Choosing the right doctor and hospital for bringing the baby into the world should be done with extreme caution and care. The expertise and experience of the doctor is of paramount importance, especially when there are any complications in pregnancy.
Visiting the hospital beforehand and observing the standards of the facilities should induce confidence in woman to go through a successful labor and delivery. For the hospital staff, this may be just another pregnancy and they witness hundreds of women delivering throughout the year. But for a couple, this is a life-changing event.
Expecting women should check whether the staff is experienced enough for the most important milestone in her life.
A large majority of women deliver healthy babies successfully without any complications. But there is a small percentage that suffer due to the inefficiency of the hospital staff. According to the Centers for Disease Control, about 6 in 1000 children get injuries during birth every year.
Usually there are risk factors involved in the pregnancy when some injuries happen during delivery. However, it is an obligation for the doctors to identify these risk factors ahead of time to help prevent injuries. Unable to foresee and make the right decision at the right time can cause harm to the mother and baby.
While most injuries can heal, some serious errors of judgement or diagnosis by doctors can result in lifelong consequences for the mother or baby.
Here are a few mistakes that can happen before, during and after the birth that could have been easily prevented by the doctors.
15 Incorrect Use Of Forceps
The doctor may decide to use forceps in cases of prolonged delivery, when the baby is in distress, or when the baby is in breech position. The use of forceps is known to cause birth injuries to the baby, but the doctor may feel it is the best option to prevent further distress to the baby.
Inexperienced doctors or negligence by the doctor can result in injury to the baby. For the knowledge of moms, forceps should not be used when the baby’s head is too large and cannot pass through the birth canal (cephalopelvic disproportion).
The injuries that can be caused due to incorrect usage of forceps are bruises on the baby’s head, fractured skull, brain damage, brain swelling, facial nerve palsy or cerebral palsy. The child may also suffer from developmental delays due to harm to the brain during forceps delivery. The usage of forceps can also harm the mother’s cervix or vagina.
Inexperienced and unskilled doctors are at a high risk of making a mistake using the forceps.
14 Negligence Causing Birth Fractures
Fractures are common injuries which do not create serious implications in the long run, but who wants their child to suffer with a fracture. Usually it is hard to diagnose a broken bone in an infant. Although there are many risk factors that may cause fractured bones, it may also happen due to inexperienced medical professionals.
- Failure to identify any risks of continuing with vaginal delivery
- Putting excessive pressure or pulling the baby
- Failure to perform emergency c-section
Some of the symptoms of fractures that happen during delivery are swelling of the affected area and the baby will not move the limb with a broken bone. Another symptom could be constant crying when the reason of crying cannot be determined. If the doctors are careful they can normally prevent any bone fracture in the baby.
13 Failure To Recognize Fetal Distress
Fetal distress can occur for a number of reasons. Fetal distress can happen in a healthy pregnancy during labor. The most common reason for fetal distress is when there is disruption in oxygen supply to the baby. Due to lack of oxygen, the baby’s brain does not get enough oxygen (hypoxia) or it does not get any oxygen at all (anoxia).
During delivery, if the umbilical cord gets pinched or if it wraps tightly around the baby’s neck, the baby is unable to receive oxygen.
The medical team is supposed to constantly check both mother and baby and be able to recognize the signs of fetal distress. Disrupted oxygen supply to the fetus for more than five minutes can result in permanent damage to the brain. Fetal distress can be treated, but the doctors needs to act quickly to correct it.
Labor induction and c-section are a couple of options that the doctor should consider.
12 Failure To Perform Emergency C-section
The doctor needs to perform an emergency c-section in case there is risk to the baby or the mother. The following complications may point toward the need for an emergency c-section.
- Fetal heart rate shows some form of distress
- Prolonged labor
- Unsuccessful attempt in forceps and vacuum extraction
- Early separation of placenta from the uterine wall
- Baby is in a breech position
- Baby is too big to pass through the birth canal
- Mother has been diagnosed with preeclampsia
- Drop in glucose levels in mother
- Signs of HELLP, a serious syndrome that includes hemolysis (breakdown of red blood cells), elevated liver enzymes and a drop in blood platelets
Even in case of a healthy pregnancy, there could sometimes be a need for an emergency c-section. When the doctor is unable to identify these signs or ignores them and continues for vaginal delivery then there is risk of damage to the baby and the mother. Sometimes the mother may not want a c-section and wants to experience a normal vaginal delivery, but sometimes the safety of mom and baby take precedent.
11 Surgical Infection
Infection after delivery, especially in case of c-section, can happen due to a number of reasons, but when the hospital or the medical staff is responsible for the infection they are liable for medical malpractice. The negligence can happen in the form of failure to count the surgical equipment in surgery and leaving something inside the patient.
This mistake by surgical staff could have happened during surgery. Infection can set in due to the foreign object or infection could be a result of unsanitary practices within the medical facilities and personnel.
One would believe that medical personnel are especially diligent about hand washing, however, surprisingly, in a study during a conference it was revealed that 10 in 50 doctors do not wash their hands after using the restroom.
While choosing the hospital and the obstetrician during early pregnancy, the parents must meet the doctor and visit the hospital and see if the facility appears to be safe, clean and well maintained.
10 Administering Excessive Medication
Spinal epidurals and anesthesia are used very commonly by anaesthesiologists these days. These medications are successfully administered to women, but in some cases it may have an adverse impact. The correct medicine and calculation of the dosage is critical as any deviation can cause serious harm to mother or child.
Whether it is labor induction medication or an epidural, the consent of the mother is necessary and doctors are obligated to inform her about the benefits and risks of the medication. Medical mistakes that can occur while giving epidurals are:
- Administering epidural before 4 cms dilation of the cervix
- Wrong calculation of dosage
- Mother is allergic to the drug
- Injection given in the wrong place
- Giving epidural despite the mother using blood thinners
- Mother had low platelet count
The parents should be very cautious in making a decision about an epidural and labor induction. These things should be discussed with the doctor ahead of time so everyone knows what to expect and how to proceed.
9 Postpartum Negligence
Excessive blood loss after childbirth should be recognized and treated by the doctor as it could prove fatal to the mother. In some cases, the doctor could be responsible for postpartum hemorrhage.
If there are any existing risk factors for postpartum hemorrhage such as hypertensive disorder or placenta accreta, then the doctor should be ready for any untoward happenings during or after the delivery. The condition of the mother such as the blood pressure, uterine size and skin color need to be under observation by the medical staff.
If the uterus has not contracted well, then massage or medication should be administered to stop the blood loss. There could be another reason of heavy blood loss and it may happen due to blood clotting disorder. It may lead to serious complications for the mother and needs to be treated immediately.
Even a seemingly trouble-free delivery could turn deadly if the mother is not monitored closely. These are the standard procedures followed in the hospital after delivery.
8 Wrongful Birth Cases
During the regular screening and ultrasound, if the doctor fails to recognize any birth defects (or risk of defect after birth) in the baby and the woman goes on to deliver, then the child may be born with serious defects and life-long disabilities. It could be either physical or mental impairments.
When the doctor identifies any abnormalities in the baby during pregnancy he has an obligation to tell the parents so they have the option of terminating the pregnancy, as difficult as that may be.
It is extremely painful for the parents to learn that they had the option to terminate the pregnancy, but the doctor failed to diagnose properly. In such cases, the parents can recover the cost of medical expenses and other necessary therapies for the child to cope with the disability. The medical practitioner can also be sued for negligence in genetic examination before conception.
But any compensation is not enough for the parents who go through the agony when they see their child suffering.
7 Carelessness During The Vacuum Extraction
Doctors use vacuum extractor for pulling the baby out of the womb, mostly in cases of prolonged labor. Since there are risks involved in vacuum extraction, the FDA has warned against unnecessary use. There are guidelines or standard practices that doctors are supposed to follow if they decide to use vacuum extraction for assisting in a difficult labor.
The mother needs to approve or give her consent for using vacuum extractor.
She also has the right to ask the doctor to use forceps instead of vacuum. If she asks the doctor needs to tell her the stage of the delivery. For using the vacuum extractor:
- The baby should not be too big to pass through the birth canal
- The cervix should be fully dilated
- The baby’s head should not be far away in the birth canal
- The baby should not be repositioned using the suction as it may cause spinal injuries
If the doctor makes a mistake, then the baby is at a risk of shoulder dystocia, skull fracture, hemorrhage or cerebral palsy.
6 Failure To Diagnose Gestational Diabetes
When the body does not produce insulin during pregnancy then the glucose levels in the body become high, leading to gestational diabetes. During pregnancy it may happen due to hormones secreted by the placenta that interfere with the functioning of liver cells. This is a temporary health issue, but it is important to diagnose and treat it. After delivery this condition usually disappears.
It may be difficult to diagnose gestational diabetes as it hardly shows any symptoms. The doctor should determine if the woman has risk factors for gestational diabetes and then offer tests. Once it is diagnosed it can be managed easily with a few changes in diet and exercises.
Failure to diagnose gestational diabetes may lead to complications in pregnancy. It may lead to premature birth, preeclampsia, an especially big baby (which may lead to c-section or labor induction), and polyhydramnios (more than required amniotic fluid that may lead to premature labor).
5 Failure To Diagnose Placental Complications
Problems with the placenta can be diagnosed in the ultrasound done in the second and third trimester. Timely diagnosis of abnormalities in the placenta can prevent problems during delivery.
The doctor can plan for a c-section if there is a problem of placenta previa (the placenta next to or covering the cervix), or placenta accreta (when the placenta abnormally attaches to the uterus), depending on the severity of the problem. There could be other placental problems such as placental insufficiency or placental abruption.
Although the problem cannot be fixed, knowing about it prior to the onset of labor can allow for proper planning. The right treatment and action plan can be developed to avoid emergency situations and accidents. If the problem is found after the mother is in labor, it may harm the mother or the child and can also result in long term consequences.
Although placental problems are rare, these are a major reason for maternal deaths. Even after any delivery the doctor should examine the expelled placenta to check if it has been completely delivered or if any parts are missing.
4 Unable To Recognize Preeclampsia
Preeclampsia is a condition where the blood pressure of the mother increases persistently during pregnancy. It can also happen after childbirth. Those who develop preeclampsia during pregnancy have a risk of developing heart problems later in life. Preeclampsia is dynamic and may be difficult to manage so it needs to be monitored regularly and closely.
Preeclampsia can be life-threatening if not diagnosed properly. Preeclampsia is prevalent in 5 percent of expectant women and can suddenly turn into eclampsia, resulting in seizures, organ failure and stroke. If can result in death for them mother and child.
Diagnosis of this disease is done by screening the blood pressure and protein present in the urine. The screening of preeclampsia is still debatable and considered unreliable, therefore the doctors regularly monitor the blood pressure during regular prenatal visits.
The doctor may prescribe bed rest and a magnesium sulphate drip and a c-section may be scheduled. The mother may be kept hospitalized until delivery if the case is severe .
3 Failure To Detect Infections During Pregnancy
During pregnancy, if the mother catches an infection such as meningitis it increases the risk of long term damage to the baby. The diagnosis and treatment should be done timely to prevent any complications for both mother and child. Symptoms of meningitis usually are similar to flu.
If the mother has high fever, severe headache, no appetite, nausea or vomiting she should immediately consult her doctor. Doctors know that there are many infections that present with similar symptoms, so they should consider more than just the obvious when a woman is expecting.
Unfortunately, pregnancy increases the risk infection from listeria bacteria, which causes meningitis. Without an antibiotic treatment this infection can prove fatal. The doctor may recommend IV antibiotics or cortisone. Any delay in treatment can cause infection in the baby that can result in ear or sinus infections after birth.
In extreme cases there could be learning disabilities as well. If it is left untreated or treated late, then it may also result in miscarriage or stillbirth.
2 Delayed Diagnosis Or Misdiagnosis
This is the most common reason for lawsuits on medical professionals. When the doctor fails to identify any serious condition or illness in the baby or the mother, then the mother and baby are at a high risk of complications and missed opportunity for getting the right treatment at the right time.
Any delay in diagnosis can cause permanent effects on the baby. This is a case of medical malpractice and the doctor can be sued for his action or non-action. There are times when a doctor honestly makes a mistake, as they are also human, however there are also times when they simply don’t take the necessary care and rush to a decision.
The misdiagnosis can be proved by considering the same circumstances with an experienced doctor and the action he would have taken against the action of treating doctor. If the experienced doctor would have taken a taken a different course, than the treating doctor is considered liable for the damage.
In case there was no damage or harm to the mother or the baby then misdiagnosis may not be considered as malpractice.
1 Excessive Use Of Oxytocin
During the labor, the time for which the contractions and relaxations happen need to be optimal. During a contraction, the baby receives less oxygen and during relaxation the oxygen levels go back to normal. Long contractions can reduce the blood flow to the baby’s brain.
Furthermore, if the baby’s blood pressure is low due to certain drugs, then the baby may receive severe brain injuries. There are reports that show that when oxytocin is used for inducing labor the relaxation time reduces to less than 60 seconds. But unfortunately increased uterine activity does not always speed up the labor.
For the labor to progress efficiently the contractions and relaxations should be evenly spaced so that the baby’s brain produces accurate physiological response to the changes. The doctor needs to closely monitor fetal heart activity to determine if the baby goes into distress and should take appropriate action, such as discontinuing the oxytocin.
The oxytocin administration should not be restarted until the fetal heart rate is normal.