When the term birth injury (or birth trauma) is used, what does it mean?
For many parents, the word is undefined until they have a child dealing with injuries at birth. The easiest way to understand a birth injury is that it is an injury to the baby which occurs at or during delivery and presents lifelong challenges to the child.
Parents can sometimes tell that their child is dealing with a birth injury when the baby is blue in color, has suffered seizures, does not give off a good cry, or must be rushed away to the neonatal intensive care unit (NICU). In addition, for some parents, evidence of a birth injury may present itself due to the fact the child cannot use their arm or hand or suffered a broken shoulder (clavicle) at birth.
What Can Cause A Birth Injury… Or How Was My Baby Injured During Delivery?
There are three common ways in which a baby can suffer a birth injury.
They consist of shortly before the child is born, during delivery, or during what is called the neonatal period. One of the most common ways in which a child can suffer a birth injury is when there is a reduction of blood and oxygen getting to the child’s brain. Poor perfusion issues can have a devastating impact on a baby’s health.
Some of the more typical birth injures deal with the following:
How Can Parents Know If Their Child May Have Suffered A Birth Injury?
As touched on above, for many, a birth injury is a foreign concept. It is not until the injury happens that parents begin to understand the world of birth trauma. For many of the parents that we speak with about their child’s injury at birth, the main things which initially catches their eye as to possible problems are the baby being blue in color, having little to no cry, or suffering seizures soon after birth, or a few minutes to a few hours later. Parents will generally see the following:
Facial Features Which May Look Abnormal
Unusually Small Head Size
Baby Will Be Blue All Over Or Extremities Will Be Blue
Trouble With Vision And Tracking
Baby Will Be Stiff
One Side Of The Body Being Favored
Maryland Birth Injury Lawyers Discuss How A Birth Injury Can Occur
One of the ways in which a birth injury can occur is due to doctors and nurses failing to recognize and move appropriately on fetal distress. An important tool used in delivery rooms throughout the US is the electronic fetal heart monitor. This tool is used to monitor the baby’s heart rate (a normal rate should be around 120bpm-160bpm), among other things.
In addition to the fetal heart monitor, there are other tests which can be used by doctors to assist with the baby’s wellbeing. Some of them are the following:
Amniotic Fluid Index
When doctors fail to properly monitor a baby who may be dealing with fetal distress, injury to the baby can occur. As mentioned above, the typical baby’s heart beat will fall between 120-160 beats per minute. When a baby’s heart rate falls outside of these ranges for a considerable amount of time and is accompanied with other problems on the strip such as late decelerations, minimal to no variability, etc., doctors have to take appropriate steps to protect baby and mom.
When the fetal heart monitor reveals that the baby is in distress a race against the baby’s reserves begins. Since delivery is stressful, the baby has what is called “fetal reserves” to help with the process. But just like adults, the reserves can only last so long.
Think of it like running on a treadmill. At the start, you may feel well, but as you run longer and longer, eventually you get to a point in which you are tired and cannot run anymore. If you keep going past your “reserves” you can suffer a heart attack or other injury. A baby’s reserves work the same way.
If doctors allow the baby to go on too long in distress, injury to the baby can occur. This is because in many instances, when a baby is in distress, it is suffering from a decreased level of oxygen. Doctors must be ready to move to a C-Section delivery when other methods have failed to cure the distress.
What Are Some Of The Common Ways In Which A Baby Can Be Deprived Of Oxygen At Birth Or Suffer Injury?
Below is a list of some of the ways in which a baby can be deprived of oxygen at birth. In addition, we have included other ways in which a birth injury can occur:
Problems with the child’s umbilical cord
Injuries Due To Forceps
Failure To Move To A C-Section When Umbilical Cord Issues Are Present And Sending Baby Into Distress. Profusion Issues Can Be Present
Doctors Failure To Recognize & Treat Infections
Placental Abruption & Uterine Rupture. These conditions can be due to fetal distress at times and require the doctors to move to a C-Section
Maryland Birth Injury Attorneys Explain Some Of The Basic Issues Associated With Shoulder Dystocia
In some instances, a baby can become trapped behind the mother’s pelvis during a vaginal delivery. The medical name associated with this condition is called shoulder dystocia. Shoulder dystocia deals with the head of the baby being delivered, but the shoulders, remaining trapped behind. Some of the risk factors associated with shoulder dystocia are the following:
Mom Is Pregnant With More Than One Baby
Giving Birth After The Due Date
A Large Baby
Shoulder Dystocia creates an emergency in the delivery room because if the baby is not delivered in time, the baby can suffer serious injury, or even death. When a shoulder dystocia condition occurs, doctors use the training and maneuvers they are taught to free the child.
If doctors panic and too much force is used, serious injury to the baby can occur. Typical shoulder dystocia injuries are:
Neonatal Brachial Plexus Palsy
Fractured Collar Bone/Clavicle
Maryland Birth Injury Attorneys Explain Hypoxic Ischemic Encephalopathy (HIE)
Blood and oxygen are two essential things needed during child birth. When there are disruptions in either, problems can arise, especially when presented with long term disruptions (acute disruptions can also be problematic). To better understand hypoxic ischemic encephalopathy, we are going to break down each of the three words separately.
One of the easiest ways to understand the word hypoxic or hypoxia is to think of it as a reduced level of oxygen. If there is a complete absence of oxygen the term is called anoxia. The second word is ischemic, which deals with blood. Finally, encephalopathy deals with an injury to the brain. When we put all the words together we get a decreased level of blood and oxygen causing a brain injury.
There are a lot of conditions which can lead to HIE in a baby. Some of the issues can stem from umbilical cord issues, to placental abruption, and uterine rupture. The use of the electronic fetal heart monitor can also help doctors and nurses determine whether the baby is in distress, thus no longer tolerating the vaginal delivery.
When a baby can no longer tolerate the delivery, and the fetal strips reveal non-reassuring patterns, doctors and nurses must act. If other methods such as intrauterine resuscitation measures do not work, then a C-Section should be performed. When doctors fail to act timely on a C-Section, the baby can suffer serious and permanent injuries, namely cerebral palsy. Babies can also develop mental deficiencies as well as issues surrounding seizures.
Parents of a child who has hypoxic ischemic encephalopathy might see the following in their child:
Blue In Color
Weak To Absent Cry
Meconium Stained Fluid
Floppy Or Poor Muscle Tone
Irregular, Or Slow, Or Absent Breathing
Maryland Medical Malpractice Attorneys Discuss Umbilical Cord Problems During Delivery & Pregnancy
The umbilical cord allows the flow of important nutrients and oxygen to the baby. It is connected to the womb of the mother. The umbilical cord allows for oxygen to be carried from the placenta to the baby. If problems arise with the umbilical cord, then the transfer of oxygen and other nutrients can be impeded. The umbilical cord consists of two arteries and a vein. In some cases, instead of being a three-cord vessel, there will be a two-cord vessel, an artery and a vein.
Umbilical Cord Prolapse
An umbilical cord prolapse occurs when the umbilical cord descends out of the uterus before the baby. Umbilical cord prolapse can present serious issues because in some cases, the weight and pressure of the baby can compress the cord, thereby restricting blood and oxygen to the baby. Doctors and nurses must be on the lookout for umbilical cord prolapse when there is a sudden decrease in the fetal heart rate. Usually, the fetal heart tracing will reveal this sudden shift in the heart rate. In some cases, there may be a drastic drop in the baseline reading. Fetal hypoxia can result if umbilical cord prolapse is not corrected in time. Below are some of the possible causes of umbilical cord prolapse:
Delivery Of More Than One Baby (Twins, etc…)
An Excess Of Amniotic Fluid
A Breech Delivery Of The Baby (Delivery Of The Baby’s Feet/Buttocks First)
Longer Than Usual Umbilical Cord
A knotted umbilical cord is an actual knot in the cord. As you may suspect, a knotted cord can have horrible repercussions on the baby, especially if the knot is tight. A true knotted cord can restrict the flow of blood and oxygen to the baby. This restriction of blood and oxygen can lead to not only hypoxic ischemic encephalopathy, but also fetal demise (death). A knotted umbilical cord can be the result of:
High Level Of Amniotic Fluid
Baby With High Movement
Older Mothers Giving Birth
Longer Umbilical Cord Than Usual
True knots can be detected with the use of an ultrasound. In addition, when a mother presents with certain risk factors, such as high risk (35 years or older), true knots must be considered and tested for with ultrasound.
When the umbilical cord is delivered wrapped around the baby’s neck, this is called a nuchal cord. In some cases, a nuchal cord will resolve itself and not cause any harm to the baby. However, this is not always the case. In some situations when a nuchal cord is present, a baby can be deprived of oxygen, which can then lead to fetal hypoxia.
How A Nuchal Cord Can Lead To Fetal Hypoxia
During labor and deliver, as contractions and pushing occurs, the baby moves down through the womb. When the umbilical cord is wrapped around the baby’s neck, the cord also moves down with the baby. The wrapped cord can then become compressed as it moves down with the baby. This compression can obstruct blood flow. Obstructed blood flow, if not properly managed can lead to hypoxic ischemic encephalopathy. The bulleted point version of how fetal hypoxia can occur during a nuchal cord is as following:
Cord Wrapped Around Baby’s Neck
Cord Becomes Compressed As The Baby Moves Down For Delivery
A Restriction Of Blood And Oxygen Getting To Baby Due To The Compressed Cord
A nuchal cord can create an emergency in the delivery room in some cases. This is because a nuchal cord can lead to a deprivation of blood and oxygen to the baby. When doctors determine that the baby is in distress, they must act to alleviate the distress. This includes moving to an emergency C-Section, if needed.
Maryland Birth Injury Attorneys Explain Uterine Rupture
A uterine rupture is a serious event during childbirth, as it presents an emergency in the delivery room. Not only is a uterine rupture life-threatening and dangerous to mother, it is also life-threatening and dangerous to baby. When the uterine wall is compromised, a uterine rupture occurs. In some instances, a partial breach of the uterine wall will occur whereas in other instances there can be a complete breach of the uterine wall. The area of focus during a uterine rupture is the myometrial wall. With a complete rupture, the contents of the uterus spill over into the body. If the rupture is where the uterus and placenta meet, then the baby can have a reduced level of blood and oxygen. This can then lead to fetal hypoxia.
How Will Doctors Know If A Uterine Rupture Is Present?
Uterine ruptures generally occur early in labor. Women who are delivering by vaginal birth following a previous C-Section must be monitored closely. One of the first signs of a uterine rupture may present with abnormalities in the baby’s heart rate. In addition, mother may experience severe abdominal pain, rapid pulse, shock, and vaginal bleeding. The following are a list of factors which can lead to a uterine rupture:
Scarring Of The Uterus
Previous Uterine Surgery, Fibroids For Example
Carrying Twins (Multiple Babies)
Use Of Pitocin
Trauma To The Uterus (Car Collision, Etc…)
Difficult Delivery Using Forceps
Because of the seriousness of a uterine rupture, doctors must treat it as an emergency. Due to the issues that a uterine rupture presents, doctors must recognize it and treat accordingly. In many delivery situations, a C-Section will be required.
Maryland Birth Injury Attorneys Explain Injuries Due To Forceps & Vacuum Deliveries
Forceps and vacuum are types of assisted vaginal deliveries. These tools are used when mother is not able to push the baby out. As it pertains to forceps, they are used, during the second stage of labor. This is due to the fact mother is usually pushing during this time. The forceps are placed on the baby’s head and used to guide the baby out for delivery.
A vacuum extractor is also an instrument used to assist in delivery. The vacuum extractor is placed on the baby’s head and used to guide the baby through the birth canal. As with forceps, a vacuum extractor is used during the second stage of labor, as this is when mother is pushing.
Injuries can occur when doctors use the wrong amount of force with the instruments or have little experience using forceps or vacuum extraction. Improper use of forceps and vacuum extractors can lead to brain and head injuries:
When doctors decide to use instruments to assist with delivery, they must use care. Doctors should not twist, or use excess pulling of the head or neck when guiding the baby through the birth canal. If delivery does not occur within 15-20 minutes, then doctors should move to a C-Section. In addition, during vacuum extraction, if the cup detaches from the head three times, then a C-Section needs to be the next step. Doctors who do not adhere to these measures risk seriously injuring the baby. Not only can brain and head injuries be the result of forceps and vacuum extraction instruments, the following can occur:
Facial Palsy (Facial Weakness)
Bleeding In The Skull
Maryland Birth Injury Attorneys Discuss Pitocin & Labor Augmented Injuries
Pitocin is a drug that is used to help induce labor. It essentially stimulates the uterus to begin contractions. The drug seeks to mimic the natural substance of Oxytocin, which is already found in the body. Pitocin can be given to mother through an IV or it can be administered through the abdomen.
Problems can occur if Pitocin is not properly administered, or if doctors fail to monitor the patient while Pitocin is administered. With the contractions artificially induced, the mother can sometimes feel longer, more painful contractions than normal. This in turn can lead to less time between contractions and less time for the baby and mother to recover between the contractions. The following can be the result of some Pitocin related birth injuries:
Maryland Birth Injury Attorneys Explain Preeclampsia & Related Injuries
Preeclampsia is a medical condition in which a pregnant mother has an unusually high blood pressure. Generally, preeclampsia is diagnosed with the first pregnancy. With that said, there are some risk factors which are more likely to place a mother at risk of developing preeclampsia. They are the following:
Giving Birth At 35+
Giving Birth To Multiple Babies
For some women, the signs and symptoms of preeclampsia are subtle. However, swelling in the hands, feet, or face can be signs of preeclampsia. Women are encouraged to report these signs to their doctors.
There can be three types of preeclampsia, mild, moderate, and severe. A mother dealing with mild preeclampsia may experience high blood pressure, protein in urine, and water retention (swelling). Severe preeclampsia can lead to blurred vision, fatigue, nausea and vomiting, headaches, and pain in the upper right part of the abdomen. Mild and severe preeclampsia can damage mother’s kidneys. Left untreated, preeclampsia can lead to Eclampsia and HELLP Syndrome in mother.
Preeclampsia, undiagnosed can be disastrous to mother and baby, which include:
Oxygen Deprivation To The Baby
If a mother is dealing with preeclampsia, doctors must pay attention to the management of mother’s care. Some of the tests and other care given to mothers dealing with preeclampsia are the following:
Blood & Urine Tests
Doctors who do not have experience dealing with high risk pregnancies should refer mothers who are high risk and dealing with preeclampsia to other doctors who have experience in this area.
Maryland Birth Injury Attorneys Talk Placental Abruption
Placental Abruption occurs when the placenta detaches from the inner wall of the uterus before delivery. The placenta develops and grows in the uterus during pregnancy. One of the main functions of the placenta is to supply the baby with oxygen and nutrients.
Not only is placental abruption dangerous to the mother, it can be dangerous to the baby because of mother’s heavy bleeding. Heavy bleeding can lead to a decrease in the baby’s oxygen supply. Some of the symptoms related to placental abruption are:
Back Pain (Sudden)
Abdominal Pain (Sudden)
Uterine Contractions Right After Each Other (No Break In Between)
Doctors must promptly deliver the baby when placental abruption occurs. As mentioned above, because of the heavy bleeding that can be associated with placental abruption, the baby is at serious risk of oxygen deprivation. If placental abruption is present, and the baby is viable, and a vaginal delivery is not imminent, a C-Section is the method chosen by most doctors. Placental abruption that starts out minor but progresses to severe presents a situation in which doctors must deliver by C-Section immediately. Risk factors for placental abruption are:
A Prior Placental Abruption
Mothers 35+ Years Of Age
When doctors choose to just monitor placental abruption (minor abruption), attention must be paid to both mother and baby. For mother, doctors must be on the lookout for things such as shock due to blood loss, the need for blood transfusions, failure of the kidneys, and uncontrolled uterine bleeding. As for the baby, attention to the fetal heart monitor is paramount, as this will alert to fetal distress and changes in heart rate, thus alerting doctors of fetal distress.
Maryland Birth Injury Attorneys Explain Breech Position Injuries
When a baby begins to descend in the uterus, in many cases the baby will descend head first. This is called the vortex position. However, for some babies, they will descend buttocks or feet first. This is called a breech delivery. For a breech baby the doctor must pay close attention to determine the best mode of delivery due to complications which can arise out of a breech delivery. With that said, many breech babies are delivered by C-Section. Some risk factors for a breech delivery are as follows:
Abnormal Amniotic Fluid Volume
Delivery Of Twins (Multiple Babies)
Breech Baby In A Previous Delivery
In a breech delivery, not only can the baby suffer a head injury (extreme hyperextension), but a deprivation of oxygen can occur, leading to fetal hypoxia or hypoxic ischemic encephalopathy. Extreme hyperextension of the head can lead to injuries to the spinal cord of the baby if a vaginal delivery is attempted. When the baby presents as the stargazer fetus, doctors must move to a C-Section.
In addition to spinal cord injuries, a breech baby runs the risk of having their umbilical cord compressed or presented with a cord prolapse. This is especially so when there is an incomplete breech (footling breech). In an incomplete breech, the foot can begin to present first, allowing the umbilical cord to slip down in a prolapse position. A prolapsed umbilical cord can result in fetal distress, which can be reflected on the fetal heart monitor. Doctors must perform a C-Section when the fetal distress cannot be remedied. A breech baby dealing with cord prolapse can suffer brain injuries such as cerebral palsy.
Head injuries from a breech baby can also occur from the improper use of forceps.
Maryland Birth Injury Attorneys Talk Cephalopelvic Disproportion (Baby’s Head Is Too
Big To Pass Through Mother’s Pelvis)
Cephalopelvic Disproportion is a term that is used to describe when the baby’s head is too big to pass through the mother’s pelvis. Failure to progress through labor, or an ineffective labor can also be another way to describe cephalopelvic disproportion and can alert doctors to possible complications. Some of the risk factors for cephalopelvic disproportion are:
Mother With Small Pelvic Region
Post Term Pregnancy
Doctors should have the baby’s head size and mother’s pelvic size from previous tests. For example, x-rays and physical examinations can give doctors important information as it relates to the mother’s pelvis. Ultrasound can give doctors information regarding the baby’s head size.
If doctors do not diagnose cephalopelvic disproportion before labor and delivery, they must diagnose the condition ASAP during labor and delivery. The reason for prompt diagnosis is due to the fact a C-Section delivery can prevent injury. Because a prolonged labor can be present in cephalopelvic disproportion, babies can suffer injuries which can lead to cerebral palsy. In addition, shoulder dystocia can present itself which can lead to brachial plexus injuries and umbilical cord compression.
Maryland Medical Malpractice Attorneys Discuss Brain Bleeds At Birth
A brain bleed at birth, or intracranial hemorrhage, is a condition which can be caused by birth injury, or trauma. For some babies, an intracranial hemorrhage can cause challenges for life. Some of those challenges can stem from a subsequent cerebral palsy diagnosis. In other instances, if the bleed is severe enough, death can occur.
Typical brain bleeds are the following:
Subarachnoid Hemorrhage: Bleeding in the space between the brain and tissue covering the brain. Parents may see their baby display seizures.
Cerebral Hemorrhage: A blood vessel which ruptures which leads to bleeding inside the brain.
Subdural Hematoma: A buildup of blood right outside of the brain. Seizures are another way parents can be alerted that their baby may have suffered a subdural hematoma. In addition, quick head swelling may also suggest the condition, among other things.
Intraventricular Hemorrhage: A bleed into the brain’s ventricular system. An intraventricular hemorrhage is common in premature babies due to the fact their blood vessels are not fully developed in many cases.
If doctors do not diagnose cephalopelvic disproportion before labor and delivery, they must diagnose the condition ASAP during labor and delivery. The reason for prompt diagnosis is due to the fact a C-Section delivery can prevent injury. Because a prolonged labor can be present in cephalopelvic disproportion, babies can suffer injuries which can lead to cerebral palsy. In addition, shoulder dystocia can present itself which can lead to brachial plexus injuries and umbilical cord compression. Typical skull bleeds:
Subgaleal Hemorrhage: Blood which is located between the skull and the head. Subgaleal hemorrhages can be caused using forceps or a vacuum delivery.
Cephalohematoma: Collection of blood just under the scalp. Parents can see a lump on the baby’s head. Cephalohematomas can last for a couple of months.
Maryland Birth Injury Attorneys Discuss Meconium Aspiration Syndrome (MAS)
Meconium is essentially stool and this substance can be harmful to a baby. The presence of meconium by itself is not an indicator of fetal distress, in some cases. However, if meconium is coupled with other factors, for example, bradycardia (baseline heart rate below 100 bpm), or late decelerations on the fetal heart strip, etc.., then fetal distress and fetal hypoxia may be present.
Meconium aspiration syndrome is an accumulation of meconium in the baby’s lungs. When meconium is present doctors will check at delivery to determine whether the substance is present below the baby’s vocal cords. If the meconium has passed below the cords it can cause airway obstructions for the baby. It can also lead to infection and lung injury. Some of the causes of meconium aspiration syndrome are:
40+ week pregnancy
Maternal Drug Use
As mentioned above, meconium aspiration syndrome is a serious medical condition. Not only can the baby suffer infection, but the injuries to the lungs and airway can lead to a lack of oxygen for the baby. When a lack of oxygen is present, the baby can develop hypoxic ischemic encephalopathy.
Maryland Birth Injury Attorneys Talk Erb’s Palsy/Brachial Plexus Palsy
Erb’s Palsy/Brachial Plexus Palsy are injuries to a baby which can occur due to a shoulder dystocia delivery. In these injuries, often the baby will become trapped behind the mother’s pelvis, creating an emergency in the delivery room. Doctors must work to free the baby before serious injury can occur. Regarding Erb’s Palsy/Brachial Plexus Palsy, injury to the arm, hand, or shoulder can occur because doctors use too much force freeing the child. Some children will have lifelong injuries to their limbs because of a shoulder dystocia delivery gone wrong.
Maryland Birth Injury Attorneys Discuss Cerebral Palsy In Babies
Cerebral palsy is a medical condition which in its basic terms, affects the movement of the body and muscle coordination. For many children who have experienced birth trauma, the lack of oxygen is the cause of their cerebral palsy. When a baby is in distress, the fetal heart monitor, along with other signals (meconium, for example), can alert doctors that the baby is no longer tolerating the vaginal delivery and that a C-Section is needed.
Boston Law Group, LLC represents victims of birth injury and medical malpractice throughout Maryland. We can help victims in:
Prince George’s County
Anne Arundel County
St. Mary’s County