Delayed C-Section and Cerebral Palsy
This article has been fact checked by a Board Certified Pediatrician. Sources of information for the article are listed at the bottom.
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Labor and delivery of a newborn is an intricate process in which the slightest mistake can lead to birth injuries. Healthcare professionals are trained to detect when an emergency C-section is needed, but if a doctor fails to act in time, serious consequences can occur.
A C-section is considered an emergency procedure when the health of the mother, baby, or both, is in danger. It’s up to a physician to determine if and when it should be scheduled and carried out.
Reasons for Emergency C-sections
Fetal or Maternal Distress
One of the most common reasons doctors make the decision for an emergency C-section is due to fetal or maternal distress. For instance, if the baby’s heartbeat is too fast or too slow, or if a mother is having medical difficulties, doctors can make the decision to deliver the baby immediately.
Fetal distress can happen relatively quickly, so it’s important that your healthcare provider keeps a close watch. Within minutes of the onset of distress, an infant could experience oxygen loss, and if not delivered in time, the baby could end up with brain damage that could lead to cerebral palsy.
If a mother’s labor is not progressing as it should, an emergency C-section may become a necessity. Prolonged labor can cause a host of problems. The baby is at an increased risk of oxygen deprivation, sepsis, and intracranial hemorrhage. These issues can lead to long-term medical complications for the infant, including outcomes such as developmental delays, cerebral palsy, and seizures.
Prolonged labor also poses risks to the mother, such as intrauterine infections, postpartum infections, and hemorrhage.
Abnormal Birth Position
Babies in a breech position or another malpresentation can, at times, require an emergency C-section. Typically, a baby is born head-first. However, if the baby is in an unusual position, the progress toward a traditional delivery can become obstructed, which can lead to a prolonged labor and related complications. In some cases, the shoulder may become stuck in the birth canal after the baby’s head is delivered. This is called shoulder dystocia and is considered to be an obstetric emergency.
Placental abnormalities, such as placenta previa and placental abruption, can place a baby at risk of oxygen deprivation and sometimes require immediate medical assistance.
Placental abruption occurs when the placenta begins to separate early from the wall of the uterus. It is a relatively rare occurrence, accounting for around one percent of all pregnancies and usually happens during the third trimester. If a C-section is delayed in the case of an abruption, the baby is at risk of developing hypoxic-ischemic encephalopathy (HIE), which is a severe form of brain damage that can lead to cerebral palsy.
Placenta previa is an uncommon yet serious medical issue that occurs when the placenta covers some or all of the mother’s cervix. Generally, this will be noted early in the pregnancy, require close monitoring, and will move upward in many cases as the pregnancy approaches term. If it does not, there can be severe bleeding, especially during the last trimester. In some instances, an emergency C-section must be performed before the baby has reached full-term.
Maternal Infections and Medical Conditions
Typically, a C-section will be scheduled in advance if the mother has certain medical conditions, such as diabetes or obesity, complications from maternal infections, a previous C-section birth, or other factors that would increase the risk of a vaginal delivery. Physicians are expected to recognize and diagnose these issues during the pregnancy, well before the onset of labor.
If a doctor fails to diagnose in advance any medical conditions that would require a C-section, these types of problems have the potential to cause harm to the baby during a vaginal delivery.
Cephalopelvic Disproportion (CPD)
CPD is a medical term for infants who, for whatever reason, are too big to fit through their mother’s pelvis, making traditional delivery extremely difficult. However, if CPD is diagnosed earlier in pregnancy, a healthy delivery is possible.
For infants who were not diagnosed in time, an emergency C-section or an operative vaginal delivery is typically needed.
Causes of CPD can vary. The common reasons include maternal diabetes, hereditary conditions, pregnancy going beyond the due date, small maternal pelvis, and abnormal fetal positioning.
The American College of Nurse-Midwives (ACNM) reports that CPD is considered uncommon. Around 1 out of 250 pregnancies result in CPD.
Prolapsed Umbilical Cord
The umbilical cord plays a vital role during pregnancy; it’s how unborn babies receive oxygen and nutrients. When too much pressure is placed on the umbilical cord, it can become compressed. A prolapsed cord can block nutrients and oxygen from reaching the baby, which can result in numerous medical issues. It may lower an infant’s blood pressure and heart rate, and the resulting loss of oxygen to the brain can quickly lead to brain damage.
Prolapsed umbilical cords usually happen during the third trimester. A baby’s movements can cause a prolapsed cord, as well as preterm premature rupture of membranes.
Why do Doctors Delay Emergency C-Sections?
According to a report by Tak Yeung Leung MD, entitled “Timing of cesarean section according to urgency,” doctors must act very quickly after determining an emergency C-section is needed in cases of compromise to the baby.
“Fetal distress is an emergency condition requiring rapid cesarean delivery. Hence, it has been recommended that the decision-to-delivery interval should be within 30 mins,” the report reads.
Other studies suggest that an emergency C-section should be performed within 10 to 18 minutes of detecting fetal compromise. Regardless, in some situations, the needed emergency surgery fails to be carried out in sufficient time to prevent complications. A delayed C-section, as mentioned earlier, can result in serious medical issues, some of which may not be reversible.
Sometimes healthcare providers fail to properly monitor for fetal or maternal distress. When a pregnant patient is admitted into a hospital, an external monitor is usually hooked up that displays the baby’s heart rate. It’s up to the healthcare providers to closely watch the monitor, and if signs of distress are noted, they must act quickly.
Crowded hospitals and busy nurses and doctors can sometimes result in waiting too long to look at the baby’s monitor. These moments are crucial, however, as it only takes a short time for an infant to experience oxygen deprivation, which can lead to brain damage, cerebral palsy, and other injuries.
Another reason doctors delay C-sections is due to a misdiagnosis or not recognizing a medical problem in time. For example, in 2011, New York mom Cathy D’Attilo was in her third trimester when she visited her doctor for a routine check-up.
A Stamford obstetrician, Dr. Richard Viscarello, noted that Cathy’s amniotic fluid had dropped to half the amount it should have been. He should have scheduled a C-section immediately, but instead, the doctor sent Cathy home.
Two days later, Viscarello performed a C-section on Cathy and, reportedly, made incisions in the wrong places. When Cathy’s son, Daniel, was born, he was pale, limp, and not breathing.
Daniel was placed on a ventilator and began to have seizures. He was later diagnosed with a severe form of cerebral palsy and epilepsy. This is an irreversible condition where he is unable to talk, eat, or sit up on his own.
His parents have struggled for years to shoulder the financial responsibility of caring for their son that they dearly love. The family eventually won a $58 million lawsuit against Dr. Viscarello and his practice. The jury determined that Daniel’s condition likely could have been prevented had an emergent C-section been carried out when indicated, two days before his actual birth.
What You Can Do
Whenever a doctor fails to perform an emergency C-section in time, babies and mothers alike are at risk. Doctors have a legal responsibility to ensure that they give the best and most expedient care possible to patients.
It’s important to understand your rights as a mother, whether you’ve given birth to a child who developed cerebral palsy or are currently pregnant or planning a pregnancy.
Medical mistakes are most often accidents made by careless assessments or negligent care. Healthcare providers who make errors that result in birth injuries should be held accountable, and families that have had to deal with the resulting financial and emotional burdens should receive appropriate compensation.
For more information, feel free to contact us at 866-579-8495 for nationwide legal assistance.