Even after a normal pregnancy without any complications, the time for delivery can be cause for concern if the baby is in a dangerous birth position. When the baby is not presenting in a head-forward position, it can make delivery more difficult. Delivery complications can cause extended labor or put the mother and baby at risk of injury. It is important for the doctor and mother to be aware of birth position complications and what it might mean for the safety of the baby.
What is an Abnormal Birth Position?
The position of the baby during labor has a big impact on how the delivery will go. The most common position for the baby is facing backward (towards the back of the mother), with the head first towards the feet. During vaginal delivery, the head will present first, angled toward one side with the neck flexed. Other fetal presentations may be a cause for concern because they could make delivery more difficult.
An abnormal position and presentation of the fetus can increase the risk of injury to the mother or the baby. Abnormal birth positioning can also delay delivery, increasing the risk of other birth complications like perinatal hypoxia. Abnormal birth positions include:
- Face-forward presentation
- Brow presentation
- Shoulder presentation
- Frank breech presentation
- Complete breech presentation
- Occiput or cephalic posterior position
- Transverse lie presentation
- Footling breech
Frank Breech Presentation
In a frank breech presentation, the baby’s buttocks are presenting. This birth position may have an increased risk of umbilical cord knotting or cut-off of the blood and oxygen supply.
Complete Breech Presentation
A complete breech involves the baby presenting buttocks first with flexed hips and knees tucked underneath. This presentation could increase the risk of umbilical cord problems or cut-off.
Occiput or Cephalic Posterior Position
Head-down and rear-facing is the normal birth position but when the face is forward (towards the mother’s belly, it may complicate delivery. Sometimes referred to as a “sunny-side up” presentation, it can delay delivery and make the delivery more painful for the mother.
Transverse Lie Presentation
A transverse lie occurs when the baby is lying crosswise in the uterus. This may make the baby present shoulder-first, increasing the risk of injury to the mother or baby and delay delivery.
Footing breach is presenting with one or both feet first. Like the breech position, this could increase the risk of injury caused by the umbilical cord getting knotted, cut-off, or blocking that limits blood and oxygen to the baby.
Delivery Options with Abnormal Birth Position
Depending on the birth position, there may be limited delivery options available. In some cases, such as occiput posterior presentation, delivery may be accomplished through assisted delivery, including a vacuum extractor or forceps. In other cases, a cesarean delivery may be necessary.
When there are birth complications, there may be an increased risk of injury to both the mother and the baby. Birth complications may include:
- Nuchal cord where the umbilical cord is wrapped around the baby’s head
- Umbilical cord prolapse when the umbilical cord comes out of the birth canal before the baby
- Hemorrhage or excessive bleeding after childbirth
- Hypoxia or reduced oxygen to the baby’s brain
Until the baby begins to breathe with the baby’s mouth and lungs, the baby relies on oxygen from the mother through the placenta and umbilical cord. Any problems with the umbilical cord may cut off the oxygen supply to the baby, increasing the risk of brain damage. Abnormal birth presentation and cut off the umbilical cord, cause the cord to become tangled or knotted. As soon as an abnormal birth presentation is identified, the medical team should act to make sure the baby’s oxygen supply will not be impaired.
Physical Injury to the Mother With Abnormal Presentation
A risk to the mother during delivery involves bleeding injuries. Some blood loss is normal in childbirth but serious blood loss that is not properly treated can lead to shock and death. Hemorrhagic shock is caused by the loss of blood. Hypovolemic shock occurs when there is a decrease in the volume of blood in the body that can compromise the body’s ability to pump blood and oxygen throughout the body.
Physical Injury to the Baby With Abnormal Presentation
Physical injury to the baby can occur with an abnormal presentation. A common birth injury involves damage to the arm and shoulder known as shoulder dystocia. When the baby’s shoulder fails to rotate through the birth canal, it can be obstructed by the mother’s pelvic bones. In trying to deliver the baby, shoulder dystocia can cause brachial plexus injury, Erb’s palsy, or clavicle fracture.
Other physical birth injuries can include:
- Cerebral hemorrhage
- Spinal cord injury
- Facial paralysis
- Broken bones
- Eye injury
Brain Injury to the Baby With Abnormal Presentation
Physical trauma to the head or brain can cause brain injury but oxygen deprivation is a more common cause of brain injury in childbirth. The brain and vital organs require a steady supply of blood and oxygen. As soon as the oxygen supply is limited, it can begin to cause damage. Initially, the body may shift blood to the brain to prioritize function to the vital organs but cell death will shortly follow if oxygen is not restored. This can cause permanent brain damage, leading to developmental delays, physical disability, and mental disability.
Brain injury caused by lack of oxygen generally occurs when there is a problem with the umbilical cord or the placenta is separated from the mother. When the placenta is separated as part of delivery or separates early because of placental abruption, the mother’s oxygen supply is cut off to the baby. The only way to restore oxygen is through delivery of the baby to breathe unassisted or to provide oxygen support to the baby.
The other primary cause of oxygen deprivation is caused by problems with the umbilical cord. In a problem delivery, this may occur when the umbilical cord is knotted, compressed, or wraps around the baby’s neck. When the umbilical cord supply is compromised, correcting the problem generally involves emergency delivery or addressing the umbilical cord issue to restore blood and oxygen flow.
Birth Injury Attorneys
If parents have questions about injuries caused by negligent care during childbirth, an experienced medical malpractice attorney can help the family recover damages and hold the doctors and hospitals accountable for their failures. Do not hesitate to contact Gilman & Bedigian today for a free consultation.