In my legal career as a Houston, Texas medical malpractice attorney, I have handled many birth injury and birth-related brain injury cases.
Both from the cases that I have handled, as well as many others that I have studied, the most common basis for such lawsuits is that the obstetrician (OB/GYN) delayed in diagnosing and treating fetal distress.
Fetal distress is a general term that describes a situation during pregnancy or labor when the baby is not receiving enough oxygen. OB/GYN physicians and labor and delivery nurses frequently detect this dangerous condition through an abnormal fetal heart rate. Without prompt action—usually an emergency delivery—the baby may die or be born with a severe, permanent brain injury caused by birth asphyxia.
Electronic fetal heart rate monitoring basics
The standard of care requires hospitals to provide electronic fetal heart rate monitoring in labor and delivery units. Hospitals must also train their nurses on how to use and monitor the machines, as well as when they should notify the OB/GYN doctor about fetal heart rate abnormalities.
When an expectant mother is admitted to a hospital labor and delivery department, one of the first things that the nurses do is hook her up to an electronic fetal heart rate monitoring machine (EFM).
The mom is placed in a bed and the nursing staff hooks up two elastic belts with monitors around the patient’s belly. One is to monitor the fetal heart rate and the other is to monitor contractions. The EFM equipment has a display screen and a print out. The top line on both is for the fetal heart rate and the bottom is for contractions.
Generally speaking, OB/GYN physicians and labor and delivery nurses like to see the fetal heart rate line squiggly and jumping around, which is called variability. Accelerations, or upward bumps in the line, are good signs that the baby is doing well.
Decelerations, or downward bumps in the line, may or may not be concerning but require evaluation by the healthcare providers. OB/GYN doctors and nurses use EFM to look for three different types of decelerations in the fetal heart rate, which are distinguished by when the deceleration occurs in relation to a maternal contraction.
Early decelerations are dips in the fetal heart rate tracing that occur before a contraction. They may be caused by compression of the baby’s head. Early decelerations are not usually a sign of fetal distress and require no intervention.
Variable decelerations are dips in the fetal heart that occur with no real pattern in terms of contractions. They may be caused by compression of the umbilical cord, so healthcare providers keep an eye on them.
Late decelerations are a dip in the fetal heart rate tracing that occurs after a contraction. You do not want to see late decelerations. An ongoing pattern of late decelerations is ominous and concerning because it indicates a failure or insufficiency of the uterus or placenta, which can cause life-threatening conditions in the baby called hypoxia and acidosis.
The standard of care requires labor and delivery nurses to notify the OB/GYN immediately when they observe a late deceleration and also to begin interventions designed to improve placental blood flow and oxygenation to the baby. Some interventions for a pattern of late decelerations include:
(1) Assessing and treating possible causes, like the mom having a low blood pressure reaction to epidural anesthesia.
(2) Continued close observation of the fetal heart rate.
(3) Changing the mom to a lateral (side) position to promote cardiac (heart) output and uterine blood flow.
(4) Administer an intravenous (IV) bolus of a blood volume expander, such as lactated Ringer’s solution, to improve the maternal blood value and promote uterine blood flow.
(5) Start the mother on oxygen via a face mask to get more oxygen to the baby,
(6) Stop any oxytocin infusion (for induction of labor) and give a fast-acting tocolytic medication, such as terbutaline, to decrease uterine contractions.
(7) Do a fetal scalp capillary blood gas assessment.
(8) Prepare for a C-Section.
Problems in labor and delivery care
As a birth injury medical malpractice lawyer, I have handled a lot of cases involving quality of care problems during labor and delivery. Many of these lawsuits came about because nurses failed to inform the OB/GYN immediately when early signs showed up on the electronic fetal monitoring monitors that things did not look good. On other occasions, OB/GYN doctors either did not answer urgent pages or calls from the nursing staff, leading to a delay in delivering the baby.
When electronic fetal monitoring shows that the baby is in fetal distress, there is often a short window of minutes for an emergency C-Section delivery, or a baby can be left with a permanent, disabling brain injury. This is why the standard of care requires hospitals, nurses, and OB/GYN physicians to be prepared and ready to respond to these emergency situations.
We are here to help
If you or a loved one has been seriously injured by a birth-related medical malpractice, call Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.
Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, doctors, surgeons, pharmacists, and other healthcare providers. In 2017, H Texas magazine recognized him as one of Houston’s top lawyers. That same year, the Better Business Bureau recognized Painter Law Firm with its Award of Distinction.