Birth Injury Overview
A birth injury is damage caused to a baby before, during, or shortly after labor and delivery. Also known as birth trauma, birth injuries can take several different forms, but most of them are minor and resolve over time. Minor injuries are common with childbirth.
More serious injuries cause lasting damage. Birth injuries include brain damage, nerve damage, bone and muscle damage, and in the worst case scenario, death. If you had a child born with a birth injury, there may be someone at fault, including the medical professional you trusted to make the right decisions about your pregnancy labor. A lawyer experienced in birth injuries can help you decide if you have a case that could lead to compensation.
Perinatal asphyxia is a common way in which infants are injured at the time of birth. It refers to an inadequate flow of oxygen to the newborn during childbirth. This may happen because blood flow to the baby is restricted or because the blood getting to the baby does not have enough oxygen in it.
The cause of perinatal asphyxia may be a genetic abnormality, loss of blood, pressure being placed on the umbilical cord, an infection, and many other possibilities. One of the common results of this birth injury is cerebral palsy.
Cerebral palsy, or CP, is a neurological condition caused by lack of oxygen to the brain. It leads to impairments in motor skills, muscle tone, and movement. There can also be related complications like learning disabilities, cognitive impairment, speech difficulties, arthritis, lung disease, low bone density, malnutrition, and limited vision or hearing. The effects of CP vary widely by individual and may be mildly to totally debilitating. There are treatments, but no cure for CP.
The most common type of CP is called spastic cerebral palsy. It is characterized by abnormal movements, muscle spasms, stiff muscles, and difficulty controlling movements. Dyskinetic cerebral palsy is the next most common type of CP and it causes repetitive movements, irregular movements that are unpredictable, and awkward posture. Ataxic CP is characterized by trouble with coordination and balance and tremors. It is not very common. A child may also have a mixed type of CP with characteristics of one or more of the other types.
While there is no cure for CP, treatments can help improve symptoms, and therapy and educational interventions can help with complications of the condition. Some types of physical therapy is the most common type of treatment for CP. It helps children develop better muscle tone, learn to move in ways that are more comfortable, be better able to walk, and speak more easily.
Medication is another possibility, and in some cases, surgery may be recommended. Medications include muscle relaxants to reduce stiffness and spasms, anticonvulsants to reduce seizures, and anticholinergics for muscle tremors and spasms. For some people with CP, antidepressants, painkillers, and Botox injections can also help. When other treatments fail or do not help enough, surgery is used to realign joints, relax muscles, and to make a child more comfortable.
Brachial Plexus Injuries and Erb’s Palsy
The brachial plexus is a bundle of nerves that controls movement and feeling in the arms. It runs from the spinal cord, through the neck, and down each arm. These nerves can be damaged during childbirth when the neck and shoulder of the baby are pulled apart too severely. This can lead to stretching of the nerves with damage that ranges from mild to severe and even to nerves that are completely torn from the spinal column.
A number of birth injuries are included under the heading of brachial plexus injuries, and most common is Erb’s palsy. It occurs when the damage to the brachial plexus causes damage to the arm such that it is weaker or lacks sensation. It may even be paralyzed if the damage is severe enough. Erb’s palsy is sometimes used to refer to any damage in the arm from injury to the brachial plexus, but it is also sometimes categorized as loss of movement or feeling in the upper arm. When brachial plexus damage leads to weakness or paralysis in the lower arm, wrists, or hands, it is often called Klumpke’s palsy.
Regardless of how it’s classified, damage to the brachial is most often not permanent. Most infants show signs right away of not being able to move one arm as much as the other, but this heals within a few months. If the damage to the nerves is more serious, physical therapy may help the baby recover feeling and heal, or surgery may be necessary to repair damaged nerves. In some cases, a person will live with symptoms of Erb’s palsy into adulthood.
If a baby’s symptoms don’t lessen or disappear by about six months of age, the nerves are not healing. This may mean that surgery is necessary to make repairs to the damaged nerves.
Depending on how severe the damage is nerves may need to be completely replaced. Donor nerves can be grafted onto torn nerves to help them heal, but can also be used to replace nerves entirely. These surgeries can help, but don’t typically correct all damage or prevent lifelong symptoms or deformities.
Other Nerve Injuries
Other nerves may be damaged in an infant in a similar way to the brachial plexus. They get overstretched, damaged, and in extreme cases, ripped or torn. Damage to the brachial plexus is the most common type of nerve damage in birth injuries, but other nerves may be affected during a difficult labor as well.
The nerves in a bundle that originates from the brain instead of the spinal cord are called cranial nerves and these can be damaged by stretching during childbirth. Depending on which nerve or nerves are damaged, a child may be born with various weaknesses or paralysis.
One possibility is that a facial nerve will be damaged. This can happen when forceps compress the nerve, but it also happens naturally as it is compressed coming through the birth canal. Symptoms of this type of injury are asymmetrical movements in the face, one side of the mouth being drawn toward the other side, smoother skin on the paralyzed side, and general lack of movement and expression on the affected side of the face.
Damage to the laryngeal nerve may affect a child’s ability to breathe and swallow. It may also cause paralysis of the vocal cords. This damage often occurs when an infant’s head is turned to the side during childbirth. A newborn with this type of nerve damage will show respiratory distress and may have a hoarse cry. Most babies born with laryngeal nerve damage will recover within a few months.
In very rare cases the spinal cord may be stretched and damaged. Although rare, this is a serious injury. The result is typically paralysis below where the damage occurred. These spinal cord injuries are most often permanent and leave a child with a lifelong paralysis to part of the body.
It may sound unlikely, but skull fractures in newborns are more common than many realize. The pressure that the baby’s head is under as it exits the womb can be great enough to cause a fracture. Forces from the birth canal and from the mother’s pelvic bones can sometimes cause a fracture. A fracture may also be caused by the instruments being used to deliver the baby.
Luckily, most fractures are not severe and heal with time and without causing any other complications. A fracture may also underlie other types of brain injuries in newborns, such as a cephalohematoma, bleeding under the skull. With a hematoma the doctor may need to drain fluid from the baby’s brain to prevent damage from the pressure of that fluid.
Injuries that occur during childbirth, or in the womb before childbirth, have the potential to cause brain damage. Fractures may cause brain damage, but most often do not. Other brain and skull injuries are also unlikely to cause brain damage. These include cephalohematomas, bleeding below the skull, as well as other types of bleeding in the brain. These cases are usually treatable and don’t often leave the baby with any permanent damage.
Other types of injury to the brain, however, can cause brain damage. There a few main causes of infant brain damage. One is hypoxic ischemic encephalopathy, or HIE. This is brain damage caused by lack of oxygen to the infant’s brain during childbirth. Inadequate oxygen can cause brain cells to die. This is a common cause of cerebral palsy.
If lack of oxygen is severe enough, it can lead to periventricular leukomalacia. This is the death of white brain matter, which leads to the loss of significant amounts of tissue in the brain. The white brain matter is specifically tied to motor function and its loss effects movement.
Cerebral dysgenesis refers to abnormal development of the brain of an infant. There are many possible causes of abnormal development, but during childbirth, it may be caused by direct damage to the baby’s head. Pressure from the birth canal or medical instruments may cause this damage. Cerebral dysgenesis can also be caused by an infection.
Most birth injuries do not lead to death of the infant, but it is possible. Infants die every year because of injuries caused at the time of birth.
There are a few types of injuries that are more likely to be fatal if severe. For instance HIE, or lack of oxygen to the infant’s brain, if severe enough may cause significant brain damage to lead to the death of the child. This may happen during a difficult labor if the infant gets stuck in the pelvic area or in the birth canal or gets choked by the umbilical cord.
Other possible causes of infant death include hemorrhaging, bleeding in the brain, newborn jaundice that goes untreated, severe damage to the spinal cord, hydrocephalus, or a severe skull fracture. In many cases the death of a newborn is considered a wrongful death. Some action, or inaction, on the part of medical caregivers directly or indirectly led to the death of the infant. If a newborn’s death is deemed preventable, it could be termed a wrongful death.
Preventable Birth Injuries
The death of an infant is always a tragedy, if it could have been prevented with better medical care, the loss is even more devastating. Even when a child is born with a birth injury that isn’t fatal, that child may have to live with lifelong complications. There are many examples of infant injuries that could not have been foreseen or that would have been impossible to prevent, but many more that were the result of negligence or wrongdoing.
Some reasons that birth injuries or fatalities could have been prevented include a failure to detect a mother’s infection while pregnant, side effects from prescribed medications, or generally a failure to detect potential issues with the mother, the fetus, or a difficult labor. Birth injuries are sometimes caused by a doctor’s failure to determine the need for a Cesarean section, for instance. This can lead to a long, difficult labor that results in birth injuries. A doctor may also fail to detect problems with the umbilical cord, or may even use forceps and other instruments in a way that causes damage.
Birth injuries range from mild and temporary to fatal with every other possibility in between. Fortunately, most birth injuries are not fatal and do not cause serious, lifelong complications, but many do. If you have a child who now faces birth injuries like cerebral palsy, Erb’s palsy or brain damage, you may feel as if those injuries could and should have been prevented. Lawyers experienced in birth injuries and wrongful deaths can help you take the steps needed to seek justice and compensation for your child.
- http://emedicine.medscape.com/article/980112-overview - a9