The birth of a child is one of life’s most exciting moments. The last thing that expectant parents want is for something to go wrong. While longstanding medical evidence has shown a high correlation between certain actions during delivery and injury to the newborn, recent literature has tried to suggest that undiagnosable, unpreventable genetic conditions may be the cause. This creates a need for a reality check!
Unfortunately, injuries during childbirth, while infrequent, are not uncommon. But when exactly are birth injuries a consequence of a doctor’s negligence?
Birth injury rates have declined over the last few decades due to advancements in obstetrical techniques and lessons learned from past malpractice claims where departures from standard practices caused injury to the baby and mother. However, injuries still do occur to the mother and child that are preventable with proper care during delivery.
Some of the most frequently seen injuries that can result from negligence of the obstetrician or other delivering doctor include:
- Erb’s Palsy is an injury to the brachial plexus nerve branch of the newborn that can result from a baby’s difficulty fitting through the birth canal (shoulder dystocia) and can become stuck. If the doctor fails to recognize shoulder dystocia or fails to perform the proper maneuvers to allow the baby to pass through the birth canal when this occurs, the baby’s shoulder becomes trapped against the pubic bone and the nerves to the arms can become severely injured preventing proper arm function.
- Brain Damage During Delivery, also known as Hypoxic Ischemic Encephalopathy (HIE), can occur when the fetus fails to get enough oxygen during delivery and brain damage results. Proper prenatal care, proper monitoring of the stages of labor, and proper interpretation of the fetal heart monitor tracings can prevent fetal distress during labor and prevent lack of oxygen injury from occurring.
- Rectal-Vaginal Fistula is a condition where stool or flatus passes through the vagina after vaginal birth when there is a tear of the rectal muscle and lining that causes a passage from the rectum to the vagina. These injuries require immediate recognition and repair. If the tear goes unrecognized and unrepaired at the time of delivery, the chances of repairing the condition later are diminished.
- Serious Genetic Conditions in babies can result from the failure to offer, perform, or properly interpret prenatal tests that would have provided information to the doctors about congenital or genetic anomalies that cause catastrophic disabilities. The failure of the doctors to detect such conditions and to advise the parents of the child’s likely future suffering deprives the parent of information that would have allowed them to choose to terminate the pregnancy and avoid the pain and suffering for both the child and parents.
- Kernicterus is excess bilirubin in the blood (jaundice or kernicterus) that causes damage to the brain. This condition is triggered by a delay in a newborn’s liver metabolism which leads to neurologic injury if untreated. The increased bilirubin levels can often be seen in the sclera of the eyes that look yellowish instead of white.
- Skull Fractures can occur during delivery and cause injuries to the newborn skull and brain. Such cases are rare but can occur with improper use of a vacuum extractor or delivery forceps.
More information on each of these conditions, the standard of care that can avoid them from occurring in the first place, and treatments, where appropriate, will be addressed in subsequent blogs.