Birth Injury Prevention

“Birth injuries” refer to any type of harm to a baby that occurs just before, during, or shortly after the birthing process. Medical professionals can prevent birth injuries by carefully monitoring the health of a mother and baby and promptly intervening if necessary.

If a medical professional fails to follow standards of care, or if a hospital provides inadequate care, this is negligence. If negligence results in birth injury to the baby, or harm to the expectant mother, it constitutes medical malpractice.

The following are some of the most important aspects of birth injury prevention:

1. Providing proper prenatal care

Doctors should recommend a variety of prenatal tests, which are done to assess the health of both the mother and baby. Prenatal testing can provide information about maternal conditions such as:

• Gestational diabetes
• Preeclampsia
• Infections

Prenatal tests can also help medical professionals recognize a wide variety of fetal issues, such as:

• Intrauterine growth restriction (baby is not growing properly)
• Suboptimal positions (e.g. breech)
• Umbilical cord problems and
• Heart rate abnormalities

These complications make a pregnancy high-risk. Women with high-risk pregnancies should be referred to a maternal-fetal specialist and receive more extensive prenatal care and monitoring. If these complications are caught early and properly managed, it is often possible to avoid serious birth injuries.

2. Detecting and addressing signs of fetal distress

Throughout pregnancy and during delivery, medical professionals should monitor the mother and baby for signs of fetal distress, which indicate that the baby is likely being deprived of oxygen. Fetal distress signs include:

• Decreased fetal movement
• Abnormal fetal heart rate (as indicated by fetal monitoring, a nonstress test, or a contraction stress test)
• Abnormal amniotic fluid volume
• Abnormal biophysical profile (BPP)
• Abnormal Doppler flow study
• Vaginal bleeding
• Cramping
• Insufficient or excessive maternal weight gain

It is especially important to watch for signs of distress during delivery. This means monitoring the fetal heart rate using an external or internal fetal monitor. For most pregnancies, it is often necessary to have continuous heart rate monitoring.

3. Preventing premature birth, and minimizing risks if it is inevitable

Infants who are born prematurely often have underdeveloped organs, weak immune systems, and low birth weights. These factors increase their susceptibility to birth injuries. Fortunately, doctors are often able to prevent premature birth by recognizing and mitigating risk factors. Three relatively common interventions are:

• Cervical cerclage: a temporary stitch that helps keep the cervix closed until the baby is ready to be born
• Progesterone: a hormone that is important to the maintenance of pregnancy
• Magnesium sulfate: an inorganic salt that can suppress preterm labor

In some cases, premature birth may be inevitable, or even medically necessary (if another pregnancy complication outweighs the risks associated with premature birth, doctors may recommend an early C-section or labor induction).

If this is the case, there are certain measures that can be taken – while the baby is still in utero – to minimize the chance of harm. These include an antenatal steroid called betamethasone (which can accelerate lung development) and magnesium sulfate (in addition to suppressing preterm labor, this can protect the brain of a baby about to be born prematurely).

4. Recognizing when vaginal birth may be dangerous or impossible

There are certain circumstances under which C-section deliveries are recommended or necessary. Among others, possible indications for C-section delivery include:

• Prolonged and arrested labor
• Macrosomia
• Cephalopelvic disproportion (CPD)
• Placental abruption
• Placenta previa
• Uterine rupture
• Umbilical cord compression (which can be caused by a variety of issues, including a cord prolapse)
• Maternal infection
• Fetal distress

In some cases, doctors attempt to get the baby out using less invasive interventions first. However, this can lengthen the amount of time that a baby is exposed to risky conditions, so the pros and cons of such actions should be weighed carefully.

5. Properly caring for babies in the NICU

Babies who are premature, have sustained birth injuries, or have other health issues will typically spend time in the neonatal intensive care unit (NICU). NICU babies are fragile, so it is very important that they receive the best possible care. Medical mistakes in the NICU can have serious consequences. Examples of mistakes may include:

• Resuscitation or breathing assistance errors
• Failure to diagnose hypoxic-ischemic encephalopathy (HIE) and quickly provide therapeutic hypothermia
• Failure to quickly diagnose and treat conditions such as maternal or and/or infections
• Other errors, including medication mix-ups and problems with tubes, IVs, and central lines.