When expectant mothers arrive at the hospital for labor and delivery, they trust that the labor and delivery will provide the best possible care for them and their unborn babies. However, a potentially dangerous condition called excessive uterine activity can sometimes fly under the radar, leading to devastating consequences.
As a Texas medical malpractice attorney, I’ve seen firsthand how this silent threat can result in brain injuries, cerebral palsy, or hypoxic-ischemic encephalopathy (HIE).
Understanding Uterine Activity During Labor
Uterine contractions are a normal and necessary part of labor. They help the cervix dilate and move the baby through the birth canal. However, the frequency (how often they occur and spacing in between them), duration, and intensity of these contractions need to be carefully monitored to ensure the baby’s well-being.
You can read more about birth injuries of this type in our article uterine rupture diagnosis and medical malpractice.
The American College of Obstetricians and Gynecologists (ACOG) defines tachysystole as more than five contractions in a 10-minute period, averaged over 30 minutes. This definition is widely used in medical practice and research. However, it’s crucial to understand that uterine activity can be harmful to the baby even when it doesn’t meet this strict definition.
The Gray Area of Uterine Activity
While tachysystole is a clear red flag, recent research and clinical experience have shown that uterine activity that falls short of this definition can still pose significant risks to the fetus. Here’s why:
1. Individual Fetal Tolerance: Each baby has a different tolerance for the stress of labor. Some may show signs of distress with fewer than five contractions in 10 minutes.
2. Contraction Intensity: The ACOG definition doesn’t account for the strength of contractions. Fewer but more intense contractions can be just as harmful as more frequent, milder ones.
3. Duration of Contractions: Prolonged contractions, even if they occur less frequently, can reduce oxygen supply to the baby for extended periods.
4. Cumulative Effect: Even if contractions don’t meet the criteria for tachysystole at any given 30-minute period, consistently elevated uterine activity over several hours can have a cumulative negative effect on the baby.
A mother name Lisa was admitted to a Houston hospital for induction of labor at 41 weeks gestation. The obstetrician ordered a low dose of Pitocin to start contractions. Lisa’s contractions never exceeded five in 10 minutes, so by definition, she didn’t experience what ACOG calls tachysystole. However, her contractions were consistently at four to five per 10 minutes for several hours, with some contractions lasting up to two minutes. Discover more about maternal deaths in our article “Mom dies after childbirth, hospital under investigation”.
Lisa’s baby started showing subtle signs of distress on the fetal heart monitor, with decreased variability and occasional variable decelerations. Despite these warning signs, the Pitocin drip wasn’t reduced, and the frequent contractions continued. By the time an emergency C-section was performed, Lisa’s baby had suffered moderate oxygen deprivation, resulting in a brain injury and developmental delays.
The Dangers of Excessive Uterine Activity
When the uterus contracts too frequently, too intensely, or for too long, it can compromise the blood flow to the placenta. This is because during a contraction, the blood vessels in the uterus are compressed, temporarily reducing the oxygen supply to the baby. Normally, there’s enough time between contractions for the baby to recover. However, with excessive uterine activity – even if it doesn’t meet the formal definition of tachysystole — the baby may not have sufficient time to recuperate, leading to a progressive oxygen deficit.
This oxygen deprivation, if prolonged, can result in:
1. Hypoxic-ischemic encephalopathy (HIE) 2. Brain damage 3. Cerebral palsy 4. Other neurological disorders 5. Stillbirth or neonatal death
Legal Issues in Excessive Uterine Activity Cases
From a legal standpoint, cases involving excessive uterine activity often hinge on several key issues:
1. Failure to Properly Monitor and Interpret
The standard of care requires continuous fetal monitoring during labor, especially when Pitocin or other labor-inducing drugs are used. This monitoring should include:
- Tracking the frequency, intensity, and duration of contractions
- Monitoring the fetal heart rate for signs of distress
- Correlating contractions with fetal heart rate patterns
In Lisa’s case, the labor and delivery nursing staff failed to recognize the pattern of frequent and prolonged contractions and its correlation with the baby’s worsening heart rate tracings, even though it didn’t meet the formal criteria for tachysystole. This failure to properly interpret the monitoring data is a common basis for medical negligence claims.
2. Improper Use of Labor-Inducing Drugs
Pitocin and other oxytocin derivatives are powerful drugs that require careful administration and monitoring. The standard of care dictates that these drugs should be:
- Started at a low dose
- Gradually increased as needed
- Reduced or stopped if signs of fetal distress or excessive uterine activity occur, even if it doesn’t meet the formal definition of tachysystole
Misuse of these drugs, such as maintaining or increasing the dosage despite signs of fetal distress, can form the basis of a medical negligence claim.
3. Delayed Response to Fetal Distress
When signs of fetal distress appear, such as decreased variability or decelerations in the fetal heart rate, the medical team must act promptly. This may involve:
- Reducing or stopping Pitocin
- Changing the mother’s position
- Administering oxygen to the mother
- Preparing for an emergency C-section if the situation doesn’t improve
In Lisa’s case, the delay in recognizing fetal distress and failure to adjust the labor management were critical factors in the resulting injury to her baby.
4. Inadequate Communication and Chain of Command
In many hospitals, obstetricians give the order to induce labor with Pitocin and then leave it up to the labor and delivery nurses to increase (titrate) the dosage at regular intervals. It’s also a nursing responsibility to continuously reassess the patient and fetal heart monitoring. When there are concerning signs, the standard of care requires them to reduce or stop Pitocin to allow the baby time to recover. You can read more about fetal heart monitoring in our article, “What you should know about fetal heart monitoring and fetal distress”.
Effective communication among the healthcare team is also important. Labor and delivery nurses should promptly report concerning findings to the obstetrician, even if the uterine activity doesn’t meet the formal criteria for tachysystole. If they’re unable to reach the doctor or disagree with the doctor’s assessment, they should utilize the hospital’s chain of command to advocate for the patient.
I’ve handled cases where labor and delivery nurses noticed problems but failed to effectively communicate their concerns or use the chain of command when necessary. This breakdown in communication can have devastating consequences.
Proving Medical Negligence in Excessive Uterine Activity Cases
To successfully pursue a medical malpractice claim involving excessive uterine activity, we need to establish four key elements:
1. Duty of Care: We must show that the healthcare providers (obstetrician or OB/GYN, and labor and delivery nurses) had a professional duty to the patient. This is typically straightforward in a hospital setting.
2. Breach of Standard of Care: We need to demonstrate that the care provided fell below the accepted medical standard. This often involves expert testimony from obstetricians, labor and delivery nurses, and other specialists who can explain how the care deviated from accepted practices. In cases where the uterine activity didn’t meet the formal criteria for tachysystole, this involves explaining why the level of activity was still dangerous for that particular patient.
3. Causation: We must prove that the breach of the standard of care directly caused the injury to the baby. This often requires testimony from neonatologists (physicians who specialize in caring for critical patients in the first weeks of life) and pediatric neurologists to link the excessive uterine activity to the specific injuries suffered.
4. Damages: Finally, we need to show that the injury resulted in significant damages. In cases of developmental delays or other neurological injuries, the lifelong costs of care can be substantial.
It’s important to note that in Texas, as in many states, there are strict time limits for filing medical malpractice claims. The statute of limitations is generally two years from the date of the injury, the deadline is longer for claims involving minors.
With that said, it’s important to realize that under Texas law the parents own a minor’s legal claims for necessary medical expenses up to the age of 18. This is frequently a considerable sum and is governed by the general two-year statute of limitations.
Preventing Harm from Excessive Uterine Activity
While legal action can help families cope with the financial burden of a birth injury, every parent will agree that preventing injury in the first place is always preferable. Doctors, nurses, and healthcare providers can reduce the risk of harm from excessive uterine activity by:
Carefully monitoring uterine activity and fetal heart rate during labor, paying attention to the frequency, intensity, and duration of contractions
Using labor-inducing drugs judiciously and according to established protocols
Promptly recognizing and responding to signs of fetal distress, even if uterine activity doesn’t meet the formal criteria for tachysystole
Maintaining open communication among the healthcare team
Being prepared to adjust labor management or perform emergency C-sections when necessary
What to Do If You Suspect Birth Injury Medical Negligence
If you believe that you or your baby has been harmed due to excessive uterine activity and potential medical negligence, it’s crucial to take action promptly. Here are some steps you can take:
Obtain Medical Records: Request complete copies of all relevant medical records, including labor and delivery notes, fetal monitoring strips, and neonatal records.
Seek Appropriate Medical Care: Ensure that your baby receives all necessary medical care and follow-up.
Document Everything: Keep a detailed record of your baby’s symptoms, treatments, and any communications with healthcare providers.
Consult with a Specialized Attorney: Medical malpractice cases, especially those involving birth injuries, are complex. It’s crucial to work with an attorney who has experience in this specific area of law and understands the nuances of uterine activity during labor.
As a top-rated, experienced Texas medical malpractice attorney, I’ve helped many families navigate the challenging aftermath of birth injuries caused by Pitocin and excessive uterine activity. These cases require a deep understanding of both medical and legal issues, as well as the ability to work with expert witnesses to build a strong case.
Remember, while most healthcare providers strive to provide excellent care, mistakes can happen. When those mistakes cause serious harm, it’s important to hold the responsible parties accountable. This not only helps the affected families but also drives improvements in patient safety that can prevent future tragedies.
If you believe that you or your baby has been harmed due to excessive uterine activity or other forms of medical negligence during labor and delivery in Texas, don’t hesitate to reach out for a free consultation. Together, we can review your case, explain your legal options, and help you make informed decisions about how to proceed.
