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25/Feb/2016
Birth Injuries

There are probably few experiences quite as shattering as learning your newborn child is starting life with the burden of injury or disability. It’s a situation that can be even more difficult by the realization your child’s suffering was caused by an error or errors made by the medical staff you trusted to help bring your baby safely into the world.

Though some birth traumas and the resulting damage can’t be prevented, there are several types of medical errors that can lead to serious injuries to newborns. They may occur when doctors or hospital employees fail to properly diagnose, monitor or deal in an appropriate and timely manner with issues that arise during pregnancy or birth. In such cases, taking legal action against the medical staff and facility involved may allow the family to obtain compensation to cover the child’s special needs or medical expenses and ensure the best possible future for them under the circumstances.

Complications To Watch For
Birth injuries may include physical damage to nerves, soft tissue or bones during the birth process, or damage to the brain caused by oxygen deprivation or physical trauma. Such injuries most often occur when some complication or difficulty arises during birth or when the birth process is prolonged.

Shoulder Dystocia
Among the most frequent birth complications is shoulder dystocia, which occurs when the baby’s shoulder gets caught behind the mother’s pelvic bone after the head has emerged. The risk of shoulder dystocia increases with newborn weight, and occurs among 5 to 9 per cent of births involving infants weighing 4 kilograms (8 pounds, 13 ounces) to 4.5 kilograms (9 pounds, 14 ounces) born to mothers without diabetes.[1]

Shoulder dystocia does not necessarily result in birth injury. Doctors usually free the baby from the birth canal using one or several of a series of recommended techniques. But trauma may occur simply because of the pressures caused by the trapping of the shoulder, or if the doctor makes a mistake such as pulling the baby’s head with too much force, moving the baby incorrectly, failing to move the mother to a different position when warranted, or not taking appropriate action quickly enough.

Breech Presentation
Also among the more common birth complications is breech presentation, in which the baby emerges buttocks-first or feet-first rather than in the usual head-first position. It occurs in 3 to 4 per cent of all deliveries.[2]

Breech presentation does pose extra risks and breech babies are for that reason often delivered by caesarian section. Problems that may occur during vaginal delivery include prolonged compression of the umbilical cord, head entrapment; rapid decompression of the baby’s head as it passes through the birth canal and damage to the internal organs or spine. Again, injuries may occur simply because of the breech situation, or because doctors don’t respond to it appropriately or quickly enough.

Other Complications
Other difficulties that arise during birth and may lead to injury include a low fetal heart rate indicating the baby is in some kind of distress; prolonged labour or “failure to progress”, sometimes for no clear reason; abnormal presentation with the baby not necessarily in the breech position but in any position other than head-down facing the mother’s back with the chin tucked to the chest; umbilical cord compression due to pressure on the cord that supplies the baby with oxygen and nutrients; and umbilical cord prolapse when the cord precedes the baby into the birth canal where it can get blocked during delivery.[3] Any of these complications may on their own result in injury, or medical staff may cause injury if they don’t handle the given situation properly.

As well, doctors may use forceps, or increasingly, vacuum suction to help pull the baby through the birth canal when complications arise. These tools present their own risks and may cause injuries if the doctor places them incorrectly, applies excessive pressure or pulls too hard. Their use has also been linked to increased risk of shoulder dystocia, and the use of one or the other after use of the first has failed is associated with worse outcomes for babies.[4]

Common Injuries During Birth
The most common injuries that may occur to the infant during any of these complications or even in their absence include:

Facial Paralysis
This injury occurs when pressure on one side of the baby’s face during the birth process damages a facial nerve. Inappropriate use of forceps or a vacuum device can cause this form of trauma. When a newborn with facial paralysis cries, the face appears asymmetric. The paralysis sometimes heals on its own, or surgery may be required if the nerve damage is more severe.

Brachial Plexus Injury
This injury occurs when there is trauma during the birth process to the brachial plexus, the network of nerves that runs over the front of the chest from the neck to the armpit. Injury in this area can affect the movement and sensation of the shoulder, arm and hand on the injured side, depending on which nerves are damaged. The trauma may occur when the nerves are excessively stretched, compressed or, in the most serious cases, torn away from the spinal cord.

This injury may be associated with excessive stretching of the neck or pulling of an arm by the doctor during a difficult delivery, which may occur with shoulder dystocia. Brachial plexus injury often resolves on its own after a few months, but occasionally requires surgery and sometimes causes permanent damage. Erb’s palsy, which usually affects the whole arm, and Klumpke’s paralysis, which usually affects the wrist and hand, are two forms of brachial plexus injury.

Brain Damage
Birth-related brain injuries are often the result of oxygen deprivation, which may occur when birth is prolonged or delayed by problems like shoulder dystocia or breech birth, or when there are complications such as umbilical cord prolapse or compression. Oxygen deprivation during birth may cause permanent neurologic damage resulting in delayed development and/or cerebral palsy, which is a disability that affects movement and motor skills.

Brain injury can also result from direct trauma to the head that might occur, for example, from improper use of forceps or inappropriate twisting or pulling of the baby’s head during delivery. The long-term consequences may include both physical and/or intellectual disabilities.

Bone Fracture
Fracture of the clavicle or collarbone is the most common birth-related bone break and usually heals quickly. It may occur in shoulder dystocia cases when the shoulder is caught behind the mother’s pelvic bone, and the clavicle may even be deliberately broken by the doctor in order to free the baby. During a difficult delivery, the upper arm bone or upper leg bone may also break, but this is unusual.

What To Do If Your Child Suffered A Birth Injury
In the courts, the outcome of birth injury cases often depends on whether doctors and nurses followed accepted standards of care, including preparing for possible emergencies. Determining whether a birth injury is the result of medical malpractice or negligence is a complicated process. Please contact Richard Bogoroch (rbogoroch@bogoroch.com) for further information on how we can assist you or a family member with legal action related to a birth injury.


Bibliography

Baxley, Elizabeth G., M.D., Gobbo, Robert W., M.D., Shoulder Dystocia, American Family Physician. 2004 Apr 1;69(7):1707-1714

Birth Injuries to the Baby, patient.info

Birth Injury, Lucile Packard Children’s Hospital Stanford, stanfordchildrens.org

Brachial Plexus Injury, Mayo Clinic, mayoclinic.org,

Childbirth Complications, WebMD

Fischer, Richard, MD, Breech Presentation, Medscape

Hook, Christina D., MD, Damos, James R., MD, Vacuum-Assisted Vaginal Delivery, American Family Physician. 2008 Oct 15;78(8):953-960

Kopelman, Arthur E., MD, Birth Injury, Merck Manuals

Notes

[1] Baxley, Elizabeth G., M.D., Gobbo, Robert W.,M.D., Shoulder Dystocia,  American Family Physician. 2004 Apr 1;69(7):1707-1714;

[2] Fischer, Richard, MD, Breech Presentation, Medscape

[3] Childbirth Complications, WebMD

[4] Hook, Christina D., MD, Damos, James R., MD, Vacuum-Assisted Vaginal Delivery, American Family Physician. 2008 Oct 15;78(8):953-960

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