Mild Brain Injury Following an Emergency C-Section Resulting in Behavioral Issues or Learning Delays

Many parents are faced with the difficulty of raising a child who presents with issues that separate them from other children. Whether it is behavioral issues, including a diagnosis of attention-deficit/hyperactivity disorder (ADHD), or learning delays, parents often seek answers as to why their child is the way they are. Parents often ask “Did I do something wrong?” Or “Is this my fault?” Sometimes the answer is that someone - not the parent - did something wrong. The good news is that the statute of limitations to find an answer extends to your child’s 20th birthday, so it likely isn’t too late!

Unfortunately, a child’s behavioral problems or learning delays may be the result of a mild brain injury caused at birth. Unlike a mild bone fracture or a mild muscle sprain, a mild brain injury can have enormous consequences. Often, these mild brain injuries go undiagnosed, unrecognized, or not even conveyed to parents. The truth is some mild brain injuries could have been preventable if there had been closer and more attentive monitoring of the mother’s labor.

How do mild brain injuries at birth go undiagnosed or undetected? First, all young children display various levels of behavioral issues. Second, it is common for mild brain injuries that effect learning to not reveal themselves until a child begins elementary school and it becomes obvious that he or she is not progressing as expected. Third, behavioral issues that parents assumed or hoped would resolve start to appear as permanent conditions.

How can you tell if your child’s behavioral issues or learning delays might be the result of a birth injury during labor? You should ask yourself the following three questions for starters:

1. Was there an emergency C-section?
2. Was there a difficult or prolonged labor with drops in the fetal heart rate?
3. Did your baby need resuscitation at birth followed by an admission to the neonatal intensive care unit (NICU)?

Was there an emergency C-section?

Brain injuries during labor can be the result of the fetus not getting enough oxygen during labor. When a fetus isn’t getting enough oxygen, the fetal heart monitor alerts the doctors and nurses of the problem and that a C-Section is needed. When medical personnel fail to deliver a baby in time and the baby is deprived of oxygen for too long, a permanent brain injury can occur called hypoxic-ischemic encephalopathy (HIE) (mild, moderate or severe). It is for this precise reason that doctors and nurses must react quickly as soon as signs of fetal oxygen deprivation are present and perform an emergency C-Section.

It is up to the medical staff to monitor a laboring patient and the status of the fetus. If doctors and nurses are not as attentive as they should be, errors in treatment begin to happen. There are times when an emergency C-Section is not enough to mitigate the errors already made by medical personnel. The damage may already have been done by the time it is decided to perform an emergency C-Section. So an emergency C-Section in addition to behavioral problems later in life can be an indication that something went wrong with the labor and an investigation into the medical records is worth considering.

Was there a difficult or prolonged labor with drops in the fetal heart rate?

Fetal heart rate monitoring measures the heart rate and rhythm of a baby while the baby is in the mother’s womb. This is a tool used to assist medical personnel in assessing the health of the baby and to ensure that the baby is receiving enough oxygen. Doctors and nurses can look at the fetal heart rate monitor to see if the baby is in fetal distress. If fetal distress is not detected soon enough, brain damage can occur.

Even though all hospitals use fetal heart rate monitoring today, tragically, doctors and nurses at times fail to monitor labor patients with the attention they deserve, which can lead to brain injuries that do not come to light until years later. One sign of fetal distress that medical personnel must pay particular attention to is drops or decelerations in the fetal heart rate. This is a sign of insufficient oxygen.

While a mother is in the hospital and the fetal heart rate is being monitored, the baby’s heart rate should show a consistent rising and falling that appears as a jagged line on the monitor, which means the baby is showing good variability. If the baby’s heart rate does not show good variability as expected, it is imperative that the cause is determined immediately because they baby may not be getting enough oxygen.

Signs that a baby has a good heart rate and is receiving enough oxygen include:

• Heartbeat between 110 and 160 beats per minute
• Increase in heart rate when the baby moves
• Increase in heart rate during contractions
• Heart rate returns to normal baseline after the baby moves or after a contraction
• Strong and regular contractions during labor

During labor, if a mother has a contraction, it is natural for the baby’s heartbeat to slightly drop. This is referred to as a deceleration. However, once the contraction has ended, the baby’s heartbeat should return to normal. If the heartbeat does not return to normal soon enough, there is cause for concern as the baby might not be receiving enough oxygen.

If the fetal heart rate monitor shows that a baby is not getting enough oxygen, there are interventions that can aid in getting the baby’s heart rate back to normal. The interventions to be aware of if a baby is not receiving enough oxygen include but are not limited to the following:

• Changing the mother’s position
• Giving the mother more fluids through an IV
• Providing the mother with supplemental oxygen
• Stopping Pitocin (medication often ordered to strengthen contractions) if the mother has been receiving it
• Taking medicine to decrease contractions

If these interventions do not bring the baby’s heart rate back to normal, the doctor must act quickly and a C-Section may be required. If medical personnel do not monitor a mother’s labor properly and allow a baby to be deprived of oxygen for too long, severe damages can occur. That is why a difficult or prolonged labor with drops in the fetal heart rate may be an indication that your child was injured at birth.

Did the baby need resuscitation at birth followed by an admission to the Neonatal Intensive Care Unit (NICU)?

When complications occur during labor and a baby is deprived of oxygen for too long, some babies will require assistance to begin breathing at birth, including resuscitation. The goal of resuscitation is to prevent the severe injuries that can occur from fetal oxygen deprivation, and also to re-establish the baby’s ability to breath on its own as well as maintain a consistent heartbeat.

The initial steps of resuscitation include the following:

• Provide warmth by placing the infant under a radiant heat source
• Position the baby’s head in a position optimal for opening the airway
• Clear the airway with a bulb or syringe or suction catheter
• Dry the baby and stimulate breathing

The baby should be evaluated by medical personnel for respiration, heart rate and color in 30 second intervals. At one, five, and ten minutes of life, a pediatrician or nurse is assigned to score or grade each newborn for Appearance, Pulse, Grimace, Activity and Respiration (the combined score is called the Apgar score). A baby’s Apgar score is also a useful guide to evaluate the newborn baby’s well-being and its response to resuscitation.

There are factors that can assist in predicting the outcome for a baby who was deprived of oxygen and required resuscitation:

• The severity of the oxygen deprivation
• Whether HIE occurred and its severity
• The quality of treatment received by medical personnel
• The subsequent medical treatment in the NICU

If a baby is admitted to the NICU, it does not necessarily mean that something went wrong with his or her treatment during labor; however, if a parent has a child with behavioral issues and/or learning delays, resuscitation along with a trip to the NICU provides reason to believe that there were complications with the birth that were not fully addressed.

Conclusion

Your child’s behavioral problems or learning delays may be caused by brain injuries that occurred at birth that were preventable if medical personnel provided proper care during labor. At Harry S. Cohen & Associates, P. C. we have represented many families where we have retrieved birth records years after the delivery and found that an emergency C-Section was followed by an unrecognized brain injury that resulted in a child enduring issues that were only recognized after the child began elementary school.

Here are some of the cases where we have successfully uncovered negligence in childbirth years after the birth and sued on behalf of the minor:

• The Jordich Case
• The Cooler Case
• The Ukanul Case
• The Lienart Case

Again, in Pennsylvania, a child’s statute of limitations to bring a lawsuit does not expire until age 20. If you suspect that any of these situations may have happened with you and your child, give us a call and we will retrieve birth records and analyze them at no charge.

To learn more about the topics covered in this article, you can give our law firm a call at 1-888-MEDMAL-1 or 412-281-3000. For further reading about birth injuries and our vast experience handling these types of cases, visit our website at medmal1.com.