New Mexico Injury Attorney Blog

In birth injury cases, a lack of oxygen is the most common cause of damage to an infant's brain. Oxygen deprivation can come in the form of asphyxia, a blockage to the airways, or hypoxia, a blockage of oxygen-rich blood to the brain. While a lack of oxygen can occur for many reasons, one cause may be due to a common medical practice: immediate cord clamping (ICC).

ICC generally occurs right after an infant's delivery. The umbilical cord that unites mother and child is clamped then cut, typically within 30 seconds after the baby has emerged. The process is thought to prevent hemorrhaging in the mother and allow the infant to be quickly transferred to a resuscitation station for further evaluation.

Recent studies suggest that clamping and/or cutting the cord too soon may lead to massive blood loss into the placenta. This reduces the nutrient-rich blood and oxygen supply a child needs when taking its first breaths. Certain infants are more susceptible to problems from this decrease in oxygen and blood, leading to a possibility of brain hemorrhage or breathing difficulties. Both of these risks can result in brain damage and a wide range of long-term disabilities.

Some experts, including the World Health Organization, recommend that three minutes should pass before cutting the umbilical cord. This will allow blood from the placenta to flow to and nourish the newborn, while the baby establishes a proper breathing pattern and starts to depend on its own bodily systems. It is advised that all signs of pulsation within the cord should cease before the cord is clamped and cut.

Experts believe the amount of blood transferred through the cord may amount to 30-50% of an infant's eventual blood volume. Studies show that infants have a built-in reflex system that will shut off the flow of blood from the cord once they have received the optimal amount. And, this nutrient-rich blood could impact the health of the infant long past birth, reducing the chance of iron deficiency in children as old as 8 months.

Traditional treatment of an infant displaying a lack of oxygen has been to re-oxygenate their systems. Unfortunately, they may be in need of blood volume replacement instead, something that is typically not addressed. Interestingly, rates of oxygen deprivation are much lower in deliveries involving professional midwives. Often, midwives delay the cutting of the umbilical cord until delivery of the placenta.

Dr. George Morley, MB, ChB, FACOG, a board certified OB/GYN states emphatically that "Perinatal and neonatal care is less successful in saving brains than saving lives." He also believes that the cause of oxygen deprivation in newborns has been misdiagnosed, leading to no real decline in cerebral palsy rates, despite intensive interventions.

While this is just one theory involving infant brain damage, expectant parent should discuss ICC with their medical providers. Many physicians may simply be following current trends in obstetric medicine by practicing ICC, without being fully aware of the possible risks this procedure may present.

If your baby has suffered a birth injury, including brain injury, it is important to contact an experienced personal injury attorney right away. There are unique medical malpractice statutes of limitation and other deadlines.

Collins & Collins, P.C.
Albuquerque Attorneys

Approximately 4 million women give birth in the U.S. each year, and more than 60% of them receive epidural anesthesia during labor. Epidural anesthesia is a process where pain management medication is injected near the nerves in the mother's lower back. And, while this process may ease pain and discomfort for the mother, it can in some circumstances create a greater risk of injury to the baby.

Epidural anesthesia has been found to increase a mother's temperature. While the link between epidural anesthesia and fevers is not well understood, one belief is that an inflammation response is triggered, generally in the fetal membranes and placenta. Other studies suggest that epidural anesthesia may decrease the mother's ability to dissipate heat at a time when she is expending energy due to the labor process.

Dr. Scott Segal at Tufts Medical Center in Boston, a teaching hospital, explains that this rise in temperature is not seen with other types of pain control or drug-free labor. Nor is there an effective, safe method for preventing maternal fever from epidural. He also cites that maternal fever in general is known to complicate up to 1/3 of all deliveries.

According to a recent study published in Pediatrics, a possible link has been found between birth injuries and women with elevated temperatures who received epidural anesthesia. The study suggests the higher the mother's temperature, the greater the likelihood the infant would experience problems at birth. These problems included breathing difficulties, poor muscle tone and even seizures.

The study documented that 19.2% of the women who received an epidural developed temperatures above 100.4 degrees. If the fever was over 101 degrees, the infant had a 2-6 fold increase in the risk for problems. Interestingly, the study revealed there was no difference in an infant's outcome for women who did not develop a fever after epidural injection versus those who did not have an epidural at all.

Many infants who experienced problems after a delivery involving a maternal fever overcame the issues associated shortly after birth; however, others did not. Maternal fever has been linked to infant brain injury resulting in cerebral palsy, muscle atrophy and learning disabilities.

And, while other factors could be at work, namely, intrauterine infections, maternal fever is certainly a risk factor that should be discussed with one's physician before delivery. Even if a mother has no plans to rely on epidural anesthesia, plans can change once labor sets in. It is best to know the risks ahead of time without the added pressure of making decisions while in the grips of a painful contraction.

These are all issues that should be discussed between an expecting mother and her physician. Only through understanding can a patient make informed decisions in the midst of delivery.

Collins & Collins, P.C.
Albuquerque Attorneys

Cesarean section (c-section) deliveries are the most common surgical procedure performed on women, according to the March of Dimes. In fact, about 30% of the 1.4 million live births in the United States are delivered by c-section, often because it is medically necessary to protect the life of the mother or the child.

Doctors have often thought that pre-term delivery, delivery before 37 weeks of pregnancy, by C-section might give a fetus with a slower than average growth-rate the best chance at normal development. These babies were considered too fragile to endure the vaginal birth process without physical trauma or other complications. A C-section was viewed as a protective measure, in which it was believed that treatment for growth issues could be better dealt with after delivery through an Intensive Care Unit.

However, recent research conducted by the Society for Maternal-Fetal Medicine (SMFM) challenged the widely held belief that a C-section delivery poses no health risks for a pre-term baby who is small in gestational age. The study found that higher rates of respiratory distress were noted in these infants delivered pre-term by C-section. In fact, they were found to be 30% more likely to have breathing issues than pre-term infants born vaginally.

Unfortunately, there may be more repercussions to pre-term C-sections than just breathing issues. C-sections performed even at 39 weeks can be problematic for an infant's brain, which is still developing. Thus, pre-term babies delivered by C-section may also face lifelong physical and developmental problems, including motor control issues like cerebral palsy.

What may have been seen as a protective measure for pre-term infants with growth issues may now end up being an improper medical recommendation. The SMFM study suggests that the best outcome for a slow growth rate fetus might be continued gestation in the mother's womb, particularly if there is no imminent danger to the mother or child.

These are all matters that should be discussed with the expecting mother's doctor. This should be a thorough discussion of all the risks and benefits of a pre-term C-section. If a doctor is recommending a pre-term C-section, then the expecting mother at a minimum should ask for a second opinion.

The doctor's office can be an intimidating place. Patients are often reluctant to ask questions. Many do not want to second guess the doctor. However, asking a question and understanding the risks of a procedure is not second guessing. It is simply a part of good patient care. And honestly, with the risks of a newborn at risks, if the doctor is offended and sees it as second guessing, then the patient needs a new doctor.

A decision that could have life-long devastating consequences to the child and the family should not be entered lightly. Expecting mothers like all patients must take steps to protect themselves. After all doctors are not perfect. Most good doctors will appreciate the patient's involvement. Those that do not are those same doctors that at times remind the medical profession of its imperfections with avoidable medical malpractice lawsuits.

Collins & Collins, P.C.
Albuquerque Attorneys

Babies bring a whole new level of adventure into the lives of their loved ones. Yet, they also bring countless concerns, particularly when they fail to reach conventional milestones, like rolling over, crawling or walking. Combine these with more significant issues as a child ages, like continued difficulty lifting one's head, physical stiffness or an inability to sit without support and the possibility of a motor disability may exist.

Cerebral palsy (CP) is the most common motor disability among children. According to Centers for Disease Control and Prevention, Cerebral Palsy occurs in 1 out of every 303 eight-year-old U.S. children, and approximately 10,000 babies will develop CP each year. It is 1.2 times more frequent in males than females, and the incident rate is significantly lower in Hispanics versus Caucasian or African American children.

Cerebral Palsy is a condition that affects the coordination between the brain and the body's muscles, thus impacting a child's ability to move and maintain posture. It is typically caused when the brain develops abnormally or is damaged during development.

Depending on the area and extent of damage, a child can have a very mild condition which results in awkwardness or clumsiness. More moderate cases may involve involuntary movement, speech problems or muscle tightness. And, more severe occurrences could include sight, hearing or speech impairment, difficulty swallowing, incontinence or mental retardation.

If the damage occurs before birth, it is considered "congenital" cerebral palsy, affecting nearly 70% of the children diagnosed with cerebral palsy. Some potential causes before birth involve infections contracted by the mother, a lack of blood supply and genetic conditions.

If the damage occurs during birth, it is still defined as "congenital"; however, this type only affects about 20% of those with a formal cerebral palsy diagnosis. During birth, a child can have problems from premature birth, delivery complications, having low birth weight or experiencing severe jaundice.

When symptoms appear after birth, typically after 28 days, it is considered "acquired" cerebral palsy. This type affects the remaining 10% diagnosed. Situations that can develop during this time include, a lack of oxygen, bleeding of the brain, or even a brain injury from a fall, car accident or physical abuse.

Of the many ways that a child may suffer cerebral palsy, medical malpractice is only one cause of the condition. The estimates of medical negligence related cerebral palsy vary wildly from 4% to 25%. However, even one case of medical malpractice leading to sever and permanent damage to a child is too many.

If you believe your child has suffered cerebral palsy as a result of medical negligence, you should seek the assistance of an experienced personal injury attorney as soon as possible to insure that your rights and the rights of your child are fully protected.

Collins & Collins, P.C.
Albuquerque Attorneys