About one-third of all births in the United States are by cesarean section (“c-section”), an operation that delivers the baby without it having to pass through the vaginal birth canal. With a small horizontal surgical incision made at waist level, the uterus is opened and the baby is taken out directly instead of going through the birth canal. This avoids the compressive forces of labor that can cause fetal distress.
There are some prenatal conditions for which c-section is planned, such as macrosomia (overweight) to prevent shoulder dystocia (baby’s shoulder caught on mom’s pelvic structure) or when certain underlying conditions in the fetus are known prior to delivery. There are other situations when c-sections are unplanned and done emergently to curtail fetal distress and prevent birth injuries.
The mother’s vital signs and baby’s fetal heart rate during labor help the obstetrical team assess whether the baby is receiving adequate blood flow and oxygen. When signs of decreased perfusion (blood or oxygen flow) first develop, as shown by changes in the fetal heart rate, the team intervenes with resuscitative measures and ultimately with c-section if the fetus’ condition does not improve. Depending on the severity and duration of the fetal distress, the baby may need to be delivered within minutes.
Other signs that a c-section is necessary are excessive maternal bleeding, uterine rupture, and placental abruption (the placenta detaches too early from the uterus).
The baby can withstand some amount of stress during labor, but when there are continuing problems with circulation through the placenta to the fetus, the baby’s ability to withstand lack of oxygen gives out. Once that happens, injuries to the brain and other organs start to occur. Without relief of the baby’s hypoxia (lack of oxygen), the brain injury worsens and ultimately causes death if severe and long enough.
Once the baby shows signs of fetal distress that is not correctable by decreasing the drug Pitocin, increasing intravenous fluids, or repositioning, c-section becomes necessary. If there is a failure to consider c-section at all or the decision to perform a c-section is unduly delayed, underlying brain injury starts, continues and becomes permanent. When there is prolonged labor, a delayed c-section can also result in serious maternal complications. Uterine atony from prolonged labor can result in massive post-partum hemorrhage requiring extensive resuscitation and intensive care support.
The most common birth trauma linked to delayed c-sections is a permanent brain injury called hypoxic ischemic encephalopathy (oxygen deprivation brain injury). Conversely, an unplanned emergency c-section during labor is often done to prevent progressive fetal distress that can result in a lack of oxygen (hypoxia) or hypoxic ischemic encephalopathy (lack of both blood flow and oxygen). In those cases, emergency c-sections are recommended to avoid brain damage to the baby.
The manifestation of the child’s neurological injury depends on whether the lack of oxygen was partial or total, long or short. Decreased blood flow to the fetus occurs during umbilical cord compression and if underlying problems with the placenta exist. Children who suffer hypoxia because of delayed c-sections exhibit disabilities across all cognitive and physical functions and levels.
Physical disabilities resulting from birth trauma include paralysis, paraplegia, spasticity, blindness, and deafness. Cognitive disabilities include delayed development, inability to read or talk, and the inability to perform daily functions of life.
These types of birth injuries often require detailed life care plans that provide physical and cognitive therapies, nursing support and physician monitoring.
Medical negligence can result by a failure to recognize the need for c-section or cause a delay in a c-section at the nursing level, midwife level, and the obstetrician level.
Babies who suffer a negligent delay in c-section delivery often have low Apgar scores, poor tone and function at birth, and seizures.
Proving negligence in a delayed c-section case requires an obstetrical expert, an obstetrical nursing expert, and often a nurse midwife expert to identify specific errors in the care. This means identifying errors in the care (deviations) during the labor based on the fetal heart monitor tracing and other clinical data that prevented a timely c-section.
After identifying the steps that were not properly done or monitoring that was improperly performed, testimony from a pediatric neurologist, neonatologist, pediatric neuroradiologist, physiatrist, and nursing care experts are required to show how the errors (and delayed c-section) caused injury to the baby and what those specific injuries are. Sometimes a pediatric neuropsychologist is needed to identify underlying cognitive dysfunctions that prevent normal development.
Once the errors and related injuries are identified, a life care planning expert provides a cost analysis for the health care the injured child will need for his or her lifetime.
The potential long-term outcomes for both the child and mother are grim in cases of perinatal hypoxic brain injury. While hypothermia in the immediate postnatal period can help lessen the ultimate extent of the brain injury, the brain injuries are permanent.
Young children can sometimes develop alternate brain pathways and recover some cognitive function, but hemiparesis and hemiplegia, blindness and deafness are not conditions that improve with time. Ultimately these lifelong disabilities prevent the child from ever being able to live independently. Children who suffer a perinatal hypoxic event develop permanent injury which requires lifelong monitoring and support.
Because the child is unable to live independently, any worry-free life of the mother and father, as well as the rest of the family, is lost. Without the ability to pay for appropriate support personnel, the family spends all its time taking care of the child.
The emotional and physical pain and suffering for the mother should not be overlooked. The mother can suffer long-term negative outcomes as well due to a delayed c-section and prolonged labor, such as uterine rupture and infection, which may necessitate an emergency hysterectomy (and therefore prevent future pregnancies).
For these reasons, proving medical negligence regarding a delayed c-section is crucial to bringing financial relief and justice to the affected child and family.
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