Having a baby is a beautiful experience. Unfortunately, it also can be one of the riskiest. While rare, labor and delivery complications are rising every year. Eighty percent of pregnancies and deliveries go just fine, but the other 20 percent experience a host of physically, emotionally and mentally harmful injuries to mother and/or baby. Statistics over the four years between 2014-2018 include:
- Pregnancy complications rose more than 16 percent; birth problems climbed over 14 percent
- Mothers who experience both pregnancy complications and birth problems have increased 31 percent since 2014
- Gestational diabetes and preeclampsia both increased significantly
- Nearly one in 10 mothers in 2018 developed postpartum depression
- Pregnancy complications increase the cost of birth by 16-18 percent; birth complications by 52 to 63 percent
Many of these complications arise through no fault of the mother or her physician. Preexisting health conditions and difficulty accessing care can increase risk, but so can negligent delay of care by a medical professional.
Common Labor and Delivery Complications
Many problems can arise during pregnancy or birth, but the following are some of the most common. Each of them can be mild or life-threatening.
This condition occurs when a lack of oxygen prevents the baby from breathing on its own before, during or after birth. This can result in organ damage, including to the heart. Symptoms include low heart rate, gasping and blue skin color. Treatment includes oxygen delivery to the mother or switching from vaginal birth to C-section.
Another important indication for this condition and many others is a low Apgar score. This is a quick test done one minute after birth and then again four minutes later to analyze how well the baby endured the birthing process and how the baby is doing outside the womb. A nurse or doctor evaluates the baby’s breathing and heart rate, muscle tone and reflexes, and skin color. Each category is scored from 0-2, with a total score ranging from 1 to 10. A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health.
This condition is a threat to mothers who have already had a C-section during another birth. The scar left by that procedure could open during delivery, depriving the baby of oxygen and causing extreme bleeding in the mother. But a previous C-section isn’t the only risk factor for this complication. The baby’s size, how labor was induced, age over 35 in the mother and what instruments were used in the delivery can all increase the risk.
Symptoms of uterine rupture may include unusually slow labor, abnormal heart rates in mother and baby, and a drop in the mother’s blood pressure. Catching it early enough can prevent permanent damage or death.
Non-reassuring fetal status
Fetal distress is the traditional term when the fetus’ health appears to be in jeopardy. It’s most commonly found when a pregnancy extends beyond 42 weeks. The term was updated by the American College of Obstetricians and Gynecologists (ACOG) because it wasn’t specific enough and could result in treatment errors. It can cause irregular heartbeat, low protective amniotic fluid, and motor issues.
Possible causes include hypertension or anemia in the mother that developed during pregnancy, insufficient oxygen and more. Changing the mother’s bodily position, increasing hydration and relieving pressure on the umbilical cord can reduce the problem.
This complication is tricky because it can appear immediately after birth or up to 12 weeks later. Excessive bleeding occurs with weak uterine muscle tone and contractions that cannot fully compensate after ejecting the placenta. Uncontrolled, it can lead to organ failure, shock and death.
While certain pre-existing conditions, such as obesity or infection, can increase risk, careless decisions by the physician can do the same. Improper use of forceps, delivery vacuums or anesthesia are all common culprits. Treatment can include medications, a hysterectomy, uterine massaging the uterus and tying off affected blood vessels.
Sometimes the baby is facing the wrong way during birth. Ideally, the position is facing down, but possibilities include upward facing, sideways or feet first (breech). The provider must intervene, and there can be a large margin of error if he/she is acting below the standard of care. The physician may manually turn the baby around, surgically enlarge the vaginal opening or transition to a C-section.
Malposition can also lead to umbilical cord complications, such as too much compression coming out wrapped around the baby’s neck. This will also require immediate medical intervention.
Birth Complications as Medical Malpractice
If these issues arise during the labor and delivery process, it’s crucial to choose the proper course of treatment and administer it as quickly as possible. Even if the doctor is not negligent in choosing how to fix the problem, delaying care for too long can increase the level of injury. Medical malpractice is defined as negligence by a doctor who fails to meet the standard of care.
Every 1,000 births have an average of seven injuries. While rare, these labor and delivery injuries are often caused by seemingly simple mistakes, such as using forceps improperly, giving the wrong medication or failing to notice fetal distress. Some can be immediately corrected; others may not appear for years, causing permanent damage.
Both an Emory School of Law graduate and MBA graduate of Goizueta Business School at Emory, Chris Nace focuses his practice on areas of medical malpractice, drug and product liability, motor vehicle accidents, wrongful death, employment discrimination and other negligence and personal injury matters.