Sometimes obstetricians (OB/GYNs), labor and delivery nurses, and neonatologists recognize when there’s been a problem during labor and delivery that could cause a newborn baby to have a brain injury. In these situations, the baby is watched closely in a neonatal intensive care unit (NICU).
That was the situation that recently confronted a young couple who planned to have their first child delivered by a midwife at a birthing center. When the midwife realized that something was wrong with the baby that exceeded her training, she appropriately sent the laboring mom to the hospital.
Shortly after connecting her to the electronic fetal monitoring equipment at the hospital labor and delivery unit, an obstetrician recognized fetal distress and performed an emergency C-section. The baby was admitted to the NICU to be evaluated for expected hypoxic ischemic brain injury.
In many other situations, though, the doctors and nursing staff may be unaware that the newborn sustained a brain injury during labor, shortly before birth. I am working on a case now where a woman well into the third trimester pregnancy went to the hospital after her water broke.
As she was in labor for a few hours, her contractions weren’t spaced sufficiently apart. That means that the unborn baby didn’t get periods of rest between each squeeze of a contraction. Over time this can lead to hypoxia, or insufficient fetal oxygenation. This is a medical condition called uterine tachysystole. The labor and delivery nurses did not recognize this concerning pattern on the electronic fetal monitoring. The OB/GYN didn’t either, at the time, although she later conceded that was present.
While the fetal heart rate looked fine for most of the time that the mom was in labor and delivery, there was a sudden prolonged deceleration, or drop, that concerned the obstetrician enough to rush the mom to surgery.
The obstetrician and mother had already come up with an elective cesarean section plan, so the surgeon proceeded with the C-section. Based on the medical record, the operating room team and neonatologist felt that the baby came through labor and delivery just fine. They admitted the newborn to the NICU because he was a little premature.
We now know from a careful review of the case, including later MRI and CT scans, that the baby experienced a hypoxic-ischemic injury during labor and delivery. Because no one was thinking that this may have occurred, though, at the time the baby was admitted to the NICU, a bias set in.
By bias, I mean the neonatologists and nursing staff concluded that everything was fine, ignoring signs and symptoms that suggested otherwise.
In this case, the baby had a brain injury from labor and delivery that caused an intracranial intraventricular hemorrhage or bleed. Although the signs were right in front of them, the doctors and nurses ignored them for nearly two weeks.
In newborns, some of the signs and symptoms of an intracranial hemorrhage include:
• Apnea (episodes where the baby stops breathing)
• Bradycardia (episodes where the baby has an abnormally slow heart rate)
• Difficulty with feeding
• Being overly sleepy or lethargic
• Being irritable or inconsolable
• Low birth weight and failure to thrive or grow normally after delivery
• Seizure-like activity
NICU doctors and providers often call episodes of combined apnea and bradycardia “As & Bs.” This baby’s medical records have numerous references to As & Bs throughout his first few weeks of life. He also had a lower-than-normal birth weight and wasn’t growing well. He also had initial blood work that had abnormal hematocrit and hemoglobin levels, showing a medical condition called thrombocytopenia.
The medical experts that will hired to carefully review the medical records pointed out that these clinical signs should’ve triggered concern on the part of the neonatologists and nurses that something serious was potentially wrong with this new point. Under the standard of care, there should have been repeated blood work, specifically complete blood count (CBC).
Additional CBC analysis in the hospital lab would have likely shown continued problems with hematocrit and hemoglobin, which would’ve allowed diagnosis of the baby’s intracranial hemorrhage earlier.
Using the clinical information, diagnostic imaging, and expert analysis, we are able to link the labor and delivery negligence by the obstetrician and nursing staff to the brain hemorrhage that has left this baby with a permanent brain injury.
When there’s a concern about potential labor and delivery brain injury, cerebral palsy, or other serious injury involving the baby that happened in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for free consultation about your potential case.