Category Archives: Birth and Brain Injuries

Possible Signs of Medical Error during Labor and Delivery

Fortunately, most births in the United States are complication-free. But in my practice, I primarily deal with parents whose child was diagnosed months or even years after birth with cerebral palsy, and who suspect medical error may have played a part. I have investigated some 10,000 of these cases over the years. As a result, I have learned there are certain events or circumstances that occur in labor and delivery situations that, if a child is diagnosed with brain injury, should merit further investigation. These include:

  • A problem during labor or delivery that was either clearly an unexpected or emergency situation, such as unrelenting pain, bleeding or absence of activity by the fetus.
  • A situation in which parents sensed that doctors and nurses were worried, that something wasn’t “right,” that resulted in a change in procedures (i.e., when an expected routine delivery develops complications).
  • When questions about labor and delivery complications are sidestepped, referred up the ladder or stonewalled. When hospital personnel delay or refuse to provide medical records following labor and delivery.

 
In my experience, parents who sensed that something went wrong during their labor and delivery are usually right. But was it preventable medical error? Doctors and other staff are supposed to follow what are known as Standards of Medical Practice to help ensure patient safety. When we evaluate a case, we look for evidence that these standards were followed. Following are some of the standards we review in relation to labor and delivery:

  • A woman entering the hospital for a normal delivery should be hooked to a fetal heart monitor within one hour of entering the hospital. A woman expecting problems with her delivery should be hooked up even sooner.
  • A woman entering the hospital experiencing unrelenting pain, bleeding or cessation of activity by the baby should be seen by a doctor immediately.
  • A woman in the labor and delivery room should have an IV inserted and ready to go, even if no fluids are expected to be needed.
  • If any problems develop with the fetal heart monitor, a woman should be switched to an internal monitor.
  • If given Pitocin, a laboring mother should expect an internal pressure catheter to also be employed.
  • If the baby’s baseline heart rate drops below 110 for 60 seconds or longer, a physician should be called and should arrive within 30 minutes.
  • If a laboring mother is placed on oxygen or advised she should lie on her left side, she should be seen by a physician within 30 minutes.
  • Parents should be consulted prior to use of vacuum or forceps and should be informed of the risks.
  • Their decision to have a C-section should be respected.

 

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Common Mistakes Leading to Brain Injury in Newborns

As an attorney with more than 20 years of obstetrical experience, I regularly sit down with parents and review situations in which medical error is the suspected cause of their child’s cerebral palsy. While each case is different, there are certain medical errors which come up most often.
 
Failure to diagnose and respond to a baby’s airway obstructions
There are many different vision disorders that can result from cerebral palsy, although many share similar forms of corrective treatment.

Acuity Loss
This always occurs after the baby has been delivered. It is caused by a foreign plug in the airway, most commonly meconium, blood or mucous. When this occurs, your baby will not be crying.
 
Mismanagement of third trimester bleeding – An example of this would be leaving a mother unmonitored and alone on a gurney waiting for a sonogram while she experiences severe enough bleeding to affect the baby’s, and also possibly her, wellbeing.
 
Waiting too long to perform a C-Section – If nurses, doctors or midwives keep trying to deliver a baby vaginally when the fetal heart monitor shows the baby is in distress and not tolerating labor, the baby can suffer brain damage. We have had many cases where, if the child had been born only an hour or two earlier, the baby would not have been injured.
 
It is amazing that many times a medical records document acknowledges the distress, yet no actions to correct it were undertaken. Also, after a doctor determines a C-section is necessary, it should be performed immediately. The absolute longest acceptable delay is 30 minutes under guidelines governing obstetrical best practices.
 
Administering too much Pitocin – Pitocin is a drug used to induce labor, but it also carries the risk of undue stress upon the fetus (which will be clearly evident on the fetal monitor strips). My firm recently settled a case where Pitocin was continued long after it should have been stopped, and the baby was born with brain and organ damage.
 
Failure to respond to signs and symptoms of a uterine rupture – These usually start with unexplained continuous severe pain experienced by mom, and are followed with obvious changes in the fetal monitor. Uterine rupture occurs almost exclusively in women who have had some sort of prior uterine surgery. It is a potentially catastrophic event for a mother and baby. Any delay in performing an emergency C-section can lead to infant brain damage and potential maternal death.
 
Misreading or misinterpreting fetal monitor tracings– Being able to correctly interpret fetal monitor strips is the most basic requirement of an obstetrician, midwife or obstetrical nurse. It is frightening how many of these healthcare providers lack this skill. In many of the cases I see, a correct interpretation of an electric fetal heart monitor (EFM) and the appropriate action in response could have avoided brain injury to a child.
 
I advise parents to learn the basics of EFM so they know enough to ask questions and demand answers if they notice certain EFM patterns happening during labor.
 
Failure to respond to signs of a placental abruption – Placental abruption, which includes any amount of placental separation before delivery, occurs in about 1 out of 150 deliveries, although severe cases are rarer. The classic symptom is unrelenting abdominal pain, with or without vaginal bleeding. If it is severe and late-term, steps must be taken to deliver the baby quickly before both the baby’s and mom’s lives are compromised.
 
Failure to respond to abnormal symptoms/behavior in a newborn – Healthy newborns will always do three things – eat, drink and go to the bathroom. This is true even if they are sick with a cold. Any significant change in your baby’s habits as it relates to these three basic functions of life should be brought to the attention of a medical provider immediately. Unfortunately, especially if early in a disease process, your complaints may be ignored. DO NOT let this intimidate you from seeking care again. If you have been discharged from an Emergency Room or your pediatrician’s office and there is no improvement in your baby in 12-24 hours, go back. Insist on testing and, if possible, hospital observation for 24 hours.
 
Failure to perform a timely delivery– Miscommunication is a major factor in many medical errors, but it’s particularly devastating if it causes a baby who needs to be delivered NOW to suffer brain damage as a result. Ensure that all your healthcare providers are talking to one another. This can be done with simple questioning of your nurse. Examples include: “Is my doctor aware of your concerns?” “Did you tell my doctor about my concerns?” “Is anesthesia aware of the concerns about the fetal monitor tracings?”
 
Failure to obtain medical experts to support labor and delivery – If a mother or baby shows signs that the labor and delivery process may be complicated – for example, a pre-existing condition such as maternal diabetes – the hospital should have the right staff and equipment ready and waiting if a difficult situation arises. Never be afraid to ask your primary provider to send you for an expert second opinion. Also, if your baby is at risk for premature birth, ensure that the hospital where you plan to deliver is capable of handling this situation.
 
If you experienced any of these errors during the birth of your child, contact us for a free consultation.

 

Giles H. Manley, M.D., J.D., F.A.C.O.G.

Giles is a Board Certified OB/GYN. He has over 20 years’ experience and delivered over 2,000 babies. He served as both Chief of Obstetrics and Gynecology and Area Medical Director in Baltimore for the Mid-Atlantic Permanente Medical Group (the physician group of Kaiser Permanente). He decided to become a lawyer to help keep birth errors from being repeated. A partner in Janet, Jenner & Suggs, he focuses his legal practice on representing victims of medical malpractice and families affected by cerebral palsy.

 

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