Perinatal Injury

After carrying a child for almost 9 months, with no major complications, a mother may expect the labor to go as planned with the delivery of a healthy baby. However, the period right before, during, and immediately following delivery can still be a very dangerous time for the baby and mother. When something goes wrong, time is of the essence to make sure the baby does not suffer a brain injury from lack of oxygen. 

Failure to properly monitor the mother and baby, delayed treatment, or delayed delivery can increase the risk of a perinatal injury to the mother and the baby. When medical errors cause a birth injury, the doctors and hospitals may be liable for damages. If you have any questions about a perinatal birth injury, talk to a medical malpractice attorney for help.

What is a Perinatal Injury?

A perinatal injury occurs in the period surrounding the birth. This could include shortly before, during, or after delivery. This can be a critical time when the baby has to transition from surviving off oxygen, blood, and nutrients from the mother to separating from the womb and breathing oxygen from the air. 

A perinatal injury before birth can involve oxygen deprivation caused by injury to the mother, the mother’s medical condition, reaction to drugs or anesthesia, or other mechanism which prevents the flow of oxygenated blood from reaching the baby’s brain. 

During birth, the baby may still be at risk of oxygen deprivation through problems with the umbilical cord that cuts off oxygen to the baby. During birth, the baby may also be at risk of injury if the baby is too big for the birth canal or there are problems delivering the baby. 

Immediately after birth, a baby may still be at risk of injury, including brain injury caused by oxygen deprivation. Complications like meconium aspiration can cause respiratory distress where the lungs are not able to get enough oxygen. 

Prenatal, Neonatal, and Perinatal 

The terms perinatal, prenatal, and neonatal can overlap, which may cause confusion for parents trying to find information about their child’s care and treatment options. In some cases, multiple terms may be used to discuss the same thing or the terms are alternated. 

• Prenatal – Prenatal generally refers to the time before and up until birth. This could include the period from conception up until delivery. It is sometimes interchangeable with the term perinatal.
• Perinatal – Perinatal refers to the time around birth. Generally, perinatal is used for the period shortly before birth, during delivery, and immediately after birth. It is often used interchangeably with prenatal.
• Neonatal – Neonatal refers to a newborn child, for the period after the child is born. 

Common Types and Causes of Perinatal Injuries

There are many possible perinatal injuries but some of the most common can be classified as oxygen deprivation injuries or traumatic birth injuries. Oxygen deprivation injuries can cause brain injury or tissue damage when the baby does not get enough oxygen. Traumatic birth injuries may involve a difficult birth where force has to be used to deliver the baby. 

Brain Injury from Oxygen Deprivation

Brain injuries during birth are some of the most devastating for parents because they can have a lifelong impact on the family. The brain in a fetus and newborn is still growing and developing and the brain is very sensitive to any disruptions in blood supply, oxygen levels, and nutrients from the mother. Lack of oxygen before birth, during labor, or immediately after delivery can cause damage to the brain. 

Brain damage in a baby can begin within minutes of lower oxygen levels. Hypoxic-ischemic encephalopathy (HIE) is a brain injury caused by oxygen deprivation due to hypoxic or anoxic injuries. Hypoxia involves reduced blood oxygenation to the brain. Ischemia involves the diminished blood flow to the brain. Depending on the extent of oxygen deprivation, hypoxia can begin to cause brain cells and neurons to die off within just a few minutes. If oxygen deprivation continues, it can cause ischemia, or tissue death. After about 10 minutes of oxygen deprivation, death is likely and there is little chance of recovery 

If a child is deprived of oxygen in the womb or at birth, it can cause brain damage and developmental delays. Unfortunately, parents may not be aware that their child suffered a brain injury until months or years later. Some brain injuries may not become evident until age 1, 2, or 3, when the child begins missing developmental milestones. Some of the common birth injuries associated with oxygen deprivation include:

• Cerebral palsy
• Epilepsy 
• Paralysis
• Problems with the nervous system
• Vision damage
• Neurological or cognitive problems
• Behavioral issues
• Fetal death

Oxygen Deprivation in the Mother 

When the mother has a medical emergency that lowers the level of oxygen in the blood, the oxygen to the baby will also be reduced. This can range from a traumatic event, like a car accident, to anesthesia complications. After oxygen deprivation, there may only be a few minutes to treat the problem before brain injury can begin to set in. 

Injuries to the head, face, or upper airways can prevent the person from being able to breathe normally. Damage to the lungs, like a collapsed lung, can impair the person’s ability to get enough oxygen. If a person is knocked unconscious, the breathing function is generally maintained. However, if the person is not breathing, they will need emergency resuscitation and may require supplemental oxygen with mechanical ventilation to keep the blood oxygenated. Serious bleeding injuries and hemorrhage can also lower the blood volume so there is not enough blood to circulate through the body and maintain a steady oxygen supply.  

Medical conditions, diseases, and illnesses can impair lung and heart function, causing oxygen deprivation. Some examples of medical conditions that can lower oxygen levels in the mother and baby include pneumonia, paralysis, chronic obstructive pulmonary disease (COPD), asthma, and severe allergic reactions. 

Oxygen Deprivation in the Womb

If the mother’s oxygen levels are sufficient, problems in the placenta or umbilical cord can still deprive the baby of necessary oxygen. Some causes of oxygen deprivation in the womb may include: 

• Uterine rupture
• Preeclampsia
• Umbilical cord prolapse
• Nuchal cord (umbilical cord wrapped around the baby’s neck)
• Umbilical cord knots
• Umbilical cord cyst

Meconium Aspiration

The baby develops waste functions in the womb, including urination and defecation. However, these functions generally are not performed until after birth. The baby’s first stool is known as meconium. In some cases, a child may defecate while still in the womb, which can be aspirated, or breathed in, by the baby.

Meconium is a dark, greenish-black stool that can appear like tar. When the meconium is aspirated with the amniotic fluid, it can cause breathing problems after delivery. Meconium aspiration syndrome (MAS) is a serious condition, which can cause respiratory distress. Particles in the meconium may block the baby’s airway or prevent the alveoli in the lungs from getting enough oxygen, leading to oxygen deprivation. 

Traumatic Birth Injury

Delivery can be a traumatic event for the mother and baby. Most traumatic birth injuries occur when there are complications with delivering the child through the birth canal. If the baby becomes wedged or stuck, a doctor may use forceps or a vacuum device to try and get the child out. 

Difficult delivery may involve a size disproportion between the mother’s pelvis and the baby’s head. In macrosomia, the baby is larger than average and may have difficulty being delivered through vaginal delivery. In cephalopelvic disproportion, the mother’s pelvis may be too small for the baby to pass. 

Other delivery complications may involve a child in an abnormal birth position, such as breech birth (bottom first instead of head first), or shoulder presentation. These types of delivery complications can require the use of extractors, labor-inducing drugs, or emergency C-section. 

Traumatic Head Injury

Head injuries during a traumatic birth can cause permanent brain damage. Using too much force on the head, forceps, or vacuum extractors can cause pressure on the brain or bleeding in the brain. A newborn baby’s skull is much softer than an adult’s and it may only take a small amount of pressure in the wrong place to cause extensive damage. 

Bleeding in the brain can also cause brain injuries. Bleeding in the head can include:

• Cerebral hemorrhage (bleeding within the brain)
• Intracranial hemorrhage (bleeding inside the skull)
• Epidural hemorrhage (bleeding in the dura mater)
• Subdural hemorrhage (bleeding between the dura mater and the arachnoid membrane)
• Subarachnoid hemorrhage (bleeding in the space between the arachnoid membrane and the pia mater)
• Intraventricular hemorrhage (bleeding in the ventricular system, where the cerebrospinal fluid (CSF) circulates

Bleeding inside the skull or brain can cause a hemorrhagic stroke. A hemorrhage inside the brain can damage the surrounding brain tissue or cause cerebral edema, or swelling in the brain. Damage to the brain can be caused by either pressure in the brain or lack of blood to provide oxygen to the brain cells. 

Nerve, Spinal Cord, and Bone Damage 

Too much pressure, improper delivery technique, or misuse of extraction devices can also cause injury to the nerves, spinal cord, or fracture bone. Nerve and bone damage in an infant can be permanent and may leave the child with partial paralysis and physical disabilities. Some examples of traumatic injuries may include: 

• Shoulder dystocia: When a baby’s shoulder gets stuck in the mother’s pelvis. Maneuvers can help reduce the likelihood of injury. Improper diagnosis and treatment of a child with shoulder dystocia can cause palsy, clavicle fracture, permanent nerve damage, or fetal death. 
• Spinal cord injury: Improper pulling or stretching of the baby’s head and neck during delivery can cause spinal cord damage. Damage to the spinal cord can lead to spinal hemorrhage, spinal stroke, paralysis, and respiratory failure. 
• Facial paralysis: Improper pulling or stretching of the baby’s neck and head during delivery can cause facial paralysis. Facial paralysis may resolve on its own but severe paralysis may be permanent or require surgery.

Medical Errors and Malpractice Causing Perinatal Injury

There are a number of complications that can arise during labor and doctors should respond appropriately, to keep the mother and baby safe. Unfortunately, some doctors fail to follow the proper protocols, putting the mother and baby in danger of a serious injury. Medical errors that cause perinatal injury may include: 

• Failure to monitor patient,
• Failure to monitor the baby’s vital signs
• Improper diagnosis
• Medication errors
• Delayed diagnosis
• Delayed delivery

Perinatal birth injuries can be devastating for parents. On the day of what is supposed to be a happy event, the family must face dealing with birth injuries that can have long-lasting effects. It can be even more devastating when the parents learn the birth injury was preventable. 

If your child was injured during childbirth because of medical negligence, talk to an experienced birth injury attorney about your options for recovery. Do not hesitate to contact Gilman & Bedigian today for a free consultation.