Defending the Rights of Mothers & Children
From the beginning of a pregnancy, women consult medical professionals for advice and insight about the changes going on with their body, as well as the state and well-being of their baby. Standards of care exist to govern this process and ensure parents get the support and information they need during the pregnancy. However, mismanaged labor and delivery is still one of the leading causes of medical negligence lawsuits. If you or your child has been injured before, during, or after birth, Christie Farrell Lee & Bell can help. Since 1993, our Indianapolis birth injury attorneys have served our community by providing trustworthy legal services to those who have been injured in accidents.
Prenatal Care Malpractice
A physician or other caregiver has a responsibility to ask exploratory questions and figure out how they can work for the well-being of the mother and the child. This duty is especially important when they are giving prenatal care to a mother. The United States has the worst maternal mortality rate in the developed world, and 60% of these deaths are preventable. The consequences of malpractice on mothers and children are often life-altering, from the very moment their special relationship begins in the world. In worst-case scenarios, medical negligence leads to wrongful death.
The parents do not know everything that can cause complications to pregnancy or what all the risk factors are. If a physician or other caregiver fails to ask the essential questions and then a parent or child suffers a negative outcome as a result, this can be considered negligence.
Here are some of the basic standards of prenatal care:
- Assessment of the patient’s medical history, lifestyle, and other factors
- Keep a detailed medical history and share records with the patient when requested
- Conduct regular examinations like ultrasound, blood work, and non-stress tests
- Identify and prevent potential complications through risk assessment
- Treat any complications that arise and follow up to keep track of outcomes
- Talk with the patient about specific risks and complications
- Educate the patient about proper nutrition and lifestyle and make dangers of bad habits known
In addition, doctors should know when to test each mother for conditions like gestational diabetes and preeclampsia.
Common Causes of Birth Injuries
Failure to Detect Gestational Diabetes
Gestational diabetes is when a woman who did not have diabetes before develops the condition during her pregnancy. Doctors should regularly test blood and urine throughout pregnancy to monitor for this and other conditions.
Failure to diagnose gestational diabetes puts a mother at risk of going into early labor due to high blood sugar. Not only does a premature birth present risks to the infant, but there are other injuries that occur to infants due to uncontrolled gestational diabetes. Because infants may grow larger in the womb due to high blood sugar, the risk of injuries to the child’s shoulder like brachial plexus injuries and shoulder dystocia are also increased in pregnancies with gestational diabetes.
Failure to Detect High Blood Pressure During Pregnancy
Preeclampsia is a pregnancy complication involving high blood pressure that every woman should be screened for. Even if your blood pressure has always been normal, at around 20 weeks of pregnancy your caregiver should begin to monitor your blood pressure. 10% of all pregnancies will be affected by high blood pressure. Uncontrolled high blood pressure during pregnancy can lead to organ damage and seizures (eclampsia) in the mother. It can also cause premature labor and increases the risk of other birth disorders or birth injuries for the baby.
Preeclampsia can develop without any symptoms. Some symptoms of preeclampsia do include:
- Swelling in the hands and/or feet (edema)
- Severe headaches
- Shortness of breath
- Nausea or vomiting
- Light sensitivity or impaired vision
- Right-side upper abdominal pain
- Decreased urination or protein in the urine
Since some of these symptoms can be common in pregnancy, it’s essential a doctor or care provider is checking blood pressure with every visit and after delivery. In the week after delivery, high blood pressure is a leading cause of death for new mothers.
A study by the CDC found that between 6-7 pregnancies of every 10,000 resulted in a mother’s wrongful death from preeclampsia. This is a rate of 15%, as high as the number in less-developed parts of the world, while other Western nations report rates as low as 5%. This is a sign that death from preeclampsia is more preventable than our current system achieves.
Negligent Caregiver During Delivery of Child
The process of labor and delivery means a mother and infant should both be monitored constantly. The mother and child should be hooked up to a heart monitor so changes in the heartbeat can be under supervision. Nurses and other attending staff must follow the chain of command and notify an attending physician immediately of any changes in either heart rate. The same monitoring and due diligence must apply to the baby’s heart rate, and the amount of oxygen the baby has should also be on the monitor. In cases where the negligent failure to monitor by a doctor or nurse causes injury or death, the timeline is essential to understand and describe to a jury.
Cesarean sections, or c-sections, are surgeries where a baby is removed from the mother’s womb without a vaginal delivery. In 1970 only 5% of US births were c-sections, but today one in three infants is delivered this way. It is worth noting that over the same decades of time, the mortality rate for mothers due to infection and other complications have also gone up. As the procedure has become more common, it may not be approached with the same focus and diligence by a doctor who finds the surgery routine. When the surgery is not performed properly it can lead to the painful formation of excess scar tissue, deformity, broken bones, severed bowels, and infertility in the mother, among other complications. A botched c-section surgery is highly unlikely to occur without some error on the part of the medical professional.
A caregiver may also be negligent if they do not perform a c-section in a timely fashion. This is believed to be one of the contributors to the rise in c-sections as doctors take steps to protect themselves and their patients from risk. When an infant shows signs of fetal distress this is usually an indicator that a c-section will occur.
OB/GYNs should also know about other risk factors that make a c-section the best option for delivery, including:
- Placental detachment or malfunction
- Previous c-section in the mother
- Breech position or other transverse position
- Herpes or other active STDs in the mother
- Multiple infants
A fistula is a serious health issue that occurs when a hole forms between two organs. In women, these injuries commonly occur between the uterus and other organs like the bladder, the bowels, or the peritoneal cavity of the body (where the uterus is located). Enterovaginal fistulas can also form between the vagina and bowels, especially after an episiotomy (cutting of the perineum) during delivery.
Each year between 50,000 to 100,000 women are affected by obstetric fistula, a hole between the birth canal and either the rectum or the bladder. These issues are not only life-threatening through risks like infection, but also lead to deep feelings of shame, helplessness, and social isolation.
Injury from Epidural
Nerve damage is a rare complication of spinal or epidural pain management. During an epidural, a needle is used to introduce a catheter tube into an area around the spinal cord. Through this tube, the pain medicine can be administered for hours or even a few days.
Injecting these drugs directly into a nerve can cause temporary tingling or numbness. A blood clot forming around a nerve can also put pressure on the spine and cause pain or injury. An abscess or infection can later develop, though this is rare. More commonly, infections occur at the skin level after an epidural.
An epidural during labor and delivery can cause injury when the needle of the epidural punctures the membrane protecting the spinal column or even the spinal column itself. Puncturing the spinal column alone is enough to cause injury, but if anything is injected into the spinal column the results become far worse. Air can also be allowed into the spinal column through a hole left by the needle. This causes nausea, inability to walk, and severe headache (spinal headache) in the mother. An epidural blood patch is one procedure that can relieve leaking spinal fluid after an epidural. Lastly, in some cases the improper placement or removal of an epidural causes part of the device to be left behind in the patient.
Failure to Diagnose Postpartum Depression
Postpartum depression is a newly acknowledged disease that affects parents of both genders in the weeks and months following the birth of a child. This puts the infant at risk for failure to thrive, accidents due to inattentiveness, and even non-accidental trauma. Postpartum depression is estimated to affect as many as 80% of new mothers and 26% of new fathers.
Medical professionals should be screening for postpartum depression, especially when symptoms of extreme sadness, low energy, anxiety, crying episodes, and changes in sleeping or eating patterns persist for longer than two weeks after a child is born. If a medical professional is negligent in diagnosing postpartum depression, that negligence may directly contribute to worse outcomes for the family.
Types of Birth Injuries
Brachial Plexus Injuries
The brachial plexus is a group of nerves around the shoulder. During delivery, injury can happen to this part of an infant’s body when:
- The infant’s head and neck get pulled too hard or put under traction
- The shoulders get stuck on the mother’s pelvis (shoulder dystocia)
- Too much pressure on the shoulders or upper arms during a head-first delivery
- Too much pressure on raised arms or shoulders during a feet-first (breech) delivery
In general, brachial plexus is commonly caused when the baby is pulled on by a doctor or midwife. A c-section reduces the risk for these injuries but does not eliminate them. Factors like a breech delivery or a larger-than-average newborn are known to contribute to the risk for a brachial plexus injury. When these factors are present, medical professionals should educate the family and perform other standards of care to protect the infant from injury as much as possible.
Erb’s Palsy is a specific type of brachial plexus injury, one which affects nerves emerging around the C5 and C6 vertebrae in the spine, with some cases affecting C7 as well. These are the vertebrae at the base of the neck, just above the shoulder blades. Approximately 1-2 babies out of every 1,000 will be affected by Erb’s Palsy. Injuries that lead to Erb’s Palsy commonly occur after the delivery of the head, when the rest of the baby’s body has yet to emerge. Efforts by the doctor from the outside cause the tension that damages nerves. It also sometimes happens during a breech delivery (feet first) when there is excessive pulling on the shoulders.
Shoulder dystocia, or the baby’s shoulders getting stuck on mom’s pelvic bone before he can exit the birth canal, greatly increases the risk for Erb’s Palsy. In fact, when a baby’s shoulders get stuck, the chance of incurring Erb’s Palsy during delivery can be up to 40%.
Other risk factors include:
- Large infants or small mothers
- Maternal diabetes
- Vacuum extraction
- Low or mid-forceps delivery
- Prolonged pregnancy, in which the baby gets too large for the birth canal.
- Prolonged second stage of labor, meaning the actual birthing of the baby takes longer than 60 minutes
- Breech birth
Many of these risk factors are known prior to delivery which can help doctors properly evaluate their birthing plan and make adjustments that will reduce the risk. When these risk factors are a known possibility but aren’t handled in a medically sound way, the result can be a lifelong injury to a baby’s arm.
Perinatal asphyxia, or birth asphyxia, is when a child does not receive enough oxygen before, during, or after their birth.
There are many causes for perinatal asphyxia, including:
- Low blood pressure in the mother
- Heart or respiration problems in the mother caused by epidural
- Compression or a knot in the umbilical cord
- Uterus seizes up and prevents oxygen from flowing to the placenta
- Other issues of poor placenta function like placental abruption
- Severe anemia in the infant
- Heart or lung disorders in the infant
- Shock or low blood pressure in the infant
Birth asphyxia is one of the leading worldwide causes of early neonatal death for infants. Cases where perinatal asphyxia results in the death of the infant have been studied to find common risk factors and signs for early morbidity, including:
- Parity, meaning the pregnancy is not the woman’s first baby
- Prematurity or low birth weight
- Hemorrhage or complications with blood flow during delivery
In addition to these physical risks, another major risk factor is the information shared by the healthcare provider with the parents. When a caregiver does not properly educate parents about the aftereffects of birth asphyxia, those parents may not carry out adequate nutrition or know when the baby needs medical attention due to a failure to inform by their doctor. When birth asphyxia results in the death of the infant, the parents may choose to consult an attorney and determine what role negligence may have played in that tragic death.
Birth asphyxia is a common contributor to cerebral palsy. This is actually a group of disorders that impair the development of muscles and control of movement. These are debilitating conditions—ones that will affect their victims for their entire lives. They often mean constant and consistent medical check-ups and procedures, physical therapy, and the need for wheelchairs or crutches. The primary cause of all types of cerebral palsy is damage to the brain of a baby while it’s still in the womb.
Infections during pregnancy are another common cause of brain damage that leads to cerebral palsy. Bacteria like rubella or cytomegalovirus can cause serious issues in a fetus’ brain development and nervous system. Severe jaundice is also a common cause of brain damage. Excessive bilirubin—a byproduct created by the clearing of old red blood cells—is usually filtered out of the bloodstream by the liver, but a newborn’s liver may not be quite up to the job yet. If jaundice is left untreated, it can lead to brain damage, which causes cerebral palsy.
Many common causes of cerebral palsy are preventable. When doctors and nurses make mistakes during labor or immediate aftercare of the infant, the child can suffer, and as a result, families are responsible for paying a significant amount in healthcare costs over the course of the child’s life.
Some of these mistakes include:
- Failure to recognize infections during pregnancy
- Failure to respond to fetal distress in a timely fashion
- Failure to perform a timely C-section when necessary
- Failure to recognize and treat oxygen deprivation
- Failure to recognize and treat meningitis
Traumatic spine injuries for an infant can also occur when there has been a misdiagnosis or failure to detect spina bifida. Spina bifida is a birth defect where the spine does not form properly to fully enclose the exposed nerves. When this developmental issue is not detected during pregnancy, the doctor may permanently damage the nerves by touching them during delivery.
Spina bifida is believed to be a complication that develops early in pregnancy. The CDC has released information about risk factors for spina bifida in infants, including:
- Low folic acid levels (vitamin B-9)
- Mother using certain medications like anti-seizure medications
- Uncontrolled pre-pregnancy diabetes in the mother
- Obesity in the mother
- Elevated core body temperature for the mother during early weeks of pregnancy, like a fever or getting in a hot tub
Spina bifida is a treatable condition and most affected individuals lead normal lives. However, a medical professional’s responsiveness to the condition, and treatment in line with best practices, is essential to that outcome.
Circumcision is a delicate and extremely technical surgery. When a circumcision is botched, or caregivers do not follow appropriate after-care standards, this can result in life-altering injuries and extreme pain for the infant. Botched circumcisions have been known to result in issues ranging all the way from infection to the amputation of a child’s penis.
Common injuries after a circumcision include:
- Removal of too much skin, meaning follow-up surgeries and a life of pain and awkwardness
- Trapped or concealed penis, where the shaft gets buried in fat
- Removal or necrosis of the head of the penis
- Bleeding and infection
Surgeons must be properly trained to perform this procedure. They must always get parental consent and should also advise if there is a physical reason a circumcision should not be performed. Failure to use sterile tools or using defective tools are other forms of negligence or malpractice that might occur during a circumcision.
Call Our Attorneys Today
These are some of the most common conditions that can put parents and infants at risk. Remember that every family’s situation is different. Having a baby is an event that changes a family forever, and no joy should be altered or cut short due to preventable issues like these.
Call our Indianapolis birth injury attorneys to get started on your claim and recover damages at (317) 245-3709.