How mothers can prevent infant brain injuries during birth
Bleeding and decreased fetal movement are two important signs that mothers should report and insist that their OB/GYN fully evaluate
One of the interesting things about a law practice focusing on medical malpractice cases is that I get to study and learn a lot about the medical issues surrounding my cases. I have handled a lot of cases involving brain injuries, including birth-related brain injuries. In many of those cases, the pregnancy was normal and the baby was healthy right until the very end. This is one of a series of articles I will share on how many of these permanent brain injuries could have been avoided with proper medical and nursing care.
Maternal fetal hemorrhage, or maternal fetal transfusion, is a serious medical condition that can cause severe injury or death in an unborn baby unless it is recognized and treated immediately. Maternal fetal hemorrhage/transfusion occurs when the fetal blood supply bleeds into, or transfuses with, the maternal blood system. With this condition, the fetal blood loss can be sudden or gradual. An acute, or sudden, loss of blood will result in a lower blood volume (hypovolemia). Over time, the fetus will replenish the lost serum, but the other bloods products will be depleted for a longer period of time. Although it is still a topic of research, medicine and science have not yet discovered what causes maternal fetal hemorrhage/transfusion or how it occurs.
When maternal fetal hemorrhage/transfusion occurs during the third trimester of pregnancy, the first sign often is a small amount of blood appearing in the urine—this is distinct from blood in the vaginal area. Sometimes doctors and nurses rush through the evaluation, ignore other signs and symptoms, diagnose a routine urinary tract infection and treat it accordingly. When the diagnosis is missed, the OB/GYN also misses the proper treatment, which is usually an emergency cesarean delivery before brain damage occurs. There are some things a pregnant mother, or family member, can do to help prevent misdiagnosis and a potentially deadly lack of proper treatment. First, it is important to immediately report to the OB/GYN any sign of bleeding, whether in the urine or elsewhere. I recommend that you go to the OB/GYN’s office and politely insist on being evaluated by the doctor. Some practice groups try to delegate unscheduled calls or evaluations to nursing or other non-physician staff, who will give mothers dangerous advice to go try some “home remedy” like drinking juice or walking around to “wake up” the baby. When a patient is facing a potentially life-threatening issue like this, it is a matter for the doctor to handle, so be firm and see your doctor. Second, be sure and tell the OB/GYN and nursing staff about any change in fetal movement.
A mother knows more about her baby’s pattern of movement in the womb than anyone else, and medical research has shown that a decrease in fetal movement is one of the best and earliest predictors of a problem with the pregnancy. Thus, is vitally important to report a decrease in fetal movement to the OB/GYN—whether or not it is accompanied by any type of bleeding. Third, if a mother cannot get evaluated at the OB/GYN office by a physician, I suggest that she proceed to a hospital labor and delivery department for evaluation by the nursing staff and a physician. Hospitals that provide labor and delivery services have trained specialists on site and advanced monitoring equipment that can be used to assess your baby’s wellbeing. Practically every facility will hook the mother up to an electronic fetal monitoring device to measure and assess the baby’s well-being, including the heart rate baseline—and whether the heart rate is too high (tachycardia) or too low (bradycardia), as well as variability of the strip—variability refers to bumps in the strip (think of an EKG and how you want the line to go up and down, rather than a flat line).
When at the hospital, the mother should remember to give a complete history of her condition, including any incidents of bleeding or decreased fetal movements. This information is important for the nurses and doctors in assessing the condition of the baby. The mother and family members should take an active role in the process, asking courteous questions, requesting to be seen by an OB/GYN physician, and feeling comfortable than they are not being rushed out the door without a complete evaluation.
As a father of four, I know that having a healthy child is a true blessing and happy occasion. Mothers and family members are an important part of the health care experience and can prevent avoidable birth injuries, including a brain damaged baby, by not taking a “back seat” role: give a complete health history, ask questions, and insist on a complete evaluation by an OB/GYN.
Painter Law Firm represents patients and their families who have suffered brain injury as a result of medical negligence.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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Published in the July/August 2018 edition of "The Houston Lawyer" magazine