervix and start labor (prostaglandins). The use of prostaglandins is common at hospitals and creates a potentially dangerous situation in which the usual medications used to treat low blood pressure will no longer work.
- IV Cannulation: Accidental injection of the anesthetic solution into the bloodstream can occur and cause the mother to twitch, have convulsions, or lose consciousness. Seizures can occur from the toxic effects of the anesthetic agent entering the bloodstream.
- Trauma to the blood vessels near the spinal column
- Punctured dura (a covering of the brain)
- Infection at the site of injection
Epidural Injuries, Anesthesia Errors, and Medical Malpractice
Mothers tend not to be adequately informed about the risks associated with epidurals during labor and delivery; therefore, many doctors do not truly obtain informed consent. Not obtaining informed consent is a form of medical negligence. Other examples of negligence surrounding the use of anesthesia/analgesia include:
- Failure to properly administer the drugs and closely monitor the mother and baby
- Failure to have a skilled team present during anesthesia/analgesia use.
- Failure of the medical team members to communicate effectively with one another during labor and delivery
- Failure to continuously monitor the baby’s heart rate
- Failure to perform an emergency C-section when a baby is showing signs of distress
Birth Injury Attorneys Helping Children Harmed By Anesthesia Errors
If your child has been diagnosed with hypoxic-ischemic encephalopathy, cerebral palsy, or another birth injury from anesthesia misuse, we encourage you to reach out to the Reiter & Walsh, P.C. birth injury attorneys as soon as possible. During your free case review, our team will determine the cause of your child’s injuries and, should you have a case, help you obtain the compensation your family needs.
The Reiter & Walsh, P.C. team is based in Michigan, but we handle cases all over the United States. Should you live outside Michigan, our attorneys will travel to your hometown as necessary. We’re also equipped to handle FTCA cases involving military medical malpractice and federally-funded clinics.
To begin your free birth injury case review, please contact the Reiter & Walsh ABC Law Centers team in whichever way best suits your needs:
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- Ledin Eriksson S, Gentele C, Olofsson CH. PCEA compared to continuous epidural infusion in an ultra-low-dose regimen for labor pain relief: a randomized study. Acta Anaesthesiol Scand 2003; 47:1085.
- van der Vyver M, Halpern S, Joseph G. Patient-controlled epidural analgesia versus continuous infusion for labour analgesia: a meta-analysis. Br J Anaesth 2002; 89:459.
- Lim Y, Ocampo CE, Supandji M, et al. A randomized controlled trial of three patient-controlled epidural analgesia regimens for labor. Anesth Analg 2008; 107:1968.
- Halpern SH, Carvalho B. Patient-controlled epidural analgesia for labor. Anesth Analg 2009; 108:921.
- Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Postdural puncture headache: a randomized comparison of five spinal needles in obstetric patients. Anesth Analg 2000; 91:916.
- Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients. Int J Obstet Anesth 2001; 10:162.
- Rigler ML, Drasner K, Krejcie TC, et al. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg 1991; 72:275.
- Auroy Y, Narchi P, Messiah A, et al. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology 1997; 87:479.
- Tao W, Nguyen AP, Ogunnaike BO, Craig MG. Use of a 23-gauge continuous spinal catheter for labor analgesia: a case series. Int J Obstet Anesth 2011; 20:351.
- Simmons SW, Taghizadeh N, Dennis AT, et al. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev 2012; 10:CD003401.
- Abrão KC, Francisco RP, Miyadahira S, et al. Elevation of uterine basal tone and fetal heart rate abnormalities after labor analgesia: a randomized controlled trial. Obstet Gynecol 2009; 113:41.
- Mayberry LJ, Clemmens D, De A. Epidural analgesia side effects, co-interventions, and care of women during childbirth: a systematic review. Am J Obstet Gynecol 2002; 186:S81.
The information presented above is intended only to be a general educational resource. It is not intended to be (and should not be interpreted as) medical advice.