When Montana Birth Injuries Become Medical Malpractice

Birth injury is damage to your child before, during, or immediately after the birthing process. Birth trauma is suffered during delivery like broken bones or nerve damage. Minor injuries to the baby are common during the process of birth, and most of them resolve without treatment. Usually, a birth injury occurs because of the natural force and pressure of a delivery.

Years ago, doctors would use forceps (a surgical instrument with rounded edges used to grasp the baby's head) during a difficult delivery in order to avoid a Cesarean section, which is when the baby must be delivered surgically instead of vaginally.

Today, Cesarean sections are considered safer than they were years ago, and are therefore less risky than using forceps; forceps are only used in the final stages of delivery and they rarely cause harm that way.

Head and brain injuries

Head injuries are the most common birth-related injury.

• Head molding isn't technically considered an “injury.” Sometimes, pressure on the head during delivery results in a change in its shape because a newborn's skull bones aren't yet fixed into position. As the baby is pushed through the birth canal, the head elongates in order to allow them to pass through, but this molding—or reshaping—of the head doesn't affect the brain and the head should gradually reshape itself by the time the baby is a few days or weeks old.
• Scalp swelling, bruising, or scratching is common and resolves on its own within the baby's first few days after birth. Even a fracture of one of the skull bones can usually heal on its own without treatment, unless it forms an indentation.
• Cephalhematoma is bleeding outside the skull bones when the blood accumulates below the periosteum (fibers that cover the skull bone), similar to a bruise. Sometimes they get larger after birth. Usually, a cephalhematoma will resolve on its own without treatment. If it becomes red or drains liquid, you should consult your doctor.
• A subgaleal hemorrhage occurs when there's bleeding directly under the scalp but above the periosteum that covers the skull bones. Unlike a cephalhematoma (where blood accumulates in one area), this blood can spread, and it could result in blood loss and shock. This condition sometimes requires a blood transfusion. In some situations, this happens because of forceps or a vacuum extractor, but other times it's the result of a blood clotting problem.
• Brain bleed (intracranial hemorrhage) is when blood vessels rupture. This can be the result of a birth injury, or it could be from an illness that restricts delivery of blood or oxygen to the baby's brain, or a blood clotting problem.

Occasionally, a brain bleed can happen in a newborn who seems healthy after an uncomplicated delivery. It's more common in premature babies, and in those with a bleeding disorder like hemophilia.

There are several ways that a brain bleed can happen:

• Subarachnoid hemorrhage: Bleeding below the innermost membrane that covers the brain, usually in full-term newborns.
• Subdural hemorrhage: Bleeding between outer and inner layers of brain covering, which places increased pressure on the brain surface.
• Epidural hematoma: Bleeding between the outer layer of tissue that covers the brain and the skull, which could be caused by a skull fracture.
• Intraventricular hemorrhage: Bleeding into fluid-filled ventricles (spaces) in the brain.
• Intraparenchymal hemorrhage: Bleeding in the brain tissue.

Symptoms of brain bleeds can include apnea (when the baby stops breathing for a period of time), seizures and lethargy.

Generally, intraventricular and intraparenchymal hemorrhages are in premature babies, and they're often because of an undeveloped brain, rather than a specific injury. Sometimes, there are no visible symptoms. When there's a larger hemorrhage, though, the baby might turn bluish gray, or their body might stop functioning normally. Babies with smaller hemorrhages usually survive without ongoing problems.

Facial paralysis

If you notice that there's no movement on one side of your baby's face when they cry, there could be facial paralysis. This could be because of pressure on the face during birth, or from forceps. If it's a bruised nerve, the paralysis should improve in a few weeks. If the nerve was torn, your baby might require surgery to repair it.

Cerebral palsy

Cerebral palsy is a condition that involves impaired muscle coordination and other disabilities. It can be hard to pinpoint the cause of a child's cerebral palsy because it can happen before, during, or after birth.

If your child has been diagnosed with cerebral palsy, it could be because of one of the following reasons:

• Low birthweight
• Premature birth
• Multiple births (twins or triplets)
• Assisted reproductive technology (i.e. infertility treatments)
• Infections during pregnancy (including chicken pox, German measles, syphilis, Zika virus, herpes, toxoplasmosis, exposure to toxins, and others)
• Rh blood type incompatibility between mother and child
• Jaundice or kernicterus that is severe or long-lasting
• Mother's medical conditions like thyroid problems, intellectual disabilities, or seizures
• Birth complications like placenta detachment, uterine rupture, umbilical cord problems

In some circumstances, cerebral palsy is caused when there's a lack of oxygen to the baby's brain that's a result of difficult labor or delivery. Sometimes, these conditions occur because the laboring mother wasn't monitored closely enough by medical personnel.

If the doctor or hospital doesn't detect fetal distress during labor, or if it uses incorrect or inadequate birth techniques, the baby could experience a hypoxic episode, which is when there's inadequate blood flow to the brain.

Oxygen deprivation

Even mild oxygen deprivation can cause life-long physical and intellectual disabilities. This can happen because the doctor doesn't monitor the baby carefully enough during labor, or if the baby remains in the birth canal too long.

Brachial plexus

Brachial plexus injuries involve nerves from the upper spine to the neck, shoulder, arm, and hand. Sometimes, these injuries are temporary but they could also result in permanent disability. Injuries happen because nerves are torn or ruptured and don't heal properly.

Fractured collarbone

A difficult delivery can result in a fractured collarbone. In most cases, a baby's collar bone will heal itself, but sometimes treatment could include an immobilization brace.

Perinatal asphyxia

This is also insufficient oxygen, but it's related to oxygen in the bloodstream, not the brain. If blood flow is insufficient, a baby can appear pale, have difficulty breathing, have seizures, shock, or go into a coma.

Spinal cord injury

Overly forceful use of forceps can cause nerve or cord damage that results in paralysis or neurological problems.