Sadly, a common type of birth injury claim is one involving neurologic injury to a newborn caused by the failure of the obstetrical team (doctors, nurses, midwives) to intervene or expedite delivery in the face of fetal distress. If the baby is incapable of tolerating the intrauterine environment for whatever reason, an urgent delivery by caesarian section or other means may be necessary. The failure to deliver the baby promptly in these circumstances can lead to oxygen deprivation, a condition known as hypoxia.
Severe or prolonged hypoxia can lead to decreased blood supply to the baby’s organs, called ischemia, and can result in permanent injury to the baby’s brain and other vital organs. Hypoxic-ischemic encephalopathy or HIE is a condition involving injuries to a baby’s brain caused by lack of oxygen (“encephalopathy” simply means brain sickness). Babies with these types of injuries may later develop permanent neurologic conditions such as cerebral palsy (CP) or other cognitive and developmental problems. Although CP has a variety of other causes, a significant number of CP cases, in absolute terms, can be attributed to impaired oxygenation during labour and delivery.
A number of factors can lead to this type of injury. These include, but are not limited to:
- Umbilical cord compression;
- Abnormal uterine contractions, particularly those occurring too frequently or lasting too long;
- Shoulder dystocia
- Low blood pressure in the mother (maternal hypotension):
- Rupture of the uterus;
- Placental abruption;
- Excessive pressure on the baby’s head during uterine contractions.
The obstetrical team is charged with monitoring fetal and maternal well-being during labour and delivery. They can monitor the baby’s well-being using a variety of surveillance techniques, including electronic fetal heart monitoring (EFM). EFM will invariably give clues about how the baby is tolerating the contractions and the stresses of labour. If a baby is deprived of oxygen, this will cause changes in the heartbeat; these changes will be evident on the EFM tracing.
Warning signs on EFM tracings must be heeded by the obstetrical team. The failure to intervene in the face of worrisome changes on the EFM tracing can result in serious injury to the baby, including HIE. Such medical errors can form the basis of a successful birth injury claim.