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Posted on 15th June 2017

Guide to a Babys Pregnancy and Birth Complications

During pregnancy and labour, your baby should be closely monitored by midwives and the birthing team. Some of the conditions listed below could be caused by a negligent act by a healthcare professional. The key to whether what happened, would be classed as negligent is very much in the detail.

The common complications that you and your baby could experience include:

Foetal Lacerations

If your baby is born with a cut or scrape after a C-section, these injuries could be caused by a negligent act by a healthcare professional. Dependant on how your baby is positioned at the time of the C-section, the lacerations could cause serious health problems such as Erb’s Palsy, Klumpke’s Palsy and spinal cord injuries. Laceration injuries to baby shouldn’t happen and are often caused by inadequate procedures performed by the birthing team.

Caput Succedaneum

This is swelling on a baby’s scalp and is caused by the baby’s head pushing through the cervix. It can also be caused by vacuum delivery. It is a relatively minor injury that usually resolves itself over a few days. The likelihood of this condition being caused by a negligent act is slim. Caput Succedaneum usually occurs when childbirth takes a long time therefore other birth complications may occur and it is important that the baby’s health is monitored to highlight any associated conditions.

If the injury is caused by the vacuum delivery tools, usually it is because the tools were not used correctly or the procedure for using the tools were not followed. These types of injury may be classed as negligent but the circumstances behind the need to use of vacuum tools should also be taken into account.

Forceps delivery injury

Forceps are used to aid delivery when giving birth becomes problematic. When mum becomes too tired to push or there is an infection or haemorrhage, healthcare professionals may choose to assist delivery by using forceps. Injuries to a baby can include facial palsy, facial injuries such as bruising and lacerations and even misshapen heads, skull fractures, seizures and brain damage. Usually assisted delivery by forceps is straight forward but some of the above complications can be caused by a negligent act and they can lead to other serious complications such as strokes, hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Forceps delivery may cause vaginal tearing.

As with vacuum delivery injuries, forceps injuries are generally caused by improper techniques or procedures not being followed. The circumstances behind forceps use should be taken into consideration.

Horner’s syndrome

Nerve damage from the brain to the eye and face is a rare condition however a high percentage of birth related Horner’s syndrome occurrences are due to birth injuries or trauma.

Horner’s syndrome from birth injuries are associated with the incorrect use of forceps during delivery, excessive force when trying to deliver the baby (which tears the sympathetic nerves), shoulder dystocia, foetal distress and breach birth. Depending on the causes, Horner’s syndrome may be due to an act of negligence .

Hydrocephalus

Derived from the Greek words Hydro (water) and cephalous (head) this condition literally means water on the brain. The water isn’t actually water it is cerebrospinal fluid (CSF). Hydrocephalus occurs when there are problems with the flow or re-absorption of CSF. Ventricles in the brain become blocked either by medical conditions such as meningitis, tumours bleeding or subarachnoid haemorrhages. In some instances hydrocephalus can be caused by head trauma during birth.

If hydrocephalus is caused by head trauma during birth, this could be a sign of an act of clinical negligence.

Bell’s palsy

This isn’t usually a long term complication and can be described as paralysis or weakness on one side of the face. Symptoms of Bell’s palsy include excessive tearing or dry eyes, increased ear sensitivity, one sided smile, drooling and increased sensitivity to sound.

It is thought that the causes of Bell’s palsy include the herpes virus and upper respiratory tract infections. Infant Bell’s palsy may be caused by a negligent act if the healthcare professionals didn’t treat an infection that mum had  

Bleeding on the brain

This is usually caused by a stroke where a blood vessel bursts causing blood to flood the brain. It can be caused by a birth injury such as if the baby was dropped just after delivery or by the use of forceps or vacuum tools, during delivery. It can also be caused by the mum having high blood pressure.

If bleeding on the brain is caused by delivery tools, it is probably due to improper techniques being employed. If however it is caused by mum’s blood pressure, negligence would depend on whether the blood pressure was correctly managed during pregnancy.

Brain ischaemia

Ischaemia refers to a reduction in blood flow, brain ischaemia is where the reduced blood flow causes brain damage. When it happens to a baby, the symptoms are hard to identify because babies cannot communicate with us. Babies may display symptoms such as loss of consciousness, lethargy, loss of movement on parts of the body as well as seizures. In babies, brain ischaemia can be caused by infections in mum, problems with the placenta, dehydration and oxygen deprivation.

With close monitoring of mum during pregnancy infant brain ischaemia can be avoided. If mum has any disorders that are congenital (from birth) in nature, the doctor should be monitoring your baby to ensure those conditions do not affect him or her.

Broken bones

Collarbone fractures are the most common form of bone injury in babies followed by limb fractures. They are not necessarily caused by a negligent act. They occur when baby is large and struggles to be born or where a healthcare professional uses too much force or the wrong delivery technique.

Forceps delivery can increase the risk of fractures. If baby is big, becomes distressed and struggles to be born naturally, an emergency C-section is usually the way to safely deliver baby.

Cephalohaematoma

A minor injury that usually heals without medical intervention, it causes a pooling of blood between the skull and inner layers of the skin. Cephalohaematoma has been linked to the use of forceps during delivery but there are other causes such as the baby’s head being larger than mum’s pelvic area.

As with other forceps injuries, medical negligence may be established if the wrong technique was used to deliver baby.

Cervical Dystonia

A neurological condition where a baby’s head muscles contracts involuntarily. It is thought that Cervical Dystonia is a result of a birth injury that leads to hypoxia and neonatal brain haemorrhage. Many babies with cervical dystonia will have developmental problems in later life and could suffer from depression.

In order for a claim for medical negligence to be brought, there has to be a link between an event that happened during the delivery of baby that shouldn’t have and the cervical dystonia. This is called causation in legal terms.

Cystic Fibrosis

This affects breathing and digestion because of a disorder of the glands that produce mucus or sweat. Often the mucus build up stays in the lungs and digestive tract as well as the liver and pancreas. It can also affect the child’s immune system causing them to be more prone to infections.

Cystic fibrosis is thought to be a genetic condition passed down via a parent and in some cases, children with cystic fibrosis may go on to develop a form of diabetes.

Cystic fibrosis is unlikely to be as a result of a negligent act by a healthcare provider.

Hypoxic Ischemic Encephalopathy (HIE)

This is a brain injury caused by a reduction in the oxygen supply to the brain and is compounded by reduced blood flow. It is thought that mums who have diabetes and vascular disease may cause HIE along with reduced blood flow to the placenta, pre-eclampsia, cardiac disease and anaemia.

The complications arising from HIE include epilepsy and developmental delays but the severity of HIE would not be fully known until the child reaches 3 or 4 years old.

If close management of maternal conditions is not performed by a healthcare professional and baby goes on to suffer from HIE, negligence may be able to be established.

Meningitis

A bacterial infection that spreads to the spinal and brain fluid. New born babies are at a high risk of this condition because their immune system has not fully developed. It is important that blood tests for group B streptococci are carried out because this is a cause of meningitis in new born babies.

The management of meningitis is the focus here because if medication isn’t given at the correct time, the results could be catastrophic and a claim for medical negligence could be pursued.

Shoulder Dystocia

If baby is too large for the birth canal, shoulder dystocia may occur. Shoulder dystocia happens when the baby gets stuck in mum’s pelvic area, when baby is delivered by forceps or when the baby is born feet first. In each instance, too much stress is placed on baby’s shoulder and neck area.

Injuries to baby such as brachial plexus palsy, broken bones and facial injuries may occur in addition to the shoulder dystocia. Symptoms include a claw like had appearance, limb paralysis and nerve damage.

If the injuries are caused by the use of delivery tools, medical negligence may be able to be proved.

Spina Bifida

Is a condition classed as a birth defect where the bone making up the spine do not completely close around the nerves in the spinal column. They symptoms from spina bifida can range from mild to severe where mild may be a birthmark or a light dimple and where sever may mean paralysis, weakness or numbness in limbs.

It is thought that folic acid can significantly reduce the risk of spina bifida.

In clinical negligence terms, it would have to be established that the management of folic acid deficiency was not appropriate and that deficiency caused the condition.

Sub conjunctival Haemorrhage

Small blood vessels beneath the eye ruptures and symptoms show a red patch in the whites of the eye. It is usually caused by a stressful delivery where doctors use forceps or vacuum tools to aid delivery and too much pressure is used. This condition will usually resolve within a few weeks though in extremely rare instances some permanent eye damage may occur. Other birth injuries may be present such as facial paralysis.

When tools are used to deliver your baby and they are used incorrectly, negligence against a healthcare professional may be able to be established.

Torticollis

This is caused by baby’s neck being twisted during birth. The most common causes include vacuum delivery, forceps delivery, excessive force used during delivery and breech delivery.

Meconium Aspirations Syndrome (MAS)

It is thought that between 1 and 3% of babies are born with MAS. This condition occurs usually around 34 weeks of pregnancy or during delivery. It is where the baby inhales a mixture of amniotic fluid and meconium.

During pregnancy or labour, if your baby becomes distressed, baby may poo and then inhale it. This thick liquid can then block their airways causing a lack of oxygen and in turn brain damage.

In most cases where meconium is present, babies are responsive and need no further treatment.

Incidents of MAS are decreasing because of the increasing levels of abnormal heart rate monitoring and induction if pregnancy passes 41 weeks.

Medical negligence claims involving MAS depend on the management of your baby during delivery.

If it can be proven that your baby was not managed correctly during birth and has meconium aspiration syndrome, a claim for medical negligence is possible.

Neonatal Stroke

Strokes are not only associated with the elderly, in fact a stroke can also occur in new born infants. If a stroke occurs within the first 7 days, it is called a perinatal stroke. It is associated with autoimmune disorders, coagulation disorders as well as infection, congenital heart disease and diabetes.

Babies who suffer from a stroke have a high chance of developing neurological complications.

Neonatal strokes can be caused by maternal infections that are mismanaged.

Persistent Pulmonary Hypertension of the New born (PPHN)

A condition which affects the blood flow to the lungs during delivery. When a baby is born, their blood pressure drops causing changes in the circulation of blood. That change in circulation causes baby to breathe on their own. In some instances the circulatory changes do not happen and baby returns to pre-delivery circulation.

When blood flow returns to foetal circulation, blood bypasses the baby’s lungs stopping them from working.

The causes of PPHN are not fully known but it is thought that meconium aspiration may be one cause.

Vacuum extraction injury

Birth assisting tools are commonly used throughout the world and if used correctly with the appropriate techniques are safe. Vacuum (Ventouse) delivery should only be used if your pregnancy is over 34 weeks. This method is less likely to cause tearing than forceps.

Any injuries to your baby or the mum could indicate negligence due to incorrect techniques used or excessive force.

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