Articles Posted in Birth Injuries

Caput succedaneum and cephalohematoma are similar – but distinct – birth injuries that cause a baby’s head to swell.

While there are important differences between caput succedaneum and cephalohematoma, the common thread between the two is they both scare parents but they are typically not serious and will heal themselves over a relatively short period.

My Child Has Caput Succedaneum and I’m Worried… What Should I Do?

Medically induced cooling of the brain can help treat damage. This relatively new procedure — the FDA approved it a little over 10 years ago —  provides the opportunity to treat babies who are suffering from hypoxic brain damage because of perinatal asphyxia.

We don’t totally understand the exact science of why brain cooling limits birth injuries.  Many theories make perfect sense floating around.  But, ultimately, who cares why it works?  It appears to work on not only the brain but other vital organs that have been harmed by oxygen deprivation.

At this point, I don’t know why any hospital with a NICU would not be capable of using cooling to protect an infant from brain damage.

Doctors may now have a new and powerful tool for the early diagnosis of newborns who suffer brain damage during childbirth. A study recently published in Scientific Reports announced that a breakthrough neonatal blood test can effectively and immediately identify those newborns with neurologic damage resulting from oxygen loss during labor and delivery.

This is a significant step forward in neonatal medicine because it enables doctors to diagnose immediately babies born with serious neurologic birth injuries such as cerebral palsy. Without this new blood test, many of these life-changing brain injuries may go undiagnosed for months and even years after birth.

Early treatment and intervention are key to making the most of birth injuries.  This is the most important implication if this technology proves effective.  As a Maryland birth injury lawyer, it is hard to ignore the litigation implications this test could have on birth injuries cases.  It would be a blow to defense lawyers trying to argue that the child was not injured a birth (and, for that matter, specious lawsuits that allege a causal connection).  In other words, it would be easier to get to the real truth as to the ultimate question of whether a doctor or nurse’s mistake caused a birth injury.  I also think it would lead to more birth injury lawsuits because many parents do not connect the dots between a mistake during childbirth with mental and physical injuries to the child that are not revealed (or confirmed) until years later.

Last week, I summarized a recent bench trial in a birth injury case.  I find these bench trial decisions to be useful and informative. They provide a unique perspective on what facts and testimony really matter in a birth injury case. In a jury trial, you just get a verdict. You do not get any meaningful explanation of what mattered and why. Appellate opinions focus on the law and not so much on the resolution of factual issues. These bench trial decisions are like detailed case studies that allow us to see how the facts were presented by each side, how the expert testimony was weighed, and exactly how the fact-finder reached their decision.

So I looked for another birth injury case with the judge as to the decider of fact. I found Coleman v. United States, 200 F. Supp. 3d 1350 (M.D. Ga. 2016), another Memorandum Decision from a birth injury bench trial in federal court.

The plaintiffs filed suit on behalf of themselves and their injured child, J.D. The healthcare providers involved in this birth injury case were employees of a federally funded health clinic in Albany Georgia. The federal government assumes liability for malpractice claims against federally funded clinics, so the United States was the named defendant.

This week I was reading through recent appellate decisions from birth injury cases across the country and I came across a unique written decision from the federal court in Chicago in Zhao v. United States 2019 WL 3956412 (S.D. Ill. 2019).

This was a fairly typical birth injury case in which the baby suffered nerve damage because of a failure to diagnose fetal macrosomia and the mishandling of shoulder dystocia during delivery. What makes this case somewhat unique is that unlike most birth injury cases that get tried by juries, this case was resolved with a bench trial in the U.S. District Court for the Southern District of Illinois (because it was against the United States in this case).

At the end of the trial, the judge awarded the plaintiff $8.2 million in damages, but more importantly, he wrote a very detailed Memorandum and Order analyzing the entire case.

Fetal macrosomia is a medical term that means fetal weight at birth is greater than 4000 grams (8 lbs. 13 oz). Compared to the size of other newborns of the same gestational age, this is considered excessive fetal growth. Your doctor will be concerned with the baby’s probable weight at delivery for a few reasons and should want more testing to be done.

Fetal macrosomia is a serious condition in pregnancy. It is well recognized in the medical literature that a major concern in the delivery of a macrosomic baby is shoulder dystocia and the attendant risks of permanent brachial plexus palsy. It requires close monitoring and frequent visits to the doctor’s office. But the reward is a healthier baby at delivery and sometimes a healthier mother, too.

Women experiencing typical pregnancies are not offered the option of inducing labor at 39 weeks.  That might change.

A recent study funded by the National Institutes of Health (“NIH”) suggests that electively inducing labor 1 week before the due date decreases the risk of complications and leads to a safer delivery.  New mothers whose labor was induced in week 39 (instead of waiting for labor to begin naturally) were less likely to require a C-section and had lower rates of preeclampsia and other complications.  The research also established inducing at 39 weeks did not increase the chances of stillbirth or other severe complications compared to mothers who were not induced.  The detailed results of this pivotal NIH study were just published in the New England Journal of Medicine: Labor Induction versus Expectant Management in Low-Risk Nulliparous Women.

It was previously believed that early induction of labor significantly increases the likelihood of an emergency cesarean delivery in response to complications.  This made many doctors reluctant to induce before 40 weeks, but no comprehensive study had ever been done before.  The Pregnancy and Perinatology Branch at NIH funded the study to fill this data gap.

A neonatal stroke (also called a perinatal stroke) is defined as an interruption of blood flow to an infant’s brain that occurs between 20 weeks gestation and first 28 days after the child is born. Neonatal strokes can be ischemic or hemorrhagic. Ischemic neonatal strokes are caused by some form of blockage in the blood vessels. Hemorrhagic strokes occur when blood vessels rupture and bleed.

In June 2018, a study was published in the Canadian Medical Association Journal which shows there has been an alarming increase in the rate of birth injuries resulting from forceps-assisted deliveries.  This does not surprise me because our obstetrician experts have been telling us for years that the new generation of obstetricians does not have the skill to use forceps.  If too much pressure or force is used, forceps can cause injury to both mother and baby.

What Are Forceps?

Obstetrical forceps are a surgical tool used by OB/GYNs to assist in difficult vaginal deliveries.  The forceps look like large plyers with metal spoons at the ends.  The spoons grip the baby’s head so that the doctor can then manually maneuver the baby through the birth canal.  Sometimes, birth injury lawyers unfairly vilify forceps. But forceps are a very effective weapon with the right obstetrician.  The problem is that they require a high level of skill and experience by the doctor.