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Intrapartum Asphyxia

Oxygen and energy are necessary for the body to function. For everyone from children to the elderly, breathing oxygen and consuming calories are what allow our bodies to move and our brains to think. Decreases in oxygen and energy can impair body function and continued depletion may cause the body to begin to break down, resulting in cell death, organ failure, and even death. 

When a baby is in the womb, the fetus has to rely on the mother for oxygen and energy. Oxygen and energy are provided through the mother’s connection through the placenta and umbilical cord. During childbirth and delivery, the baby transitions between relying on the mother’s oxygen supply to breathing air outside the womb. 

The transition period between inside and outside the womb is generally the most important to monitor the baby, to make sure the child is getting enough oxygen. If the baby is not breathing on its own or oxygen is not getting to the lungs and blood supply, supplemental oxygen may be necessary to prevent organ damage and brain damage. Oxygen deprivation can cause the child to suffer brain injury, hypoxic-ischemic encephalopathy, coma, or death. 

The time inside the womb is just as important as the transition outside the womb. The baby needs a continuous oxygen supply. However, it may be more difficult to monitor the baby inside the womb compared to after the child is born. Doctors need to be aware of changes in the baby’s heart rate, signs of stress, and other indications that there is a problem while the baby is still in the womb. Failure to treat oxygen deprivation inside the womb can lead to serious birth injuries.

What is Intrapartum Asphyxia?

Asphyxia is the impaired exchange of oxygen and carbon dioxide, which we think of as “breathing.” If someone is deprived of oxygen for long enough, it can lead to a state of respiratory and metabolic acidosis. Respiratory acidosis is a condition where the body is not able to remove enough carbon dioxide (CO2), which causes the pH of the blood to decrease, making the blood too acidic. Metabolic acidosis is a condition that is caused by increased acid production. 

Intrapartum asphyxia or intrauterine asphyxia can be suspected by signs of fetal stress, passage of meconium or meconium staining, monitoring the fetal heart rate, or through taking fetal blood samples. 

Asphyxia and Fetal Acidosis

In a baby, acidosis can cause birth complications, brain injury, or death. Fetal acidosis is a condition where the body fluids are too acidic. A pH level of 7.35 or lower is considered acidosis. Metabolic acidosis can be caused by problems in oxygen diffusion through low oxygen levels or hypovolemia. Fetal metabolic acidemia is defined as an umbilical vessel pH of less than 7.20. 

Respiratory acidosis is generally caused by a buildup of carbon dioxide in the blood. Respiratory acidosis in the fetus may be caused by problems in the mother, like a low breathing rate or conditions affecting the lungs, like asthma or emphysema. Respiratory acidosis can also be caused by problems in the placenta or umbilical cord that prevent carbon dioxide from being carried away from the fetus. 

Intrapartum Asphyxia vs. Perinatal Asphyxia

Intrapartum and perinatal are sometimes used interchangeably. Some of the terms can overlap or have multiple applications, which can make it difficult for parents to understand what the doctors are talking about when they change terms. 

Intrapartum asphyxia: Intrapartum means “occurring during labor or delivery.” This can mean any oxygen deprivation from just before, during, and after delivery. 

Perinatal asphyxia: Perinatal means “relating to the period shortly before and after birth.” This can mean any oxygen deprivation from just before, during, or after delivery.

Intrauterine asphyxia: Intrauterine means “within the uterus.” Intrauterine asphyxia generally refers to asphyxia while the fetus is still in the womb. 

Birth asphyxia: Birth asphyxia is a general term that may refer to asphyxia before, during, or after delivery, as well as within the womb. 

Every fetus experiences some level of hypoxia or elevated carbon dioxide during normal vaginal delivery. This makes it difficult to define the exact level of asphyxia that may cause problems for newborn infants. The most important aspect of treating a child is monitoring the child’s vital signs, acid levels, breathing rate, oxygen levels, and other signs and symptoms of distress, hypoxia, and acidosis. 

Intrapartum Asphyxia and Hypoxic-Ischemic Encephalopathy (HIE)

Intrapartum asphyxia is sometimes used interchangeably with hypoxic-ischemic encephalopathy (HIE). However, generally, asphyxia refers to the lack of oxygen and HIE is the brain injury that results from oxygen deprivation. Hypoxic-ischemic encephalopathy is a type of brain injury caused by the lack of blood and oxygen to the brain. 

When there is a lack of oxygenated blood to the brain, or ischemia, the body tries to compensate by moving blood and oxygen away from other parts of the body to prioritize oxygen to the brain and other vital organs. If the brain continues to suffer from oxygen deprivation, brain cells begin to die off. Brain cell death is generally permanent and after only a few minutes, a baby may suffer a permanent brain injury. 

Neonatal Complications of Intrapartum Asphyxia

Intrapartum asphyxia is associated with a number of neonatal complications, the most serious of which are multiorgan failure, encephalopathy, neurological impairment, problems with motor development, and death. One of the disorders associated with asphyxiated term infants is cerebral palsy

Cerebral Palsy

According to the Mayo Clinic, cerebral palsy is “a disorder of movement, muscle tone or posture that is caused by damage that occurs to the immature, developing brain, most often before birth.” Cerebral palsy can affect different areas of the brain and cause different types of movement disorders including spasticity, uncontrolled movements, and poor balance or coordination.

Cerebral palsy caused by intrapartum asphyxia commonly involves dyskinetic or spastic quadriplegia types. Spastic quadriplegia/quadriparesis involves all four limbs, the trunk, and the head. These individuals may not be able to walk, suffer developmental disabilities, have problems speaking or hearing, and suffer seizures. Dyskinetic CP involves uncontrollable movements of the hands, arms, feet, and legs. Individuals may be unable to walk or find it difficult to sit down. The uncontrolled movement may also affect the head and face, making it difficult to eat, swallow, or talk. 

Asphyxia Birth Injury Malpractice Lawyer

How does a medical error lead to asphyxia, encephalopathy, and brain injury? The fetus is sensitive to any changes in body chemistry, including reduced oxygen levels. If the baby’s oxygen levels are falling, blood or body fluids are becoming more acidic, or the fetus shows signs of stress, it is important for the medical team to take action. Delays, improper delivery techniques, or failure to monitor are errors that can lead to a serious birth injury. 

Even when the doctor or hospital knew they made a mistake, they may not admit any wrongdoing. Parents may struggle to get answers, only to get the runaround from the hospital. Contacting an experienced birth injury attorney may be the best way to get the answers you need.  

If you suffered negligent medical care during childbirth, talk to an experienced birth injury malpractice attorney about your options for recovery. Do not hesitate to contact Gilman & Bedigian today for a free consultation.

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