Birth ought to be the safest medical event in modern medicine. Expectant mothers go into hospital equipped with protocols, trained staff and equipment that are designed to provide a safe environment for the birth of their babies. Brain injuries during birth occur, though, and while some brain injuries are truly unavoidable, many of them occur as a result of something that should have been done but wasn’t.
The goal of understanding how brain injuries occur during birth is not to blame every baby who is delivered the slightest bit untidy; the intention is rather to distinguish between situations in which complications were impossible to avoid for everyone involved and situations in which complications occurred due to failure of adhering to the required standard of care. This distinction is vitally important for families to understand in order to make sense of the injuries that their loved one may have incurred.
If Oxygen Supply is Compromised
The most common cause of brain injury during delivery is related to oxygen. A newborn’s brain is extremely sensitive to a lack of oxygen even for a few minutes. The oxygen supply that nourishes a newborn’s brain during labour and delivery occurs via the umbilical cord, and any issue that leads to disruption of that flow will have consequences for the baby’s brain within minutes.
Cord compression often occurs when a newborn’s umbilical cord is compressed, often due to contractions or positioning that has caused it to wrap around the baby’s neck. Medical staff that are involved in the delivery should be monitoring this on a constant basis using fetal heart rate tracings. The monitors are not just there for decoration; they indicate the baby’s tolerance of labour. When readings show a worrying change in pattern or drop in heart rate, it is the baby’s way of indicating that it is under distress.
Where things can go wrong here is most often with delayed response. If medical staff either miss the reading or fail to act with appropriate urgency after noting their concerns, time can become an enemy in preserving the baby’s health. A baby can go from healthy to brain-damaged while the medical staff hold a meeting about what intervention should be delivered.
Another compromise with oxygen delivery occurs when placental abruption occurs. This is a situation where the placenta comes away from the uterus before the newborn has been delivered. The baby’s oxygen supply will be immediately cut off, and the situation requires caesarean delivery as soon as possible. The required standard of care in this situation? Swift recognition and even swifter delivery.
Families who are living with the consequences of delivery-related brain injuries sometimes find that opting for Brain Injury At Birth Compensation sheds light on whether or not care was delivered according to this required standard of care in these time-sensitive situations.
Problems with Difficult Deliveries
Some babies are just notoriously tricky to deliver, often due to size or positioning or due to anatomical features of their mothers. “Difficult” does not, however, mean “acceptable to injure”. There are ways to safely manage complicated deliveries without endangering the baby’s life or brain.
There are techniques and equipment available for medical staff to make use of during difficult deliveries, and there are also some absolute thresholds that should be adhered to in order to prevent placing a baby at risk. Assisted delivery can be used, but so can caesarean sections if necessary.
One of the scariest circumstances medical staff may face is shoulder dystocia; this is when the baby’s head is delivered, but its shoulders become stuck. Specific manoeuvres are required to free the baby, and they should be done in a specific order and very quickly. After the head has been delivered but before the chest has cleared the birth canal, a baby’s oxygen supply becomes compromised since its airways have yet to be exposed to air. Medical staff should be trained in how to deal with these situations and their training must include an understanding of how precious every second is in getting the baby safely delivered.
What absolutely should not happen is an overzealous process to get the baby delivered without adhering to set protocol. Excessive pulling, incorrect use of forceps or vacuum extractors can all lead to a situation where direct trauma causes brain damage; Other failures can result in oxygen deprivation that has similar consequences.
If Monitoring Gets Missed
Continuous fetal monitoring exists for a reason; it gives medical staff insight into how a baby is coping with labour. The monitoring devices measure vital parameters continuously and print out strips of paper showing, sometimes often, how the baby’s heart rate reacts and copes under certain conditions. The medical staff working with pregnant women should be trained in reading these patterns.
Fetal monitoring is only effective if someone else other than the equipment manufacturer is actually monitoring it, though. If monitoring gets missed, or if the responsible team is unable to recognise the patterns shown on monitors, they will miss rescue attempts that they could have otherwise implemented on behalf of the newborn.
Staff on duty during a delivery can become undermanned, distracted or they might simply not understand what they are looking at on their monitors. There have also been scenarios where monitors have had faulty settings that lead to erroneous conclusions; foetal heart rhythms can vary tremendously from one patient to another.
Units that experience intermittent monitoring, where continuous monitoring was indicated, can also result in injury cases; high-risk deliveries, cases where pregnancy complications are either expected or history makes such high risk pregnancies probable, should be continuously monitored during active labour. Heart rate patterns can change rapidly and a 15 or 30 minute check-up cycle might not be enough time for patterns indicating distress or danger to manifest.
If Response Times are Unreasonable
Even if everything was done correctly, patterns recognised and protocols followed, time is still required for everything related to those actions. Decision making takes time; so, does theatre availability for any emergency procedures that need to be performed; even anaesthesia takes time. Response times should not stretch into hours or even long minutes, though.
The standard time frame for an emergency caesarean section operation still remains below thirty minutes from when the decision has been made to perform it. This may seem like a long time when one recalls that obstetric patients find themselves in an operating theatre every hour, but delayed response times do sometimes occur due to organisational issues (for example if hospitals experience high volumes of patients), staff issues (availability of trained personnel), technical problems (problems with operating machines) or human problems (treating patients with urgency).
Infant response times are similar; babies who need resuscitation after birth are still babies who need immediate treatment; their brain functions may already be suffering damage at this stage if treatment don’t occur immediately after delivering.
Skill in neonatal resuscitation should be available as well as equipment; delaying these life-saving skills and tools unnecessarily can lead to critical brain damage related outcomes for newborns who may otherwise have fully recovered from foetal distress factors.
What Should Have Happened
In most instances involving birth-related brain injuries that could have been avoided if the required standard of care had been adhered too, answers to what should have been done tends to be rather simplistic:
- The staff involved should have monitored continuously
- The staff involved should have reacted accordingly
- Delays in reacting should have been avoided
- Standard procedures in difficult deliveries should have been followed
- Emergency solutions should have been considered within safe time frames (response times)
In circumstances where failure to follow these procedural steps resulted in injury, parents can potentially apply for brain injury at birth compensation; through reviewing patients’ cases history files over months and years, accuracy can often be determined in cases where actual history during complicated post-natal problems fails to correspond with medical records.
Medical care in hospitals is not experimental; families should be able to expect basic levels of care from their providers. In cases where medical staff fail, families should have recourse that leads potential patients away from similar undesirable outcomes again in future cases; adherence to guidelines leads families away from unnecessary harm!
Brain injuries during birth does not always result from preventable negligence; when they do occur due to failure by medical providers to ensure that all steps taken met basic standards though, questions need be asked regarding accountability! The difference in these instances lie in whether medical practices adhered to standards compared to surgeries wherein families emerged without having satisfactory care being provided by those in charge of their health outcomes.
For parents awakening daily to “complications” they did not foresee when processing yet another day with their brain injured child post-partum, these questions become important immediately after blood-dried faces finally comprehend what happened during their delivery process; pivotal months and years later when they attempt to make sense of their child’s required routine interventions or errors within post-operative procedure notes compared with what they recall from days spent with uninstructed members attending births instead of trained staff; tears induce trauma counselling techniques while wondering “what should have happened?”
