Birth Injury and Medical Malpractice
By Aaron Larson
March, 2005
Contents
"Birth injury", or birth trauma, is ordinarily a description of an injury to a baby resulting from complications during labor and delivery. Birth injuries can range from very mild to extremely serious. Not all birth injuries result from medical malpractice. A qualified malpractice lawyer can help you determine if a specific birth injury may constitute a basis for a malpractice lawsuit.
Common Birth Injuries
Bone Fractures - Sometimes during birth a baby will suffer a fractured bone, particularly during a difficult birth or breech delivery. The most common birth-related fracture is to the clavicle (collar bone). In most cases, the baby recovers quickly once the bone is immobilized.
Brachial Palsy Injuries (Erb's Palsy and Klumpke's Palsy) - This type of injury involves trauma to the brachial plexus (the group of nerves which control movement of the hands and arms). A brachial palsy injury most often results from "shoulder dystocia", a term which describes birth difficulties which occur when the baby's shoulders impair its passage through the birth canal. If a brachial palsy injury causes only bruising or swelling, the baby will usually recover within three months. In more severe cases there may be permanent nerve damage, necessitating physical therapy and surgery
Brain Injury - Birth difficulties can result circumstances where the baby is deprived of oxygen, usually due to blood loss, or the twisting or compression of the umbilical cord. Prolonged oxygen deprivation can cause brain damage, and thus may result in mental impairment, seizure disorders, or cerebral palsy.
Bruising and Forceps Marks - Sometimes the mere passage through the birth canal will cause a baby to experience bruising on the face or head, due to contact with the mother's pelvic bones and tissues. When forceps or a vacuum extraction device are used during delivery, they may leave temporary marks or bruises on the baby's head, and a vacuum extraction may cause a scalp laceration. In extreme cases, the use of forceps can cause depressed skull fractures which may require surgical elevation.
Caput Succedaneum - This condition involves severe swelling of the baby's scalp, often as a result of a vacuum extraction. This swelling will ordinarily disappear within a few days of birth.
Cephalohematoma - This condition involves bleeding between a bone and its fibrous covering. In childbirth, this type of injury is typically seen on the baby's head. A cephalohematoma will ordinarily resolve within two weeks to three months. If a cephalohematoma is particularly large, the baby may become jaundiced as the red blood cells within the the hematoma break down.
Facial Paralysis - A baby's facial nerves may be injured as a result of pressure on the baby's face during labor or birth, or through the use of forceps during childbirth. If the injury is in the form of bruising of the nerve, paralysis will typically clear up within a few weeks of birth. With more severe nerve damage, surgery may be required to repair the damaged facial nerves.
Subconjunctival Hemorrhage - This common birth injury results in bright red band around the iris of one or both of the baby's eyes. A subconjunctival hemorrhage does not cause damage to the eyes, and usually disappears completely within seven to ten days.
What Can Cause Birth Injury
Birth injuries have a variety of causes, and are most likely to occur during difficult deliveries. The following factors may contribute to the difficulty of a baby's delivery:
- The Baby's Size. If a baby weighs more than eight pounds, thirteen ounces (four kilograms), the possibility of birth injury can increase significantly. Low birth weight babies, including premature babies (those born before 37 weeks), are also more susceptible to injury.
- The Baby's Position - a "breech birth", where the child's buttocks or legs are presented first during delivery, is more likey to result in birth injury.
- Cephalopelvic Disproportion - This refers to a situation where the size and shape of the mother's pelvis is not adequate for the child to be born by vaginal delivery. Such a size incompability can make vaginal delivery difficult or impossible.
- Difficult Labor - Sometimes called "dystocia" difficult or prolonged labor is more likely to involve injury to the baby.
Where a mother has experienced complications during a prior birth, doctors should be on alert for similar complications during any subsequent birth.
Medical Malpractice
Errors made during delivery can cause birth injuries, or can increase an injury's severity or permanence. Errors which may support a medical malpractice action include:
- Delay in Ordering a Caesarian Section - In appropriate cases and circumstances, doctors should not delay in ordering a medically necessary c-section.
- Failing to Anticipate Birth Complications - Particularly in cases involving a larger baby, or where there is a history of maternal health complications;
- Failing to Observe or Respond to Umbilical Cord Entrapment - where a baby is tangled in the umbilical cord, there may be signs of distress which can be measured through a fetal heart monitor, and there may be cause to perform an ultrasound for signs of entrapment before performing a vaginal delivery.
- Failure to Respond Appropriately to Bleeding - The failure to respond appropriately to bleeding, either of the mother or baby.
- Failure to Respond to Fetal Distress - Signs of distress include irregularities in the fetal heartbeat, or sudden drops in the fetal heartrate.
- Inappropriate Administration of Pitocin - Pitocin is a synthesized hormone used to induce or augment (speed up) labor.
- Mechanically Assisted Delivery - The misuse of a vacuum extractor or forceps during delivery can result in birth injury;
Birty injury can also be caused by poor care delivered after birth, including the failure to properly attend to an infection, the failure to properly treat neonatal hepatitis, or mistakes made during a circumcision.
In evaluating a possible medical malpractice claim, a lawyer will ordinarily want to review all of the baby's medical records, including those from the child's birth and neonatal care, and will often also have them reviewed by a nurse or physician.