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Birth trauma refers to injuries a child sustains during delivery. While the term “birth injury” is usually used to describe something that affects a baby’s body, the phrase “birth trauma” encompasses injury to the baby’s tissues and organs. It also includes the long-term consequences of the injury, such as cerebral palsy, hypoxic ischemic encephalopathy (HIE), Erb’s palsy, seizures and intellectual disabilities.
Traumatic birth injuries are often caused by mechanical force, but can also be caused by the overuse of delivery drugs, abnormal presentation, the negligent use of forceps or vacuum extractors, attempts at delivering babies too large to fit through the mother’s pelvis, and attempts at delivering a baby whose shoulders are stuck.
Doctors can avoid birth trauma by following best care practices and being skilled in spotting labor and delivery complications. The terms “birth trauma” and “birth injury” are often interchangeable, but birth trauma is usually thought of as being caused by mechanical damage. Birth injury typically refers to injury caused by a lack of oxygen to the baby’s brain or a brain infection, such as meningitis.
Labor and delivery can be traumatic for the baby. However, most instances of birth trauma can be avoided.
Birth trauma can usually be avoided if the physician and medical staff:
Complications that can cause birth trauma include:
Forceps and vacuum extractors are very risky because they attach to the baby’s head. They are used to help pull the child from the birth canal. Traction is usually applied during a contraction while the mother is pushing. Physicians often lack skills in the use of these instruments.
Forceps are applied to each side of the baby’s head. They can cause trauma to the skull and spinal cord, as well as brain bleeds and hemorrhages.
Vacuum extractor use is more common. A vacuum extractor is a small cup that is placed on the baby’s head. The pressure of the suction cup can cause a type of bleed called a subgaleal hemorrhage. This occurs when the vacuum ruptures a vein that bleeds into the space between the scalp and the skull. The result is often severe oxygen deprivation. If the bleed is not properly managed, almost half of the baby’s blood volume can end up in the subgaleal space.
Intense contractions result from Pitocin and Cytotec use. Birth trauma can also result from the cumulative effect of prolonged periods of contractions and pushing. These force the baby’s head repeatedly against the mother’s pelvis in a setting where the baby is a tight fit. This increases the baby’s risk of suffering a brain bleed or hemorrhage. Pitocin (oxytocin) is often used in this scenario in an attempt to avoid a C-section, but Pitocin can increase the intensity of the contractions and risk of brain bleeds.
Excessive Pitocin can cause contractions to occur less than 2-3 minutes apart. This limits the ability of the placenta to replenish its supply of oxygen-rich blood for the baby. Excessive frequency and strength of contractions is called hyperstimulation. When hyperstimulation prevents replenishment of oxygen in the placenta, the baby’s brain can be deprived of sufficient oxygen, with the deprivation getting progressively worse.
Hyperstimulation with Pitocin is dangerous because there are no precise methods of measuring the effects of the drug on the uterus. The effects of any given dose vary widely. They can range from excessive and severe contractions and fetal oxygen deprivation to absolutely no discernible effect on uterine contractility.
Cytotec is another drug used to induce labor. It works by aiding the cervix in producing contractions. The drug has serious risks, however. These include uterine rupture and hemorrhage. The dosage and method of administering Cytotec raises many concerns.
Unlike Pitocin, Cytotec is a pill that is administered vaginally. The pill is usually cut into quarters, with one quarter inserted every four hours. However, this drug can affect every pregnant woman and baby differently. There is no way to predict how they will tolerate Cytotec. If the mother or child has an adverse reaction to the drug, it cannot be rapidly discontinued like other drugs, since the medication is absorbed into the body.
In recent years, there have been concerns over the number of birth injuries that have occurred in cases where Cytotec was used. Like Pitocin, Cytotec causes hyperstimulation that can lead to serious oxygen deprivation in the baby. When hyperstimulation is evident, there is also the danger that the umbilical cord is being compressed and the baby is not receiving enough oxygen. This is an obstetrical emergency which requires an emergency C-section.
Uterine rupture occurs when the excessive contractions associated with hyperstimulation cause the uterus to tear, either partially or completely. The baby then must be delivered via emergency C-section.
A breech birth occurs when the baby enters the birth canal with the buttocks or feet first. Though labor and vaginal birth are possible for some breech positions, certain fetal and maternal factors influence the safety of vaginal breech birth. The majority of breech babies should be delivered by C-section.
At the beginning of labor, the baby is generally facing either the right or left side of the mother’s back. Delay in descent is a sign of possible problems with the delivery of the head. Umbilical cord prolapse may occur, particularly in the complete, footling, or kneeling breech positions. This happens when the lowermost parts of the baby do not completely fill the space of the dilated cervix.
When the mother’s water breaks, it is possible for the umbilical cord to drop down and become compressed. This can severely diminish the flow of oxygen-rich blood to the baby, or cut it off entirely. Cord compression is an emergency that requires immediate delivery, usually by C-section.
Oxygen deprivation may occur from either cord prolapse or prolonged compression of the cord during birth, as in head entrapment. If this deprivation of oxygen prolongs, it may cause birth asphyxia and cerebral palsy. Injury to the brain and skull may occur as a result of rapid passage of the baby’s head through the mother’s pelvis.
This occurs when the arm, shoulder, or trunk enter the birth canal first. When a baby is in transverse lie position during labor, the only way to successfully deliver her is by C-section.
Mothers who have polyhydramnios (too much amniotic fluid), are pregnant with more than one baby, have placenta previa, or a small fetus (which can occur when the baby has intrauterine growth restriction (IUGR)) are at risk of the baby being in a transverse lie position. Once the membranes rupture, there is an increased risk of umbilical cord prolapse in this position. A C-section should ideally be performed before the membranes break.
Failure to quickly deliver the baby by C-section when transverse lie presentation is present can cause severe oxygen deprivation due to cord compression and trauma to the child. This can lead to HIE and cerebral palsy.
Face presentation occurs when the baby’s face is the first part of the baby to present at the opening of the birth canal. This happens when the baby’s neck is extended backward so that the back of the head touches the back. This is extremely dangerous. It inhibits head engagement and descent of the baby through the birth canal. If face presentation is mismanaged, serious birth complications can occur, such skull trauma and swelling, brain bleeds and hemorrhages, and prolonged labor.
Trauma during labor can cause swelling in the upper airway. This can result in respiratory distress in the baby at birth, which can cause other complications, such as overventilation injuries, hypoxic ischemic encephalopathy, and cerebral palsy.
If the baby’s chin is facing the front of the mother, vaginal delivery may be attempted. But it is still very risky. In all other types of face presentation, a C-section delivery is required.
A baby can become very large when a pregnancy is post-term or when the mother has gestational diabetes. This may prompt a physician to use forceps or a vacuum extractor for delivery assistance, which increases the likelihood of birth trauma to the baby, such as brain bleeds and head injuries.
Macrosomia also increases the chances of prolonged labor due to problems such as shoulder dystocia or cephalopelvic disproportion. The risks associated with macrosomia can lead to the baby having permanent brain damage and cerebral palsy, as well as Erb’s palsy.
CPD injuries occur when the baby’s head or body is too large to pass through the mother’s pelvis. Initially, physicians will have information about the mother’s pelvis type and size by x-ray, physical examination, and ultrasound. It also is important to know how the baby’s head is positioned in the pelvis.
Some parts of the head can mold to conform to the pelvis. Except for macrosomia, physicians will usually not assume CPD based on measurements alone… Although measurements are one piece of information that should be considered when deciding whether to deliver vaginally or by C-section. CPD requires a C-section delivery. One indication of CPD is failure to progress. This means that labor either stops or does not move as quickly as it should.
Physicians should identify any risk factors for CPD before the start of labor. Risk factors include:
Sometimes it may be necessary to plan to deliver the baby early. When CPD is present, attempts to deliver the baby vaginally will typically cause trauma. This can lead to brain bleeds, oxygen deprivation, HIE and cerebral palsy.
Some mistakes made by physicians when CPD is present that can cause birth trauma include the following:
Continued Labor: Physicians may allow labor to progress for too long. Labor is stressful and traumatic for babies, and when prolonged, this can cause brain bleeds and HIE. The end result can be cerebral palsy.
Prolapsed Umbilical Cord: When there is less room in the uterus, either because of a large baby or a small pelvis, a prolapsed umbilical cord is more likely. This puts the baby at risk for HIE and cerebral palsy.
Shoulder dystocia occurs when the baby’s shoulder gets stuck on the mother’s pelvis during delivery. When this causes a failure of progression during labor, physicians often apply too much force to the baby’s head in an attempt to deliver.
In some cases, physicians may use forceps or vacuum extractors to assist with vaginal delivery. If the physician applies too much pressure to her head in order to deliver, this can cause the nerves in the shoulder area, called brachial plexus nerves, to stretch and tear. This may cause partial or full paralysis of the arm. This arm paralysis is called Erb’s palsy. Use of forceps and vacuum extractors can not only cause Erb’s palsy, but can also lead to brain bleeds and hemorrhages… And result in cerebral palsy.
All the conditions discussed above increase a baby’s risk of experiencing birth trauma and brain bleeds and hemorrhages. Listed below are different types of brain bleeds and hemorrhages associated with birth trauma.
Intracranial hemorrhages. Intracranial hemorrhage refers to any bleeding within the skull or brain.
Cerebral hemorrhage. This is a form of stroke where bleeding occurs within the brain.
Subarachnoid hemorrhage. This occurs when there is bleeding within the subarachnoid space, which is the area between the innermost two membranes that cover the brain. This type of bleeding usually occurs in full term babies and produces seizure activity, lethargy and apnea.
Intraventricular hemorrhage. This is bleeding into the brain’s ventricular system, where spinal fluid is produced. It is the most serious type of intracranial bleeding and is usually seen in premature infants and infants with low birth weight. This is because blood vessels in the brain of premature infants are not fully developed.
Subdural hemorrhage or subdural hematoma. This occurs when there is a rupture of one or more blood vessels that are in the subdural space, the area between the surface of the brain and the thin layer of tissue that separates the brain from the skull. These ruptures are usually caused by difficult deliveries. Seizures, high levels of bilirubin in the blood, rapidly enlarging head, a poor Moro reflex, or extensive retinal hemorrhages (bleeding of the vessels in the retina) sometimes occur with these kinds of hemorrhages.
Extracranial hemorrhages. These are potentially life-threatening brain bleeds that occur just outside the skull.
Cephalohematoma. This is bleeding that occurs between the skull and its covering, starting as a raised bump on the baby’s head. It occurs a few hours after birth and lasts anywhere from 14 days to a few months.
Subgaleal hemorrhage. This occurs when veins rupture and bleed into the space between the scalp and the skull. This is life-threatening for the baby and can cause severe oxygen deprivation. If the bleed is not properly managed, about 50% of the baby’s blood volume can end up in the subgaleal space. A vacuum extraction delivery puts a baby at a high risk of experiencing this type of bleed.
Research shows that when babies are delivered by C-section as opposed to vaginal delivery, they are less likely to have traumatic birth injuries, or birth trauma. Physicians must investigate medical histories and perform physicals examinations of the mother. They must also closely monitor and assess the baby during pregnancy to be aware of any risks that can make labor and delivery high-risk.
It is very dangerous to attempt to deliver a baby vaginally when certain high-risk conditions are present, such as CPD, abnormal presentations, and shoulder dystocia.
In many instances, a C-section is required. Repeated attempts at vaginal delivery, especially in instances in which vaginal delivery is against the standard of care, can cause brain bleeds and other traumatic injuries. These can cause hypoxic ischemic encephalopathy and cerebral palsy.
When any signs of distress appear on the fetal heart rate monitor, the baby must be delivered as quickly as possible, and C-section delivery is usually the best and safest way to do this.
If you are seeking the help of a birth trauma lawyer, it is important that you choose a legal team that focuses on birth injury and birth trauma cases. Willens Law Offices is a leading national injury law firm that has been helping children for decades.
If your child was diagnosed with a permanent disability, such as cerebral palsy, Erb’s palsy, a seizure disorder, or hypoxic ischemic encephalopathy (HIE)... The award winning birth trauma lawyers at can help. We have helped children throughout Illinois obtain compensation for lifelong treatment, therapy, and a secure future.
We give unrivaled personal attention to each child and family we represent. Our nationally recognized firm has numerous multi-million dollar verdicts and settlements that attest to our success. No fees are ever paid to our firm until we win or settle your case. Contact us today for a free case evaluation. Our award winning birth trauma lawyers are available 24/7 to speak with you.
The plaintiff went to a Chicago hospital for delivery of twins via cesarean section. In the delivery room, a suspicious rash was recognized on one of the twins and later, fecal and urine cultures confirmed the presence of candida. She was started on prophylactic anti-fungal medicine and is healthy. The other twin was clear of any rash and though she was at risk for fungal infection, she was not treated in a timely manner. Later, a head ultrasound and MRI confirmed the diagnosis and damage to her brain. A lawsuit was filed on the plaintiff’s behalf. The case was vigorously defended by lawyers for the physician and the hospital that he worked for over 3 years. Eventually, a mediation took place at which time the defendants offered $3,000,000 to settle, which the plaintiff rejected. It was not until trial that the case settled for $10,000,000.
Birth injury cases are among the most complicated medical malpractice cases to litigate. With years of experience in birth trauma litigation our legal team has the skills, the resources and experience necessary to address and win a wide variety of birth injury cases. Our legal team has secured millions of dollars in compensation for birth injury victims.
With decades of hands-on experience working with top healthcare professionals in labor and delivery, our legal ream has access to some of the top medical professionals in the world. As in many types of medical malpractice cases, high quality expert are essential in obtaining justice.
Our firm was established to focus on the unique needs of our clients. We work with top medical, life-planning, and forensics experts to determine the causes and extent of injuries, prognoses of victims, and areas of medical negligence. Our passion for helping birth injury victims allows our attorneys to deliver unrivaled legal services for your family.
Willens Law Offices have helped the families of children across Illinois get the compensation they need for a secure future.
We strive to give the utmost personal attention to each child and family we represent.