Child Injury Laws - By Jonathan Rosenfeld

As medical malpractice lawyers involved in different types of birth injury cases, we recognize that the specific events that occur behind the scenes can be difficult to compartmentalize.  While the fact patterns behind different incidents may vary-- or overlap, the following areas have become consistent aspects in some of our cases.  Consequently, we have expanded the birth injury section at Rosenfeld Injury Lawyers, to further refine the expanse of birth injury cases we get involved with.

Please take a moment and review this expanded section with pages devoted to:

• Cerebral Palsy
• Death of mother during childbirth
• Meconium Aspiration 
• Group B Strep
• Perinatal Encephalopathy / Oxygen Deprivation 
• Erb's Palsy / Shoulder Injury
• Stillbirth
• Twin-to-twin transfusion syndrome
• Untreated jaundice in newborns
• Uterine Rupture
• Placental Abruption

Of course, no family anticipates that these terms will ever become part of their vocabulary.  However, if the situation should arise, our team of medical malpractice attorneys remains committed to seeing your case through with the interest of you and your child first and foremost.

One of the scariest parts of becoming a parent - aside from the roller-coaster ride of pregnancy - is the possibility of having a “preemie,” or baby born before 37 weeks.

All premature babies have an increased risk of serious medical complications, and usually begin their lives in the hospital’s “NICU” - neonatal intensive care unit.

No parent wants to imagine this “nightmare scenario” happening to them and their child. But when 1 in 8 babies are born prematurely in the U.S. (a total of 500,000), the possibility of having a premature birth must be seriously considered.

So, what - if anything - can parents do to prevent a premature birth?  According to a  recent interview with March of Dimes’ Deputy Medical Director Diane Ashton, regular vaginal ultrasounds before week 20 might help lower the risk. Several recent studies have shown that ultrasounds are a more accurate way to determine a woman’s due date, versus basing it off of when her last menstrual cycle began.

The thing that makes premature births so difficult to prevent, however, is that doctors simply don’t know what causes most of them. In up to 40 percent of premature births, the cause of prematurity still remains a mystery.

“There will always be pregnancies that need to be delivered early due to medical concerns for the mother or child,” said Dr. Hal Lawrence, vice president of the American College of Obstetricians and Gynecologists. “Prematurity will never entirely go away, but we need to work to make the instance of premature birth as low as we safely can.”

Doctors do know that there are four main factors that contribute to premature labor: bacterial infection, psychosocial stress, uterine bleeding, and the stretching of the uterus; due either to multiples in the womb or excessive amounts of amniotic fluid. The stretching of the uterus has the potential to release chemicals that cause early contractions.

Presently, the premature birth rate in the U.S. is 12.3 percent - a slight drop from the previous year’s rate of 12.7 percent. Still, it’s far from the March of Dimes’ goal of 7.6 percent.

Related:

Left Undiagnosed, Umbilical Cord Compression Can Result In Brain Injury To Baby

Is the rush to induce labor, jepordizing the safety of mother and baby?

The Needs Of Children With Cerebral Palsy Need Special Consideration For Their Optimal Functioning

Chronic Conditions, Functional Limitations, and Special Health Care Needs of School-aged Children Born With Extremely Low-Birth-Weight in the 1990s (pdf) JAMA, July 20, 2005—Vol 294, No. 3

Change in Cognitive Function Over Time in Very Low-Birth-Weight Infants (pdf) JAMA, February 12, 2003—Vol 289, No. 6

What are the risk factors for a child developing cerebral palsy?

What is the cause of CP?

When it comes to delivering babies, we can sometimes think that Britain has it better-better healthcare system; better birthing procedures. But a recent story from England proves that traumatic birth injuries can occur in even highly developed European countries.

Leo Whiting, now 7, suffered “catastrophic injuries” as he was being delivered at a hospital in London in 2004, according to a recent BBC report.  Several delays led to Leo being starved of oxygen, and as a consequence severely brain-damaged. The injuries were so severe that they left Leo incapacitated for life; unable to walk or stand on his own. An Evening Standard report indicated that Leo has cerebral palsy.

In what can be an usual move in England, Leo’s parents sued the National Health Service for personal injury and financial losses. They claimed that the hospital where Leo was delivered, St. George’s, should be held responsible for Leo’s healthcare over a lifetime.

A justice at a High Court Hearing agreed, saying Leo “will never be able to live independently, will not be capable of any form of employment, and will never have the necessary mental capacity to be able to manage his own affairs.” She ordered the St. George’s Healthcare Trust to pay a lump sum of $2.7 million, as well as additional annual payments that will total over $3 million.

While this was certainly a victory for Leo’s parents, I have to wonder if this was an adequate punishment for a lifetime of suffering. At the very least, I hope the doctors who delivered Leo received a real wake-up call, about the consequences of not correctly monitoring a delivery. 

Related:

Parents Settle Medical Malpractice Lawsuit Where Child Suffers Brain Injury At Birth

8-Year-Old Quadriplegic Awarded $29 Million in Medical Malpractice Case

Facts About Cerebral Palsy

Record Setting Cerebral Palsy Jury Award Demonstrates The Incredible Expense Of Caring For A Child With Cerebral Palsy

Chicago Family Files Medical Malpractice Lawsuit Following Hospital's Deadly Medication Error Involving Infant

Lifetime Financial Benefits For Cerebral Palsy

Parents Name Doctor And Hospital In Lawsuit Alleging Child's Cerebral Palsy Related To Physician's Negligence

Two years of litigation has achieved a $7.5 million settlement in a birth injury lawsuit initiated by the grandparents of a child born with cerebral palsy.  As reported in the Chicago Sun Times, the medical malpractice lawsuit was brought against Christ Medical Center and treating obstetricians for their respective roles in the way they responded to a situation involving signs of fetal distress of a baby born at the hospital in 2002.

As with many birth injury lawsuits, the allegations of medical malpractice centered around the delay of hospital staff and treating physicians had with respect to taking action upon learning of the potential dangers facing the baby. The delay in responding to signs of fetal distress was blamed for oxygen deprivation and ensuing complications including brain damage and cerebral palsy.

Now, 9-years-old, and with significant care-related needs, the funds from the settlement can be used to provide for the extensive skilled-care needs that this child will need for the remainder of her life.  In addition to the care, some of the funds will likely be used to modify the child's home to make it more accommodating for specialized physical needs such a wheelchair access.

Significant Settlements For Birth Injury Cases:

While settlements such as this are indeed eye-popping for their significance, it is important to remember that the funds from the settlement of birth injury lawsuit are intended to provide for the needs of these children for the remainder of their lives.  In the case of a child with cerebral palsy, many physicians will opine that these children will have a normal life expectancy --- similar other children their age.

Additionally, in situations involving funds awarded to children in cerebral palsy or other types of birth injury cases, the funds are customarily put into a trust or other type of restrictive account where a only a parent or guardian can access the funds for the direct needs of the child.  

Many times, a judge oversees the administration of the funds to further protect the child from improper acts of a third-party--- and to assure that the funds last protect the needs of the child in the future.  Usually, an annual accounting is ordered to be filed with the court where all expenditures and trust income is accounted for in order to detect any issues as quickly as feasible.

Further distinguishing funds set-aside for a child's birth injury, is how the funds are to be invested.  Unlike accounts used for investment and growth, accounts established for special needs children are intended to utilize extremely conservative--- and inherently safer--- types of investment vehicles to further assure the needs of the child can be provided for in the future regardless of the overall economic volatility.

Related:

A lack of oxygen, or Hypoxic Ischemic Encephalopathy, is the frequent cause of baby brain damage at birth

Parents Settle Medical Malpractice Lawsuit Where Child Suffers Brain Injury At Birth

Life Expectancy: Cerebral Palsy

Life expectancy in children with cerebral palsy, BMJ 1994; 309 doi: 10.1136/bmj.309.6952.431 (Published 13 August 1994)

Diagnosing Cerebral Palsy

A pending matter, my office is working on involves a boy who sustained a brain injury due to the doctors' delay in perfoming a c-section.  The condition referred to as; hypoxic Ischemic Encephalopathy (HIE), also known as perinatal encephalopathy, may result when the brain does not receive enough oxygen (hypoxia).  HIE can refer to any brain injury caused by oxygen deprivation, but it often refers to an injury common to newborns that can cause long-term disability and death.  

HIE in newborns is caused by injury or complication during birth where the fetus or newborn suffers oxygen deprivation.  Causes of HIE include:

• Birth injury
• Perinatal asphyxia
• Delivery complications with delayed delivery
• Umbilical cord wrapped around neck of infant
• Trauma to the brain during delivery process

In the United States, HIE occurs in one to eight of every 1000 births.  If HIE is severe, the mortality rate is around 20% with deaths occurring mostly in the first week of life, with 25% of survivors suffering permanent neurological defects.  For infants who survive severe HIE, up to 80% of them develop serious complications, 10-20% develop moderate disabilities, and up to 10% have no complications.  For infants with moderately severe HIE, 30-50% have serious complications, and 10-20% have minor neurological problems.  

The lack of oxygen occurs to the brain as a whole not just one part of the brain.  HIE results in brain injury as a result of oxygen deprivation (hypoxia) and reduced cerebral blood flow.  Brain cells require proper circulation to receive oxygen and remain viable.  If the brain does not receive proper circulation and oxygen, the cell membranes of brain cells become compromised and the neurons die.  Within five minutes of oxygen deprivation, a child may suffer from irreversible brain damage.  

The extent of damage depends on how long the brain is without oxygen.  Brief oxygen deprivation may cause only minor brain cell injury while longer deprivation can cause damage to more sensitive areas of the brain including the hippocampus (plays an important role in memory).  

The damage can cause long-term disability, mental retardation, epilepsy, seizures, learning disability, delayed development, and cerebral palsy.  (See Rosenfeld Injury Lawyers “Cerebral Palsy” and Child Injury Laws Blog “The Needs Of Children With Cerebral Palsy Need Special Consideration for Their Optimal Functioning”)  

Diagnosis of HIE usually includes a physical exam along with any of the following tests: CT scan, MRI scan, electrocardiogram (EKG, ECG), blood test, electroencephalogram (EEG), or ultrasound.  In cases of severe HIE, treatment involves resuscitation, mechanical ventilation (artificial respiration) to help with breathing, oxygen treatment, medicine to help control seizures, and treatments to help with circulation.

If your child suffered a preventable brain injury from hypoxic ischemic encephalopathy (HIE) because doctors were negligent in the delivery of your child, you may be entitled to compensation.  Please give us a call for free legal consultation today regarding your potential claim.  Our legal consultations are always free and confidential.  (888) 424-5757.

Thank you to Heather Kiel, J.D. for her work on this Child Injury Laws Blog entry.

Resources:

eMedicine: Hypoxic-Ischemic Encephalopathy

Children’s Memorial Hospital: Hypoxic Ischemic Encephalopathy

NYU Langone Medical Center: Hypoxic Ischemic Encephalopathy

Neuropathology: Cerebral Ischemia and Stroke

Pediatrics: Interventions for Perinatal Hypoxic-Ischemic Encephalopathy

Rosenfeld Injury Lawyers: Cerebral Palsy

Child Injury Laws Blog: The Needs Of Children With Cerebral Palsy Need Specia Consideration for Their Optimal Functioning

Perinatal Encephalopathy / Oxygen Deprivation At Birth

The Bayonne Medical Center (New Jersey) settled a medical malpractice case with the family of a severely brain-damaged son for $8.5 million.  

The mother, Emily Ordonez, was 32 years old when she went into labor on August 14, 2005.  Ms. Ordonez went to the hospital at 1:30 am, when she first experienced labor pains.  The prenatal tests indicated a healthy baby and pregnancy.  However, at 9:32 am, the heart monitor indicated that the baby’s heart rate dropped from 140 beats/minute to only 60 beats/minute.  

The delivery room nurses waited half an hour before calling the attending obstetrician, who arrived 22 minutes later.  Then, the doctor waited until 10:55 am to start the emergency cesarean section, despite the baby’s low heart rate.  The reason for the low heart rate was that the umbilical cord was compressed, which resulted in the baby not receiving adequate oxygen.  (See Child Injury Laws - “The Needs of Children with Cerebral Palsy Need Special Consideration for Their Optimal Functioning”)

As a result of the delayed actions by the nursing staff and the doctor, the baby suffered permanent brain damage.  The child, José Ordonez, is now five years old and requires full-time care because of his brain injury.  José cannot see, walk, hold his head up on his own, and is prone to seizures.  While the settlement will not do anything to reverse the injury that the boy and his family suffered, it will provide $6 million for future medical care and needs and $2.5 million for the family’s emotional pain and suffering.  

José’s parents provide him with 24-hour care and also take him to Concordia Learning Center at St. Joseph’s School for the Blind.  The school has helped the boy improve his cognition and recognition capabilities.  In cases of cerebral palsy, early diagnosis and treatment of the condition can help improve the child’s capabilities.  

If your child suffered a birth injury because the doctor or nursing staff committed medical malpractice, you may be entitled to compensation.  (See Child Injury Laws “Birth Injuries”) Medical negligence cases such as these, involving severe and permanent brain injury, can cause a serious emotional and financial burden.  If you want to discuss your case, please give us a call for free legal consultation at (888) 424-5757.

Thanks to Heather Keil, J.D. for her work on this Child Injury Laws entry.

Resources:

New Jersey Local News: Bayonne family accepts $8.5 million to settle medical malpractice suit over boy’s brain damage during birth

Child Injury Laws: The Needs of Children with Cerebral Palsy Need Special Consideration for Their Optimal Functioning

Child Injury Laws: Birth Injuries

Medicine Net: Childbirth Complications

Cerebral Palsy Lawyers FAQ: Medical Malpractice Lawsuits

Diagnosing Cerebral Palsy

As a lawyer, who litigates birth injury cases, I've noticed that there is still quite a bit of confusion about c-section deliveries.  I've noticed that many doctors fail to adequately explain the procedure to their patients and many times is is done so during a particularly stressful time--- like when the woman is in labor!!

Why are they needed? Are there risks to mother or baby?

Below is some information that I have learned over the years as well as some terrific resources regarding this potential confusing medical procedure.

A cesarean delivery (C-section) is a surgical delivery of a baby requiring an abdominal incision and a uterine incision.  C-sections can be elective or medically necessary. 

Reasons for a C-section include:

    •    Stalled labor (failure to progress)
    •    Baby has reduced oxygen supply (changes in baby’s heartbeat)
    •    Baby is in breech (feet or buttocks first) or transverse position (side or shoulder first)
    •    Carrying multitudes (twins, triplets)
    •    Problem with placenta
    •    Problem with umbilical cord
    •    Baby has a large head
    •    Mother has medical condition (heart condition, genital herpes)
    •    Baby has a health concern

If your doctor determines that a C-section is medically necessary, a delay in the procedure can cause preventable injury to the mother or the baby.  

In other situations, the mother requests a C-section (elective c- section).  There are many reasons that can lead to this decision:

    •    Convenience of scheduling
    •    Fear of vaginal birth (fear of labor and pain)
    •    Fear of sexual dysfunction after birth
    •    Avoiding vaginal birth compilations
    •    Previous vaginal birth complication

There are risks associated with C-sections because it is a surgical procedure.  Risks to the mother include:

    •    Longer recovery time
    •    Surgical injury (to nearby organs)
    •    Wound infection
    •    Endometritis (inflammation and infection of the uterine lining)
    •    Increased bleeding
    •    Reaction to regional anesthesia
    •    Blood clot
    •    Increased risk of complications during future pregnancies

Risks to the baby include:

    •    Breathing problems (transient tachypnea, respiratory distress syndrome)
    •    Fetal injury (nicks or cuts on the baby’s skin)

Besides the medical risks, C-sections also require a longer recovery.  You may require help with childcare or household help in the weeks following your C-section.  This can be difficult for some families, especially because some C-sections are last minute emergency decisions.  Therefore, it is important to prepare for the possibility of a C-section birth even if you plan on vaginal delivery.

It used to be that if you had a C-section, you could not have a vaginal delivery in the future.  But now, a vaginal birth after C-section (VBAC) is possible in many cases. 

So, choosing a C-section for your first child does not necessarily preclude you from experiencing a vaginal birth with subsequent children.  In women who choose a VBAC, 60-80% have a successful vaginal delivery.  Factors that improve the chances of a successful VBAC including:

    •    Only having one prior low transverse uterine scar (most common uterine incision)
    •    Pregnancy is progressing normally and mother and baby are healthy
    •    Labor begins naturally on-time or before your due date
    •    You have had previous successful vaginal delivery

The C- section procedure can usually be completed in less than an hour.  First, the health care team cleans the abdomen, place a catheter in the bladder, and start an IV line to provide fluid and or medication.  Then, regional anesthesia in delivered, which in most cases is a spinal block. 

Next, the doctor makes two cuts, one to the abdominal wall, and another to the uterus.  Finally, the doctor removes the baby, clamps the umbilical cord, removes the placenta, and closes the incisions with sutures.   Following a C-section, the mother and baby usually stays in the hospital about three days, while health care professionals help monitor your pain and help you recover.  (C-section birth video)

It is important that you discuss delivery options with your the health care provider, so an informed, safe, and healthy decision can be made.  If fear is your primary motivator in requesting an elective C-section, it is important to talk to your doctor first about your concerns. 

Oftentimes, a frank and open discussion with a medical professional can help you understand what to you can expect.  Why people like to tell birth horror stories to expectant moms is beyond comprehension.  There is nothing wrong with telling these people that they can share their, supposedly well-intentioned, stories after you have your child.  

Determining whether a C-section is necessary requires the risks and benefits to be weighed.  The health of the mother, the health of the baby, the mother’s wishes, the mother’s medical history, and any complicating factors must all be considered when deciding whether a C-section or vaginal birth is appropriate. 

It is important to remember that although C-sections are a relatively common procedure, it is still abdominal surgery that carries with it the risks and complications of any surgery.  Some people even assert that medical literature is fraught with misinformation because it is written to defend birth trauma lawsuits.  This just further reinforces the importance of finding a health care provider that you trust, so that all decisions are made with you and your baby’s best interest in mind.  

Some people believe that many C-sections performed are unnecessary, putting both the mother and the baby at increased risk for complications.  In 2004, 29% of all babies born in the United States were born by C-section.  In a CNN article, one woman (Barbara Stratton) discusses how her obstetrician induced her labor a week early because she was worried that the baby would be too large if they waited. 

Ms. Stratton ended up requiring a C-section because her labor would not progress.  Then, the baby ended up weighing only 8 pounds, 7 ounces, which was much smaller than the obstetrician had thought.  Ms. Stratton reported that she suffered from pain every day for a year and a half after she gave birth to her son by cesarean section, which affected the quality of her mothering.  She advocates that women should ask questions about whether induction or a C-section is absolutely necessary.  

There are also cases where birth injuries occur as a result of a preventable delay in a C-section procedure.  For example, in the case of a California woman, Aliscia Towles, the mother alleges that her son was stillborn because doctors at Centinela hospital Medical Center failed to immediately deliver her son when it was apparent he was in fetal distress. 

Doctors gave Ms. Towles Pitocin to accelerate labor, but this failed to help her labor progress, and instead caused a change in the baby’s heart rate.  Ms. Towles alleges that her doctor purposely delayed the delivery of her baby to increase the chance that the baby would die before delivery because of increased chance of brain injury.  

It is important to feel that you have an advocate during your delivery, so that your concerns and wishes are taken into consideration.  If you do not feel like your doctor is taking the time to answer your questions about vaginal births and C-sections, you may want to look for a new doctor or enlist a birth advocate to be present during the delivery.  If the unthinkable happens and you or your baby suffers an injury during a C-section, either because the C-section was unnecessary or the procedure was delayed, you may be entitled to compensation.  

Special thanks to Heather Keil for her assistance with this Child Injury Law entry.

Sources:

Opposing Views: The Necesarean – When Is A C-Section Really Necessary?
Mayo Clinic: C-section
Mayo Clinic: Elective C-section – Keep fear out of the decision
Mayo Clinic: VBAC (vaginal birth after C-section)
CNN Health: Five ways to avoid a C-section
Baby Center: Giving birth by cesarean section
ChildBirth.org: The Cesarean Section FAQ
The Women’s Health Activist: Cesarean Section When It’s Not Medically Necessary – Safe Practice or Risky Decision?

Within the first few moments babies are pulled from the womb doctors administer the first test of their young lives.  Known as an Apgar score, doctors use the scale to evaluate each infants physical condition --- and determine if there are any deficiencies that require additional medical addention— or that need to be monitored.

Doctors usually will perform an Apgar test on the baby within the first few minutes of birth, with a follow-up to test to be given shortly thereafter or as necessary.

Five, different factors are evaluated when calculating a babies Apgar score:

• Heart rate (pulse)
• Breathing (rate)
• Grimace (responsiveness to stimuli)
• Activity (muscle tone)
• Appearance (colorization in skin)

Each factor is given a score of 0, 1 or 2, then the scores are added together to calculate a baby’s Apgar score on a scale of 0 to 10. 

In the past, Apgar scores weren’t given particular weight when it came to determining a babies long-term health as child developmental needs vary considerably. 

Now, new research tends to question this long-held assumption as there does indeed appear to be a correlation between low Apgar scores and a later diagnosis of Cerebral Palsy.

In evaluating more than 500,000 children born in Norway, the study analyzed the Apgar scores in children who were diagnosed with Cerebral Palsy.  The results revealed that children with Apgar score below three were more than 100 times more likely to be diagnosed with Cerebral Palsy than their higher scoring peers.

Certainly, more research needs to be conducted in this important field of infant vitality, but the now that the connection between Apgar scores and Cerebral Palsy has been strengthened, the next step would be to evaluate if there is an explanation for the low Apgar score at the time of delivery.

Though genetic factors and pre-mature births can impact Apgar scores, other explanations may related to physician error during delivery. The following conditions are related to to Apgar scores in children as suggested by brighthub.com:

• Precipitous delivery. Hypoxia (oxygen deficiency) can occur from a fast birth due to strong contractions or trauma to the baby's head.

• Nuchal cord. If the cord is wrapped around the fetal neck (one or more times) and obstructs blood flow, hypoxia can occur.

• Prolapsed cord. When the cord becomes trapped in the vagina before the fetus is delivered, hypoxia can occur from obstructed blood flow.

• Placenta previa or abruptio placentae. Both can cause low infant Apgar scores because the placenta separates from the uterus before delivery, interrupting blood flow.

• Meconium aspiration. The fetus can have a bowel movement (meconium) in utero when distressed and may inhale some into their lungs, thus causing respiratory problems.

• Maternal analgesics and/or anesthetics. Narcotic drugs (normally given within 4 hours before birth) that pass from mom to fetus can suppress their ability to breathe.

• Preterm infants. Immature lungs and hypoglycemia are a couple of problems that can occur with preterm infants.

• Other common causes of low Apgar scores include maternal and fetal factors, such as maternal hemorrhage or fetal heart problem.

If you suspect that your child’s low Apgar score was a predecessor to a later discovered brain injury or Cerebral Palsy, we would honor the opportunity to discuss your potential legal rights with you today without any cost or obligation for you. (888) 424-5757

Resources:

Association of cerebral palsy with Apgar score in low and normal birthweight infants- population based cohort study (PDF) by Kari Kveim Lie, senior researcher,1 Else-Karin Grøholt, senior researcher,1 Anne Eskild, professor2,3

Apgar Score MedicineNet.com

Regional Brain Volume Abnormalities and Long-term Cognitive Outcome in Preterm Infants (PDF) JAMA, October 18, 2000—Vol 284, No. 15

Should parents be concerned if their child has been diagnosed with meconium aspiration syndrome?

Labor induction (or inducing labor) is a procedure to bring on (induce) labor either because labor does not start on its own or because there is concern for the mother’s or baby’s health. In the United States, about 20% of pregnant woman undergo labor induction.  

Some people question whether medical professionals rely too heavily on induction, especially before safer alternatives have been exhausted.  There are serious risks associated with labor induction including increased likelihood of a C-section, which also has associated risks.  So, the benefits and risks of induction should be carefully weighed before a mother is induced.

In a typical pregnancy, labor usually begins on its own between weeks 37 and 42.  If labor does not begin spontaneously or there are risks to the mother or baby, labor can be induced.  Induction causes the mother’s cervix to thin out and open in preparation for vaginal birth (diagram of cervical changes).  

Reasons for induction include:

• Post term pregnancy (> 42 weeks)
• No contractions after water breaks
• Water breaks too early
• Infection of the uterus
• Placenta is deteriorating (placental abruption)
• Baby stopped growing at the expected pace
• Medical condition (such as diabetes or high blood pressure) that puts mother or baby at risk
• Practical reasons (home is far from hospital, history of quick deliveries, convenience)

There are serious risks associated with labor induction, such as:

• Premature birth if labor is induced too early
• Change in fetal heart rate
• Infection
• Umbilical cord problems
• Need for a C-section
• Increased risk of uterine rupture if you had a previous C-section

Methods of labor induction:

• Dilating the cervix – medications can prepare the cervix for labor or dilators can be inserted into the cervix to widen it
• Stripping the membranes – doctor sweeps their finger over the membranes connecting the amniotic sack to the wall of the uterus, which causes the mother’s body to release prostaglandins that soften the cervix and can cause contractions
• Rupturing the amniotic sac (breaking the mother’s water)
• Oxytocin – naturally occurring hormone that causes contractions

Pitocin is the brand name for synthetic oxytocin, which is one method used to induce or speed up labor (usually within 12 hours of receiving the drug).  It acts by starting or improving uterine contractions.  The drug is usually given to the mother in an IV drip.  Pitocin is not recommended for elective procedures or to speed up the birthing process for convenience.  

Instead, it is only recommended in pregnancies with a medical reason for inducing labor.  As with any other medication, there are possible side effects including: nausea, vomiting, cramping, stomach pain or more serious side effects including: irregular heartbeat, headache, dizziness, severe bleeding after childbirth, or blurred vision.  

Some people question the frequency and safety of pitocin use, especially in light of the fact that it is only recommended in pregnancies where induction is medically necessary.  A new Duke University study in the American Journal of Obstetrics and Gynecology raises questions about the use of pitoctin, showing that prolonged use of pitocin during labor and delivery is probably more dangerous than beneficial.  

The study found a link between high doses of pitocin and serious postpartum hemorrhage (excessive bleeding following birth).  Fetal monitoring is required when pitocin is used because fetal distress is more common than spontaneous labor.  The most common side effect is hyperstimulation, which means that contractions can be stronger, last longer, and be more frequent than normal contractions.  In addition, the continuous fetal monitoring requires that the mother be confined to the bed, which can make contractions more difficult to deal with, which can require pain medications.  

If there is time (no serious medical risks), it is best to try alternative methods of inducing or augmenting labor such as walking, changing positions, and nipple stimulation.  Then, if labor still is not progressing after exhausting other options, pitocin can be used to help the mother with the labor.  

It is important to remember that while labor induction and pitocin can be helpful to help labor progress or speed up if medically necessary, they should not be overused, especially for the sake of convenience.  There are serious risks associated with both, which makes it all the more important to try safer alternatives first.  

It is important that you have medical professionals that you trust, so decisions are made with the mother’s and the baby’s best interest in mind.  Some families choose to have a midwife or doula in the birthing room, so they know they have an advocate in the room.  If you think labor induction procedures or pitocin caused an injury to you or your child, you may be entitled to compensation.  

Special thanks to Heather Keil, J.D. for her assistance with this Child Injury Laws Blog entry.

Resources:

Parent Time: Pitocin – Risks and Reasons for Induction and Scheduled Births

ACOG: Labor Induction

Does inducing labor pose any threats to baby?

Mayo Clinic: Labor Induction

Medicine Net: Pitocin

Child Birth: Pitocin FAQ

Rx List: Pitocin

Drugs.com: Pitocin

About: How is pitocin used to induce labor?

US News-Health: Induced Labor Linked to Raised Risks for First-Time Moms

Indy Channel: Study Raises Questions About Childbirth Drug

Learning about childbirth and talking to the doctor can help address any anxieties or concerns that parents may have.  

In most cases, labor progresses normally, but problems and complications can occur.  Umbilical cord compression is one possible complication that can lead to serious injuries.  

During labor, the umbilical cord can become stretched and compressed, which can result in a decrease in blood flow.  This can cause periodic changes in fetal heart rate (variable decelerations).  

Fetal heart rate monitors can usually detect these abnormalities, so doctors can monitor the fetus for any serious problems.  (See Child Injury Laws – “The needs of children with cerebral palsy need special consideration for their optimal functioning”)

Cord compressions are actually pretty common, occurring in about one in ten deliveries. Most times the umbilical cord straightens out and the fetus does not go through any real distress.  However, if the fetus shows signs of distress such as decrease of fetal blood pH or heart rate worsens, an emergency cesarean section might have to be performed.  

In one unfortunate case, a Florida couple’s son died when he was three years old after a brain seizure.  The boy suffered serious and permanent brain injury during delivery when his umbilical cord wrapped around his neck, cutting off his blood supply.  

The couple filed a medical malpractice claim in 2005 where they were awarded $60.5 million to provide medical care for the child over his lifetime.  Their child could not sit, speak, or eat and required constant care including a feeding tube.  The baby’s injuries could probably have been prevented if doctors were monitoring the fetal heart rate to look for signs of distress.  (See Child Injury Laws “Delay in performing c-section results in baby’s brain damage & costs doctor $3 million”)  

If your child suffered an injury during delivery, we would honor the opportunity to speak with you for a free case evaluation.  

Thank you to Heather Keil, J.D. for her assistance with this Child Injury Laws Blog entry.

Sources:

Medicine Net: Childbirth Complications

Chicago Birth Injury Lawyer Blog: Couple Awarded $10.2 Million for Wrongful Death Lawsuit

Pub Med: Umbilical cord compression associated with amniotomy – laboratory observations

Pub Med: Regional cerebral blood flow changes during severe fetal asphyxia produced by slow partial umbilical cord compression

Why is umbilical cord compression a concern for the fetus?

Pub Med: Amnioinfusion for umbilical cord compression in labor

Child Injury Laws: Delay in performing c-section results in baby’s brain damage & costs doctor $3 million

Poor communication probably accounts for a fair number of arguments amongst my wife and myself. However, at the end of the day, our miscommunication usually accounts for nothing more than the wrong brand of bread retrieved from the the grocery store or perhaps a delayed dinner.

However, in the medical field basic miscommunication can have disastrous consequences for young and old patients alike.  In perhaps a medical communication breakdown for the record books, an English couple is blaming a communication meltdown between hospital staff for a significant delay in the delivery of a baby that resulted in serious injury to both the moth and infant.

Like many late-term mothers, Jennifer Kennedy arranged to go to her local hospital for a scheduled delivery where doctors would delivery the baby via cesarean section.  Forty weeks pregnant, Ms. Kennedy arrived at the hospital as was told the doctors would perform the procedure within two hours.

Soon after Ms. Kennedy's arrival, there was a shift change for her attending nurses and physicians.  Apparently, the game plan was not communicated to the fresh staff.  

Things turned drastically wrong after the the staff failed to timely perform the scheduled c-section.  More than twelve hours after the c-section was intended on being performed, Ms. Kennedy's babies heart stopped and her uterus had ruptured.

A crash cesarean was performed to save both mother and baby.  However, the delay in performing the c-section is believed to account for depriving the baby of oxygen for an extended period and for causing severe bleeding in mother.  After delivering the baby, doctors had to resuscitate the baby in order to get its heart beating.

The failure to timely perform the c-section is believe to have caused the oxygen deprivation in the baby and resulting brain damage.  According to Ms. Kennedy,

The worst thing about all this is that he was a perfect little baby until that day in the hospital.  Now he has brain damage and will need constant care.  He doesn't deserve that.  We did all that was asked of us and we were let down by the people you're meant to trust.  It's hard to deal with.

While the above may have occurred overseas, the scary fact remains that similar delivery horror stories still happen in the United States.  Therefore, as a lawyer who represents families in matters relating to birth injuries, I feel strongly about taking the depositions of all medical personnel associated with the event.  In many circumstances we learn that simple communication breakdown is at the heart of the problem.

Just last month, the FDA issued some fairly impressive warnings regarding women's use of Topamax during pregnancy.  In fact, the FDA re-categorized the drug from a Category C- Pregnancy Drug to Category D-- an important reclassification due to the scientific evidence linking Topamax usage with birth defects.

Like other drugs categorized as a Class D, the FDA has conclusively established the use of Topamax with "human fetal risk based on adverse reaction data from investigations or marketing experience or studies in humans."  However the FDA's Class D warning goes on to say that even with the known risks, the use of the drug may be acceptable if the pregnant woman has a medical condition that threatens her life.

In particular, Topamax has been associated with birth defects such as:

• Cleft lip
• Cleft palate
• Heart defects
• Facial deformities
• Deformed limbs

While some of these Topamax birth defects, appear to have been known by the medical community years before the stern warnings, I find it particularly troubling that an added side-effect of Topamax usage is the ineffectiveness of oral contraceptives taken by woman to avoid becoming pregnant.  

A study published in 1996, the same year the FDA approved Topamax for treatment for partial onset seizures, indicates that seizure medications-- such as Topamax may substantially increase the likelihood of a woman becoming pregnant while she is on birth control.

The net result of this important information is that many woman were likely taking Topamax before they knew they were pregnant in the first place.  Given the nature of fetal development, it is likely that many of the facial malformations and cleft palates are due to the mother taking Topamax during the vital first trimester when many of these features form.

As we begin the process of learning just how much Ortho-McNeil and other generic manufacturer had about this drug, I believe the drug's impact on the effectiveness of women's birth control medication will prove to be important as women begin to disclose the fact that they may never have intended to give birth to a child with birth defects.

Rosenfeld Injury Lawyers is in the process of evaluating Topamax (and generic equivalents) cases.  Please use our contact form or call us and we will return you call promptly. 

Related:

Effect of Topiramate on the Pharmacokinetics of an Oral Contraceptive Containing Norethindrone and Ethinyl Estradiol in Patients with Epilepsy.pdf By William E. Rosenfeld, Dennis R. Doose, Sally A. Walker, and R. K. Nay Epilepsia, 38(3):3 17-323, 1997

New FDA Warnings Suggest Correlation Between Topomax And Birth Defects Including: Cleft Lip & Cleft Palate

Years ago, the treatment options for children with cerebral palsy were incredibly limited. Today, there is an increased understanding of the condition and the specific treatment needed to provide the most significant impact for children with CP. 

The Center for Independence through Collective Education is part of a new generation of treatment facilities specifically geared towards helping children with cerebral palsy.  Children at the center receive various types of therapies to help them live as normal a life as possible.

Currently, the Northern Illinois facility serves 12 children living the the Chicagoland area with hopes of growing to accommodate a significant void for children with similar disabilities who don't currently have access to specialized treatment.  

Utilizing conductive education, a program developed by Hungarian researchers in the 1940's, the program focuses on using techniques to re-train the brains of children. The Center utilizes the expertise of: physical therapists, occupational therapists in conjunction with other therapeutic modalities.

Not surprisingly, the costs for these treatments can be significant. In an effort to offset the expense and expand the service to a larger group of children, the Center for Independence through Education is holding its 5th annual fundraiser on March 4th.  For more information call (847) 401-2995.

Cerebral Palsy In Children

Unlike many medical conditions afflicting children that may be due to genetic defects, cerebral palsy is a condition that may be traced to an injury to the brain.  Many scientists now believe the brain injury is due to a lack of oxygen immediately prior to and during the birthing process.  A diagnosis of Cerebral Palsy is usually made during the formative years.  

Though the extent of disability associated with Cerebral Palsy varies significantly from child-to-child, most children require a good deal of intervention to assist in learning basic developmental skills such as eating, dressing and using the toilet.

Rosenfeld Injury Lawyers represents families in cerebral palsy due to trauma at birth.  If your child has been diagnosed with cerebral palsy, call us today and talk candidly about your concerns.  All legal consultations are free and completely confidential.  Why not begin the process today and secure your child's future? 888-424-5757