Birth Injury and Birth Trauma
Do you suspect birth injury malpractice or negligence?
Parents having a baby offers so much joy and unexplainable happiness that can never be equaled by anything in the world. However, this experience can be overwhelming when a birth injury or birth trauma occurs. Children can become permanently disabled, requiring life-long care or, worse yet, even die from a birth injury. Parents, siblings, grandparents, and other loved ones may experience overwhelming and devastating physical, emotional, and financial hardships as a direct result of a child injured at birth.
Potter Burnett Law’s birth-related injury attorneys can assist you in determining whether your baby was injured due to medical negligence. When a healthcare professional’s performance falls below the standard of care expected or required in the medical community, this is referred to as medical negligence. Following a birth injury, parents may elect to file a medical malpractice/negligence lawsuit against the doctor(s), nurses, or other medical professionals who were involved with the care and treatment during the delivery of their child.
Do you suspect that your infant may have suffered a birth injury or birth trauma? If so, get medical attention for your child right away. Timely and proper treatment of the suspected or recognized birth injury will increase the odds that your infant will survive with as little damage as possible.
Failure to recognize and treat a serious birth-related injury may lead to a lifetime of expensive medical care. Your child should be able to benefit from the most advanced treatment available to increase their quality of life after birth and beyond. There is a big difference between the most advanced treatment and the treatment and services covered by private medical insurance and programs like Medicaid.
Many preventable issues can transpire during pregnancy or delivery that are hazardous to an infant. There are many different types of birth injuries that have temporary to long term damaging effects. Common birth injuries include: Bleeding in and around the brain, nerve injuries, birth-related bone injuries, injuries to the skin, dermis, and subcutaneous soft tissues, and Perinatal asphyxia which may lead to permanent signs ranging from mild learning disorders to delayed development to cerebral palsy.
Many injured children require continuous medical treatment with a variety of pediatric specialists depending upon their specific injury. Determining the level of care needed and who will pay for specialized care can be a daunting and overwhelming process for parents. If your child has suffered preventable birth injuries, the compensation you may receive from a successful birth injury lawsuit might be the only realistic option to provide the medical services and supervised care your child deserves to maximize their recovery and quality of life.
Obstetrics and gynecology (OB/GYN) providers embrace the responsibility of anticipating any potential problems reasonably foreseeable, and where necessitated, the authority to actively intervene during labor and delivery to prevent harm. Negligence—the failure to act in accordance with accepted standards of care—are correspondingly at the center of birth injury.
The most common birth trauma and birth injury causes include:
- Miscalculations of the size of the fetus
- Improper dating that causes post- or pre-mature delivery
- Infections and medical problems in the mother or the fetus
- Rh incompatibilities (blood incompatibility between mother and baby)
- Improper medications administered during pregnancy and/or delivery
- Lack of responding to fetal distress due to improper fetal monitoring
- Abnormal presentation which also includes shoulder dystocia
- Failure to actively performing a timely c-section
- Delivery instruments used improperly (forceps or vacuum suction)
- Newborns failing to receive oxygen when required (hypoxia birth injury)
The consequences of injuries to a baby during difficult labor and delivery may range from mild to severe and may be temporary or permanent. These traumatic birth-related injuries may involve the other parts of the body and specifically, the brain. Some of the most common preventable birth injuries may even result in death.
Preventable birth injuries that are the most common include:
- Brain injury from birth (which also includes Cerebral Palsy)
- Brachial plexus birth injuries (including Erb’s Palsy)
- Kernicterus resulting from untreated jaundice
- Meconium aspiration
- Excessive and abnormal bleeding
- A myriad of Infections
- Subcutaneous bleeding beneath the scalp
- Subdermal bleeding inside the skull
- Bruising resulting from improper use/force from forceps
- Internal Skull fractures
- Clavicle fractures and resulting trauma
- Cranial nerve trauma
- Traumatic spinal cord damage
- Irreversible facial paralysis
- Skin irritations and dermis reactions
- Soft tissue injuries including muscles, ligaments, and tendonsStillbirth after 20th week of pregnancy
Bleeding around and within the brain (intracranial hemorrhage) is typically caused by the rupture of blood vessels which may have originated during birth. These blood-related issues may include:
- Injuries sustained at birth
- Decreases of delivery of blood or oxygen to the brain which may result in significant illness in the newborn
- A severe issue with blood clotting
Most infants with bleeding will not exhibit external symptoms, whereas others may show outward signs such as being sluggish (lethargic), they may feed poorly, or might even show signs of minor to extreme bodily seizures. There can be many causes of bleeding and it is important to understand that early diagnosis and treatment is critical following delivery.
Bleeding in the brain is much more common among very premature infants following delivery. There is also an increased risk of bleeding in the brain by newborns who have bleeding disorders (such as hemophilia).
This typically is a solid swelling of clotted blood within the tissues. Bleeding can occur in several places in and around the brain:
- The most common type of intracranial hemorrhage in newborns, usually occurring in full-term newborns is subarachnoid hemorrhage. This type of bleeding is found below the innermost of the two membranes covering the brain. Infants with subarachnoid hemorrhage may occasionally have apnea (periods when they stop breathing), traumatic bodily seizures, or some form of lethargy during the first 48-72 hours of life but, when recognized, have a low mortality rate.
- Subdural hemorrhage, much less common because of improved childbirth techniques, is bleeding between the outer and the inner layers of the brain covering. Increased pressure on the surface of the brain is a direct result of subdural hemorrhage and newborns with this condition may develop increased problems such as seizures.
- Epidural hematoma, bleeding between outer layers (dura mater) of tissue covering the brain (meninges) and the skull, may be caused by a skull fracture. If the soft spots between skull bones (fontanelles) from an epidural hematoma bulge, this will increase the pressure in the brain. Newborn infants with epidural hematoma may exhibit dramatic episodes of apnea or involuntary seizures.
- Intraventricular hemorrhage is when bleeding fills the normal fluid-filled spaces (ventricles) in the brain.
- Intraparenchymal hemorrhage occurs directly into the brain tissue. Intraventricular hemorrhages and intraparenchymal hemorrhages typically occur in premature newborns usually as a result of an infant’s underdeveloped brain. Though these hemorrhages don’t cause outwardly recognizable symptoms, large hemorrhages may cause apnea or bluish-gray skin discoloration. Additionally, as an extreme reaction to large hemorrhages, the newborn’s entire body may suddenly stop functioning. Newborns diagnosed with large hemorrhages unfortunately have a poor prognosis; infants with small hemorrhages when recognized, have a low mortality rate. Newborns with hemorrhages—large or small—may be admitted for monitoring in a neonatal intensive care unit (NICU), additional supportive care (including warmth), administering of fluids given by vein (intravenously), and additional other vital treatments to maintain body function.
Nerve injuries—minor or life-threatening—may occur pre-delivery or during delivery. These nerve-related birth injuries typically cause weakness of the muscles controlled by the affected nerve. Nerve injuries symptoms may be observed through:
- A lopsided facial expression, resulting from facial nerve damage, or facial palsy
- Arm and/or hand weakness, called Brachial plexus nerve damage
- Difficulty breathing, called Phrenic nerve damage
- Paralysis, known as spinal cord damage which is very rare
When a newborn cries, and the face appears lopsided (asymmetric), a facial nerve injury may be suspected, such as facial palsy. This loss of controllable (voluntary) muscle movement in an infant’s face is usually due to pressure on the facial nerve in the face just before or at the time of birth. Facial nerve weakness can be temporary or permanent, and symptoms may persist throughout the life of the child into adulthood. The cause of this nerve injury may include:
- The fetus position in the uterus before birth
- The facial nerve being pressed against the mother’s pelvis during delivery
- Improper use of forceps to assist the delivery
The large group of nerves between the neck and shoulder, leading to each arm is called the brachial plexus. Neuropraxia is the mildest form of brachial plexus injury which involves the stretching of the nerve. A neuroma is more severe—where the nerve is torn and does not heal properly. Rupture involves the tearing of the nerves, yet they remain attached to the spine. An avulsion is the most severe condition of brachial plexus—where the nerve roots are completely dislodged from the spine, creating complete paralysis. One or both of the baby’s arms, during a difficult delivery, can be improperly stretched, injuring the nerves of the brachial plexus, causing weakness or paralysis of part or all of the infant’s arms and/or hands. When there is a weakness of both the shoulder and elbow, this nerve damage is called Erb palsy. When nerve damage results in a weakness of the hand and wrist, it is called Klumpke palsy. Brachial plexus injuries are related to difficult deliveries, typically involving large babies who should’ve been delivered via C-section (caesarian), and not vaginally.
When Brachial plexus birth injuries are suspected, recommendations state to heal the nerves, extreme movements at the shoulder should be avoided. Milder injuries resolve over a few days, however, if the abnormality is more severe or lasts for more than 1 or 2 weeks, proper positioning and gentle movement of the arm through physical therapy or occupational therapy is strongly advised. Doctors urge parents that if there is no improvement over a 1-2 month period, a pediatric neurologist and/or orthopedist at a pediatric specialty hospital should evaluate the baby to decide whether surgery may be beneficial for future movement.
The nerve traveling to the diaphragm (the muscular wall that separates the organs of the chest from those of the abdomen and assists in breathing), is called the phrenic nerve. When this nerve is damaged, it results in the same-side paralysis of the diaphragm. The newborn may exhibit difficulty in breathing and sometimes, may require assistance with breathing.
Spinal cord injuries, a result of overstretching during delivery, are rare. In breech deliveries (born bottom-first instead of head-first), the lower cervical and upper thoracic regions of the spinal cord are the most likely to be injured. Spinal cord damage may occur when there is a blunt force trauma that affects the spine. This manifests in the form of a bruise (a contusion) or even a complete tear (a transection). Spinal cord damage can also come from a lack of diagnosis or misdiagnosis of spina bifida, a condition where the vertebrae doesn’t completely enclose the raw nerves of the spine. An infant with spina bifida –especially myelomeningocele—the nerves of the spinal column are at risk of injury, especially when the medical staff touches or damages the nerves because they are unaware of the condition. Nerve damage resulting from a spinal cord injury may result in paralysis below the specific site of the injury and are often permanent. In general, the higher up in the spine that the injury occurs, the more serious the damage will be. Spinal cord injuries that occur high up in the neck can be fatal because they prevent the newborn from breathing properly.
Cerebral Palsy is one of the most common causes of brain disorders affecting infants in the United States. According to the CDC, it affects around 4 children out of every 1,000 children. How these deficiencies affect the individual will vary depending on what type of disorder the person has. Cerebral palsy is often used as an umbrella term, but there are several different types, each with unique characteristics.
Knowing the type is important in finding the right treatment and therapy to improve mobility and independence:
- Spastic- This is the most common type that includes stiff muscles that may become weak or paralyzed, which can affect the ability to walk.
- Athetoid- This form may result in rigid, involuntary movements as well as overactive facial muscles.
- Ataxic- This condition is unique as it affects balance and coordination more than movement. It may result in speech problems, abnormal walking, tremors, and vision problems.
- Mixed- A result of more than one type of cerebral palsy resulting in any combination of symptoms.
Children affected by cerebral palsy may have difficulty walking or speaking. They may experience tremors, seizures, involuntary movements, or lack of muscle coordination. The child’s symptoms may be less noticeable or show up in the form of delayed milestones such as sitting up and crawling, excessive drooling, difficulty swallowing, or muscle tone that feels too floppy or too stiff.
Cerebral Palsy means there is a partial dormancy or paralysis of a baby’s brain. In many cases, the baby’s hearing, touch sensation, and vision are also affected. Cerebral palsy develops as a result of brain malformation before, during, or shortly after birth. However, the vast majority of cerebral palsy cases occur just before or during childbirth.
There can be many causes for cerebral palsy, but some of the more common causes include:
- Lack of oxygen to the brain during childbirth
- Maternal infections
- Labor complications such as a breech birth
- Bleeding into the brain
- Head injuries
When medical professionals fail to take the necessary precautions, fail to diagnose a condition, or fail to treat a condition that another doctor would have caught; the subsequent Cerebral Palsy diagnosis could be the result of medical malpractice.
A newborn’s bones may be broken (fractured) during delivery, even when the delivery is considered normal by all other observations.
- In 1 to 2% of newborn birth injuries, a collarbone (clavicle) fracture is considered relatively common. A lump of tissue forms around the fracture which are not usually recognized until several days after delivery.
- When fractures of the upper arm bone (humerus) or upper leg bone (femur) occur, physicians typically apply a loose splint to limit the newborn’s extremities movements. These fractures may cause pain with movement in the first few days, but fractures usually heal quickly—unless the head of the bone (where growth occurs) is part of the fracture.
The newborn’s skin may exhibit minor injuries after delivery, especially those areas receiving additional pressure during pre-delivery contractions, or bodily surfaces that first emerge from the birth canal during delivery. Forceps and assorted instruments required for normal delivery procedures, can certainly injure the skin. Following breech deliveries, swelling and bruising may appear around the eyes and face during face-first deliveries, and on the genitals. No additional treatments are required for these bruises which usually dissipate very quickly.
Added stress on the newborn (such as asphyxia) and the use of delivery instruments during delivery can injure the subcutaneous fat under the skin. This skin injury appears red, somewhat firm, with raised areas on the trunk, arms, thighs, or buttocks of the newborn. This type of injury, again, usually resolves on its own over weeks to months. If it does not resolve, this may indicate a more serious problem.
A decrease in blood flow to the baby’s tissues, or decrease in oxygen in the baby’s blood pre-, during, or post- delivery is called Perinatal asphyxia. Some of the most common causes of Perinatal asphyxia include the following:
- Placenta has separation from the uterus before delivery (placental abruption)
- Umbilical cord blood flow due to obstruction
- Fetus with abnormal development (specifically, when there is a genetic abnormality)
- Fetus with a severe infection
- Certain drugs exposure before birth
- Severe maternal hemorrhage or illness
Infants who have experienced decreased oxygen will appear pale and lifeless at birth. They have a very slow heart rate and breathe weakly, or sometimes, not at all. Newborns with these symptoms must be revived (resuscitated) immediately. The use of a resuscitation bag and mask pushes air into the lungs or insertion of a breathing tube in the newborn’s throat (endotracheal intubation). The newborn may be in shock if asphyxia resulted from rapid blood loss. In this case, infants are immediately given fluids by vein, sometimes requiring a blood transfusion.
Newborns with asphyxia may show signs of injury to one or more organ systems, including:
- Heart: Poor color, low blood pressure
- Lungs: Difficulty breathing and low oxygen levels
- Brain: Lethargy, seizures, or even coma
- Kidneys: Reduced output of urine
- Liver: Difficulty digesting milk
- Blood forming system: Low platelet count and bleeding
To assist with their proper heart function, newborns may need drugs and a mechanical ventilator to support their breathing. Some revived newborns may benefit from having their body temperature lowered below the normal temperature of 98.6° F (37° C) for up to 72 hours. To manage problems with the blood-forming system, blood cell transfusions and plasma may be necessary for the infant following delivery. If timely recognized, organs damaged by perinatal asphyxia can recover, but brain damage may persist and should be monitored for immediate treatment. Babies who receive proper care with minimal injury to the brain may be completely normal. However, babies who do not receive proper care may have moderate to severe injury to the brain and exhibit more permanent signs of damage. These permanent signs may range from mild learning disorders to delayed development to cerebral palsy. Some severely asphyxiated infants do not survive following post-delivery and specialty treatments.
Was Your Child Injured at Birth?
Birth injuries can cause permanent damage. Our experienced team of attorneys can help your family determine whether your child may have been a victim of medical malpractice. If your baby was harmed because of negligent medical care, you have the right to compensation. Our legal team has worked with a number of insurance companies over the years on birth injury and birth trauma cases that resulted in a medical neglect settlement. You can rely on the pride at Potter Burnett Law to use that “inside information” to help protect the rights of you and your loved ones impacted by a loss or set-back due to a birth injury. Contact Potter Burnett Law today to discuss your available options.
Please let us provide a free legal evaluation of your birth injury or birth trauma claim. We’ll find out if your child’s injury could have been avoided.