The normal progression of labor is marked by dilatation of the cervix, thinning out of the cervix, and descent of the baby down the birth canal. If any of these progression markers are delayed or stalled, the medical staff needs to evaluate whether there’s prolonged or arrested labor. Failure to properly manage labor can lead to serious complications, including cerebral palsy caused by medical negligence.

Symptoms

Mismanagement of labor can result in an excessively long or stunted labor. Other symptoms of mismanaged labor leading to an abnormal delivery process include:

• Labor extending for 14-20 hours or longer
• Maternal distress or exhaustion
• Pain in the sides and back of the body radiating to the thighs resulting from prolonged intense pressure on the mother’s back
• Decreased labor pains due to muscle fatigue
• Maternal increased pulse rate due to stress, dehydration and exhaustion
• A uterus that is tender to the touch due to not fully relaxing between contractions
• Abnormal contraction patterns, including coupling and tripling

Diagnosis

To determine if mismanagement of labor occurred, a legal/medical team will likely examine the following:

• The baby’s heart rate pattern as shown on the fetal monitor
• How long the labor lasted
• The strength and frequency of contractions , and periods of relaxation of the uterus between contraction

Risk to Fetus

Several issues can occur during labor and delivery. Experienced and diligent medical professionals should be able to identify these issues and provide appropriate treatment in a timely manner. Allowing labor to continue for an extended period of time carries serious health risks for both the fetus and the mother.

Potential risks to the fetus include:

• Oxygen deprivation
• Trauma
• Permanent injury

Potential risks to the mother include:

• Infection
• Bleeding

Treatment

If there are signs of an abnormal labor process, the healthcare team should start measures to relieve the issue causing the problem. Nurses may reposition the patient, start oxygen to the mother or, if Pitocin is running, turn down the rate. If those interventions do not normalize the fetal heart rate, a physician should be called to the bedside.

The physician may then intervene to effect a safe delivery.

Pitocin

If a mother has a prolonged active labor phase, her doctor may administer Pitocin, a synthetic hormone used to strengthen uterine contractions and induce labor. Doctors sometimes use Pitocin to try to avoid a C-section. However, it’s essential to carefully consider the benefits and risks of its use.

If incorrectly administered, Pitocin may lead to tachysystole, or excessive uterine contractions, which can potentially jeopardize the baby’s oxygen supply and put both the baby and mother at risk.

Artificial Rupture of Membranes

Amniotomy, or the artificial rupture of the membranes, is when a doctor ruptures the mother’s membranes with a special tool or finger to accelerate the labor and delivery process. However, there are conflicting beliefs on whether amniotomy effectively speeds up the process. When used together with Pitocin, amniotomy can help to augment or induce labor.

However, it’s important to be aware of the potential risks associated with both Pitocin and amniotomy. Some medical professionals feel that amniotomy can treat arrested or prolonged labor and delivery by promoting contractions. However, there isn’t any concrete evidence that amniotomy, when used on its own, induces labor, shortens labors, or prevents the need for a C-section. Potential risks of performing an amniotomy should be weighed against the possible benefits, and you should talk to your medical team to make an informed decision.

Forceps and Vacuum Extractors

Vacuum extractors and forceps are medical instruments that doctors use to help during vaginal deliveries. When used properly, they can help speed up the labor and delivery process. However, if used incorrectly, they can cause traumatic birth injuries, some of which can result in permanent conditions and disabilities.

Injuries associated with improper use of forceps and vacuum extractors include cerebral palsy, hypoxic-ischemic encephalopathy (HIE), Erb’s palsy, seizures, and hemorrhages or brain bleeds. Because of these serious risks, vacuum extractors and forceps aren’t typically used to manage arrested or prolonged labor and delivery.

Cesarean Section

If the medical team cannot accelerate your labor using other methods or if delivering vaginally or delaying delivery would put you or your baby at risk, your doctor may decide a cesarean section is necessary. Conditions that may require a baby to be immediately delivered with a C-section include:

• Fetal distress
• Uterine rupture
• Cord prolapse (the umbilical cord comes out of the womb ahead of the baby)
• Stalled labor
• The baby’s shoulder becomes stuck behind the pubic bone

Prevention

In most cases, there isn’t much you can do to prevent cerebral palsy caused by medical negligence and mismanagement of labor and delivery. If it’s possible, take the time to carefully select each member of your birthing team. Make sure the doctors, nurses, midwives and other medical professionals you’ve chosen are trained and experienced in handling unexpected complications during delivery.

Ensure you have proper prenatal care and that your medical team is aware of any pre-existing conditions that may lead to complications during labor and delivery.

If your child has cerebral palsy because of labor and delivery complications due to mismanagement of labor, the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs, LLC can help. If you think you have a case, contact us today for a free, no-obligation consultation.

Reviewed by:
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

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