Birth Asphyxia and Cerebral Palsy
When most people hear the word asphyxia, their thoughts turn to suffocation or strangulation of an adult. Few people realize that asphyxiation can occur during the birthing process, often causing lifelong complications for the child.
What Is Birth Asphyxia?
The term “birth asphyxia” refers to a loss or reduction in the oxygen and blood supply to a fetus before, during, or immediately after birth. The term anoxia describes a condition when there is complete deprivation of oxygen. Asphyxia or anoxia can occur as a result of a variety of delivery complications. Compression, occlusion, or restriction of the umbilical cord during birth is the most common cause of asphyxia. When oxygen flow to an unborn baby is compromised, there is a high risk of brain injury, cerebral palsy, or death if action is not taken immediately.
Causes of Birth Asphyxia
A baby in the womb relies on the mother’s blood for the oxygen and nutrients it needs to grow. The blood travels from the placenta into the umbilical cord, where it provides the infant with oxygen and nourishment. If the mother’s blood is affected in any way, it can interfere with oxygen levels and pose a dangerous risk to a baby’s health. Some other causes of birth asphyxia include the following—some of which may also contribute to cerebral palsy:
- Placenta previa (when a baby’s placenta partially or completely covers the mother’s cervix)
- Placental abruption (when the placenta separates early from the uterus)
- Umbilical cord problems, such as the cord wrapping the baby’s head or umbilical cord compression
- Baby’s airway is blocked or unformed
- Anemia (when a baby’s blood cells cannot carry enough oxygen)
- Serious infection in mother or baby
- High or low blood pressure in mother or baby
- Heavy maternal bleeding and fetal distress, leading to maternal shock
How Asphyxia Causes Brain Damage
When the brain is deprived of oxygen, pH and blood gas levels may be altered, putting the infant at risk for brain-damaging cerebral hypoxia and acidosis. Asphyxiation may lead to increased carbon dioxide and other gases in the blood, as well as an imbalance of the umbilical venous blood’s pH. This event may trigger decreased pH and lead to fetal acidosis and brain damage.
Birth Asphyxia Symptoms
The signs of birth asphyxia can occur before, during, or just after birth. Babies who are born prematurely have a less mature nervous system than full-term babies, and as a result they may not show some, or any, of the common symptoms of birth asphyxia. These symptoms include:
- Pale or bluish skin tone
- Low heart rate
- Baby being silent and not crying
- Unalert or low level of alertness
- Weak muscle tone
- Weak reflexes
- Infant seizures
- Poor circulation
- Lack of breathing or difficulty breathing
- Hypotonia (the baby’s body is floppy and limp)
- Low blood pressure
- Lack of urination
- Abnormal blood clotting
Birthing Complications That Can Result in Asphyxia and Infant Brain Damage
Birthing complications and maternal and neonatal factors can put an infant at risk for asphyxia. Risk factors include:
- Cord prolapse—occurs when the umbilical cord precedes the fetus when the fetus moves downward into the pelvis. This condition demands immediate attention and action, normally resulting in a Cesarean section.
- Induced labor
- Breech deliveries
- Forced extraction by means of forceps, vacuum, or mechanical forces during vaginal deliveries
- Low umbilical cord pH
- Umbilical cord wrapped around the neck. Although relatively common, this condition could put a fetus at severe risk during the delivery process.
Fetal heart monitoring can help detect asphyxia and fetal distress, but only if used and monitored properly. Providing the mother with supplemental oxygen during delivery can help prevent fetal acidosis and brain injury. Quick, efficient labor minimizes the baby’s stress factors and goes a long way to preventing birth asphyxia.
Healthcare professionals may not recognize the signs of distress in time or at all. In other cases, the results may be misinterpreted as negative and the mother unnecessarily sent for forced extraction or Cesarean section delivery.
When used properly, fetal heart monitoring is responsible for saving many infants from high-risk situations and neurological damage during the birthing process. Doctors are studying new approaches to labor and delivery which can minimize the consequences of asphyxia and birthing traumas that are sometimes unavoidable.
Birth Asphyxia Treatment Options
There are a number of ways that birth asphyxia is treated, which sometimes can help prevent the severity of cerebral palsy. The type of treatment, however, will depend on the severity and cause of the birth asphyxia. Common treatment options include:
- Providing extra oxygen to the mother if birth asphyxia occurs before delivery
- Putting the newborn on a respirator
- Administering intravenous (IV) nutrition
- High-frequency ventilation to send oxygen directly into an infant’s lungs
- Placing the baby in a hyperbaric oxygen tank
- Induced hypothermia to cool the body and prevent brain damage
- Medication to help control seizures
- Life support with a heart and lung pump
Birth Asphyxia Outlook
Not all infants who endure birth asphyxia will develop brain damage. In fact, babies with mild to moderate birth asphyxia who receive immediate treatment may even make a full recovery. For babies with moderate to severe brain damage, there are available treatment options to help improve their condition. However, these patients may also develop mild to severe medical conditions that require ongoing treatment, such as:
- Breathing problems
- Cerebral palsy
- Issues with organs
- Learning disabilities
- Social and behavioral issues
In rare cases, birth asphyxia in infants can be fatal, with a 30% or more death rate in the first days following birth. This makes it crucial that mother and baby receive proper care and monitoring before, during and after the baby is born.
If you believe that your child’s CP or other severe birth injury may have been caused by medical negligence, the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs, LLC may be able to help. Contact us today to see if you have a case for compensation.
Trish Fletcher, MS, BSN, CRNP, NNP-BC, ALNC
Neonatal Nurse Practitioner | Birth Injury Legal Nurse Consultant
Tricia is a dedicated, focused, Birth Injury Legal Nurse Consultant and Neonatal Nurse Practitioner with more than 25 years of experience. Her strong clinical and critical thinking skills, paired with expertise caring for neonates in a Level III Neonatal Intensive Care Unit (NICU), ensures meticulous medical records review. READ FULL BIO