Birth Trauma Introduction
By definition, "Birth Trauma" can involve any part or portion of the mothers or the childs body, including any organs or limbs. The more severe forms of Birth Trauma usually involve injury to the brain and/or the nervous system. The brain requires a large amount of oxygen to survive and to function and is the primary center for regulating and coordinating all body activities. The transmission of oxygen to the brain from the respiratory system is crucial to maintenance of the brain and support of its vital functions. Birth Trauma can result from mechanical injury, such as the improper application of obstetrical forceps to a baby's head during the birth process. Severe, moderate or mild damage to the brain caused by low oxygen supply (hypoxia or anoxia) during labor may cause permanent injury and a variety of neurological problems.
The incidence of Birth Trauma that causes lasting injury to babies has been estimated at 2 to 7 per 1,000 live births, or roughly 0.5%. Factors which predispose the infant to Birth Trauma include an abnormally large body, a disproportionately large head, a difficult labor, prolonged labor, and the presentation of the buttocks (breech birth) instead of the head in childbirth. Overall, 5 to 8 newborn infants per 100,000 die of mechanical injury, while about 25 per 100,000 die of hypoxic injuries.
Mechanical trauma involves some physical insult to the body of the infant. The most devastating traumatic birth injuries involve deforming or fracturing the skull, resulting in hemorrhages in or around the brain. Common mechanical causes of brain injury include the improper use of obstetrical forceps, vacuum extractors, and other instruments, allowing abnormal labor to continue for too long, and use of excessive force to push on the uterus or pull on the baby. Another type of mechanical injury results when the nerves of the brachial plexus are stretched or torn by the obstetrician's use of excessive force, causing either partial or total paralysis of the baby's arm. Such paralysis may be either temporary or lifelong and may be improved by later surgery.
Certain maternal, placental and fetal conditions can interfere with normal blood and oxygen flow to the brain of a fetus or a newborn baby. Non-mechanical causes of neonatal brain damage usually involve interference with the transport of oxygen from the mother's lungs to the fetal brain. Such factors include maternal conditions (such as eclampsia), placental (as premature separation from the uterus), umbilical (knotted umbilical cord), hemorrhagic (fetal or maternal bleeding), infectious (chorioamnionitis), and fetal (heart abnormalities). After a baby is born, various conditions can indicate that hypoxic injury occurred while he or she was in the uterus: low APGAR scores, abnormal cord blood gases, seizures, jitteriness, low blood sugar, damage to the heart, liver or kidneys, cessation of breathing, neonatal infection and hydrocephalus ("water on the brain").
Birth Trauma can occur in the absence of negligent care, or such injury may be caused by physician or nursing malpractice, or both. Malpractice is a form of negligence and involves the failure to do what a reasonable health care professional would do, under the same or similar circumstances. Unfortunately, malpractice is one of the common causes of Birth Trauma. Nurses and obstetricians often fail to recognize abnormal signs and symptoms in their pregnant patients, interpret electronic fetal monitor records incorrectly, or act too slowly to correct dangerous conditions and protect their patients. Sometimes, a nurse will be asleep when she should be providing patient care, or an obstetrician refuses to come to the hospital when she or he should.
Occasionally, evidence of Birth Trauma is apparent immediately after birth, and the clinical condition of the newborn baby is so severe that professionals or parents will recognize the problem at once. Unfortunately, there is little that can be done to treat brain damage and other organ damage or their long-term effects. In other cases, the occurrence of Birth Trauma may not be discovered by the baby's parents or attending pediatrician, until the child suffers developmental delay. For example, a child with brain damage who fails to walk at the usual age (milestone) may be showing evidence of cerebral palsy.
Cerebral palsy is a group of lifelong abnormalities of movement that may be caused by hypoxia, mechanical head injury, and a variety of other conditions. Many children with cerebral palsy are of normal or high intelligence; normal minds trapped in crippled bodies. Others are mentally retarded or suffer from seizures and other neurological conditions. Sometimes only their legs are affected, but sometimes both the arms and legs are weak and uncoordinated. When cerebral palsy is diagnosed, sophisticated testing can often determine the cause and whether or not any health care provider has been at fault. Often, physical therapy and surgery can improve the mobility of a child with cerebral palsy, but such treatment can be very expensive.
When parents determine that their child is not developing properly, they must seek the help of pediatricians, pediatric neurologists, and other physicians to discover why the normal pattern of development is delayed. Parents are sometimes told by a physician that their child's abnormal development or behaviors began during the birth process but were unavoidable. But careful review of the medical records may alert the parents to occurrences and omissions during labor and delivery, which caused the brain damage. Under these circumstances, the injured child and his family are entitled to compensation for the injuries that they have suffered and will suffer in the future. Sometimes, extensive medical care and custodial care will be needed. The potential of the child to take care of himself and to earn a living must be assessed and adequate supplemental resources provided.
