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Articles About Birth Injury Lawsuits And Childbirth Injury MedicineCerebral Palsy, Medical Malpractice and Hospital Negligence
I still remember, in the minutes before my twins’ birth more than three months premature, the neonatologist’s answer to my question, “what are their odds of being okay?”
“Twenty percent,” he said, which I thought sounded good under the circumstances. When a child is in danger, you’ll take any hope you can get.
We then spent 78 days in the neonatal intensive care unit (NICU) — less time than expected —and after that six months of sleepless nights with their apnea & bradycardia alarms going off, twice-weekly visits from a physical therapist, and many trips to the hospital for difficulty breathing, until at three years old my twins were discharged from the ‘special babies’ followup program run by the NICU.
We were lucky. Not every family follows the same course. I saw it first-hand in the NICU, and I’ve seen it in our birth injury cases. For many of these children, help may be available. If your baby showed signs of an injury at birth — like if your baby had seizures, or had special treatment in the NICU like extra oxygen, surgery, or head cooling — and you’re looking for answers, please keep reading or call my office at (215) 948-2718. Our birth injury lawyers, expert physicians, and nurse paralegals review birth injury cases quickly, confidentially and at no cost to you. If we represent your child in a lawsuit, we pay all the costs on the case, and we’re paid from the settlement or verdict. We never ask our clients to pay any money to us or towards winning the case.
Many Doctors Downplay The Medical Danger Of Childbirth
Childbirth involves not just a complex physical process, in which the baby needs to twist and turn in delivery without injury, but also a complex chemical process. Although we all imagine the baby being born, getting a slap on the bottom, and then starting to breathe, the transition from fetus to newborn also involves a switch from using fetal hemoglobin in the low-oxygen environment provided by the placental to using adult hemoglobin in the high-oxygen environment provided by the lungs.
Even a typical childbirth can cause temporary injuries like plagiocephaly (flat head syndrome) or torticollis (twisted neck). Obstetricians, laborists, delivery nurses, and midwives are all specially trained to recognize when there’s a problem during child birth, like fetal distress or shoulder dystocia, and to treat it appropriately.
But sometimes they’re negligent, and, through their malpractice, fail to properly treat their patients, and thereby cause serious injuries.
The Three Main Types Of Birth Injury Malpractice
There are a wide variety of medical malpractice claims relating to pregnancy and birth — like claims under the federal Emergency Medical Treatment and Active Labor Act (EMTALA) when doctors and hospitals refuse to admit women in active labor into the Labor & Delivery wards, and claims when treating physicians failed to recognize during pregnancy transfusion problems with the placenta or umbilical cord — there are three main types of birth injury lawsuits.
1. Failing To Treat Fetal Distress, Leading To Hypoxia, Then Brain Damage and Cerebral Palsy
As described above, in a typical childbirth the baby transitions from the low oxygen environment in the world to the high oxygen environment of normal air without serious problems. Even when something goes wrong, like a placental abruption or decreased heart rate variability, there is usually a window of opportunity the baby can be born without any serious complications or injuries.
The problem comes when the obstetricians, nurses, or mid-wives fail to recognize the signs of a problem — such as if they are misreading the fetal monitoring strips, and so not diagnosing fetal bradycardia, decelerations, or the absence of fetal heart rate variability — or if they recognize the problem and fail to begin an appropriate treatment course, such as by not immediately inducing labor or ordering an emergency cesarean section.
That delay in birth can lead to a situation in which the baby needs air and treatment but is still inside the womb, increasingly causing hypoxia (a lack of oxygen) and acidosis (increasing acidity of the blood), which can lead to anoxia (no oxygen) and hypoxic ischemic encephalopathy (brain damage). That brain damage takes many forms, including intraventricular hemorrhage (bleeding into the ventricles surrounded by the brain, near the brain stem).
Cerebral palsy is a general term used to describe a variety of related brain and nervous system conditions. (Read the National Institute of Health’s page on cerebral palsy here.) Most cerebral palsy is not caused by malpractice in the birth process, but malpractice in delivery can cause cerebral palsy, particularly spastic quadriplegic or dyskinetic palsy.
Learn more about Cerebral Palsy and Fetal Distress.
2. Treating Shoulder Dystocia With An Improper Technique, Causing Birth Trauma, Brain Damage or A Brachial Plexus Injury and Erb’s Palsy
The birth canal is very narrow, so narrow that, even with extremely premature newborns that weigh than two pounds, mothers still have to push hard and doctors sometimes still have to use an episiotomy to cut part of the vaginal wall to let the baby out.
Thus, newborns of all sizes — and particularly macrosomic (unusually large) babies — can get stuck at the shoulders during birth, with the shoulder catching on the mother’s pelvic bone, even if they’re head-down and not in the breech position (bottom-down). Prolonged labor, premature rupture of membranes, and unusual birth positions can make dystocia more likely. It’s a common problem, one that doctors are specifically trained to handle, like with manual techniques including the McRoberts maneuver (pulling the mother’s legs towards her abdomen) and Wood’s Corkscrew (rotating the baby’s shoulders), with the use of tools, like forceps and ventouse (vacuums), or with the administration of medicines like oxytocin to induce labor. In certain circumstances, an emergency c-section is warranted, even though the baby has already presented in part.
In the context of a shoulder dystocia, medical malpractice takes one of two forms. First, if the appropriate maneuvers and techniques are used, but not fast enough, then — like with undiagonsed fetal distress — the baby can be deprived of oxygen and suffer brain damage. Second, if the delivering doctor uses improper techniques (like yanking or pulling on the baby’s head or otherwise applying force to the neck), or applies them negligently, then the baby can be injured.
Some of the injures can be minor, like limited fractures of the clavicle or humerus, but many of the injuries are major, like fracturing the spinal cord, vertebrae, or causing a brachial plexus injury.
The brachial plexus is a bundle of nerves that control the muscles from the shoulder down to the hand, including the arm, forearm, wrist, and fingers. An injury to this area can causes permanent injuries like paralysis or numbness of the shoulder, arm or hand, loss of functional range of movement, shortness in the affected arm (like Martin Sheen, who himself was born with a brachial plexus injury), altered positioning of the rotator cuff and shoulder blades, and atrophy of the connected muscles. (Read the National Institute of Health’s page on brachial plexus injuries here.)
Learn more about Erb’s Palsy and Shoulder Dystocia.
3. Improper Management Of Pregnancy, Such As High-Risk Pregnancies Involving Pre-Eclampsia or Placenta Previa
The third most common form of birth malpractice relates to the management of the pregnancy prior to the actual delivery. Pregnancy induces a significant stress on the mother’s body, sometimes causing serious complications like pre-eclampsia or HELLP syndrome (an acronym for Hemolysis, Elevated Liver enzymes, and Low Platelet count). Other times, mothers have pre-existing conditions like diabetes or develop gestational diabetes in the course of the pregnancy. Other times, complications related to the flow of nutrients through the umbilical cord to the baby develop, like placenta previa or twin-to-twin transfusion syndrome.
Most of these pregnancy complications can be managed, but they are often overlooked by obstetricians who are not as familiar with the diagnosis as a specialist like a maternal-fetal medicine physician. Sometimes, the condition is recognized but no treatment is prescribed, exposing the mother and baby to unnecessary risk.
Birth Injury Lawyers for Brain Damage Lawsuits
In 2008, I was co-counsel for the parents of an 18-year who died as a result of plastic surgery; the jury awarded her family $20.5 million, $15 million of it in punitive damages, the largest punitive damages in a Pennsylvania medical malpractice case, in Philadelphia County, a venue where defendants win 75% of trials. That verdict was then upheld in appeal — also a rarity in large-verdict medical malpractice cases, and in punitive damages cases — in November 2010.
We are intimately familiar with obstetrics, and what fetal heart rates should indicate a problem, how shoulder dystocia should be managed when a baby gets stuck, when an emergency c-section should be ordered for fetal distress, when cerebral palsy was avoidable, and why babies are referred to head cooling for hypoxic-ischemic encephalopathy or to extracorporeal membrane oxygenation (ECMO) for meconium aspiration.
If your child has been diagnosed with Cerebral Palsy, Erb’s Palsy, or other serious injuries and you suspect medical malpractice may have been the cause, please contact me using this online form below for a free, no-obligation review and consultation by our experienced nurses, doctors, and attorneys. We are based in Philadelphia and focus our law firm’s work on Pennsylvania, New Jersey and Delaware. For birth injury cases outside of those areas, we partner with other firms to extend our representation nationwide.
You can also read some of my articles about childbirth injury lawsuits.