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Cerebral Palsy: When the Unspeakable Happens in the Delivery Room

Newborn infants can suffer cerebral palsy, other profound brain injuries, seizure, or even death, when their brains are deprived of oxygen (asphyxia or hypoxia) during labor and delivery.

I recently attended a specialized multi-day workshop where I met with and learned from some of the top lawyers and medical experts in birth injury medical malpractice cases, hosted by the American Association for Justice.  One recurring point that we examined during the workshop was the problem of vulnerable fetuses and individual circumstances.  These differences can impact health outcomes and the proper treatment in appropriate cases.  For example, if the fetus has lower oxygen supplies to draw on than would be considered typical, it can make a big difference in these kinds of cases, and it has to be considered and evaluated.

It is heartbreaking for parents to wonder whether the obstetrician, nurses, or other health care professionals should have intervened sooner and delivered their baby before it suffered hypoxic brain injury. There is a tool that is available to help the medical professionals evaluate this risk, electronic fetal monitoring (EFM) tracings.  

EFM helps obstetrical doctors and other clinicians detect crucial warning signs, including low pH (acidosis), which could indicate that the fetus does not have enough oxygen.  When the tracings show that the fetus is experiencing signs of deteriorating conditions, doctors need to make sure the baby is getting an adequate oxygen and blood supply.  

Medical societies and other medical industry groups have developed a three-category system to assess the fetal heart rate:  Category I (normal), Category II (indeterminate), and Category III (abnormal).  If a medical doctor or health care worker finds that there is a Category III reading on the FHR tracings, often it is too late – the baby may have already reached a point of no return, and serious fetal asphyxia may have already happened.

Category II cases present a problem that requires careful treatment, and vigilance by the medical team.  With Category II tracings, the physician owes a duty to continue to monitor the fetal heart rate and determine whether the baby can be delivered safely. While the symptoms and medical descriptions involved here are sometimes complex, the rule for action is simple:  Where urgent warning signs are present, caregivers must proceed to deliver the child urgently.  

When the child has been delivered and experiences problems, such as a low Apgar score, that can indicate that the baby was not delivered quickly enough and that there was a problem in the delivery room.  Apgar stands for Appearance, Pulse, Grimace, Activity, Respiration.  Each of the five factors is given a score of 0, 1, or 2, for a total possible score of 10.

This kind of injury is progressive, and so medical professionals must remain vigilant to catch the problem before it is too late.  Continual monitoring is important, because the problem can develop gradually, or all too quickly in the case of a delivery rupture or prolapse.  The Babcock Law Firm helps families and their children that have suffered birth injuries. Call 912-574-7575.