Families with a child who has been diagnosed with a birth injury understandably have many questions. Your questions may be related to your child’s care, his or her condition or what the future holds. Here, Birth Injury Guide has compiled a list of the questions that our clients ask us most often. We hope that these questions and answers will provide you with a starting point as you seek answers about your child’s condition.
Birth Injury Questions
A birth injury is a trauma experienced by infant before, during, or shortly after childbirth. It can range in severity and result in minor complications to severe, life-threatening conditions. Some birth injuries heal on their own and an infant will go on to have relatively few problems, while other birth injuries require extensive treatment and often result in long-term complications.
A birth injury is not a defect. A birth defect is something that a baby is born with due to a DNA makeup that predisposed them toward a deformity or disability. However, there are some instances in which a birth defect is caused by medical negligence. For example, prescribing certain medications to pregnant women may heighten the risk of the infant developing a birth defect.
However, it’s important to note that while many birth defects are inherited, exposure to medications while pregnant may also cause them as well. Certain anti-depressant, birth control, and narcotic medications have been linked to birth defects such as spina bifida, cleft palate, limb abnormalities, and more. For additional details on medications and birth defects, refer to our article, Medication Birth Defects.
The Apgar score is a number that is assigned to a newborn right after birth. The score helps measure the infant’s overall health. To score a newborn, healthcare providers look at several factors, such as appearance, pulse rate, reflexes, activity, respiratory function, and more. Generally, the scores are broken down as follows:
- 7 or higher – normal (most of the time, there are exceptions).
- 4-6 – Below normal. Indicates that the infant needs medical intervention.
- 1-3 – Critically low. Indicates the infant may need resuscitation or other emergency interventions.
Birth injuries manifest in several different forms and in many different ways. Some birth injuries are obvious and seen immediately, such as bruises and/or lacerations. Other immediate symptoms of birth injuries may include:
- Arched back while crying
- Bulges on the infant’s head
- Appearing blue or extremely pale
- Spastic motions
- Lack of breathing or difficulties with breathing
- Limp or no movement in affected limbs
Some birth injuries can’t be seen immediately because they are internal. These types of birth injuries are identified when developmental milestones are delayed or skipped. Symptoms of birth injuries you may see later include:
- Missing milestones such as sitting alone, crawling, grasping objects and cruising along furniture
- Poor weight gain
- Poor growth
- Speech difficulties
- Abnormal, frequent outbursts
While a trained medical professional knows to avoid certain actions, mistakes occasionally happen. Some malpractice cases involve the doctor leaving the nurse to deliver the baby alone, while others exemplify nurses who administer the wrong medication or the wrong dose of the right medication.
Some birth injuries happen from midwives who are not medically trained to handle emergency situations, and some birth injuries happen from doctors who misdiagnosed circumstances they should have foreseen with testing and checkups. Ultimately, there are a number of reasons why birth injuries happen.
According to the Agency for Healthcare Research and Quality, at least 30% of all birth injuries are caused by communication errors between physicians and medical staff regarding medical history and patient health information. Failure to diagnose fetal and/or maternal distress accounts for many other birth injuries, as well as hospital negligence. In these instances, birth injuries are almost always preventable.
In fact, the sheer amount of preventable birth injuries each year has prompted many hospitals to participate in safety programs, such as the 2008 Premier Perinatal Safety Initiative. This particular initiative took place over a 5-year span, involving a total of 14 hospitals in 12 different states. After assessing over 250,000 births from 2008 to 2013, results indicated that several medical errors, which could have been prevented, were the primary reasons for the majority of birth injuries.
There is no way to predict human errors, but there are some things that expectant parents and healthcare providers can do to prevent birth injuries. These include:
- Proper prenatal care
- Detecting signs of fetal distress quickly
- Treating fetal distress
- Recognizing risks of premature birth
- Recognizing when a vaginal birth is dangerous
- Ensuring infants get proper care in the NICU
- Ensuring that the mother is properly cared for during and after delivery
Doctors are required by law to report any disability or abnormality to the parents before delivery, so if you were expecting a normal, healthy baby, yet the infant has a disability, this is one indication of a problem. In many instances, failure to properly diagnose health issues leads to birth injuries that could have otherwise been prevented.
Additionally, the color, health, and status of the baby at delivery is generally an indication of whether or not a birth injury has occurred, though some birth injuries don’t make themselves obvious until later. If you have any doubt in your mind, however, about your child being the victim of a birth injury, it’s important to speak up so as to get your child the necessary care.
Birth injuries should not be taken lightly. It’s perfectly natural to look at your child’s case and to wonder if your child will have a lifetime disability or if the disability is temporary.
Unfortunately, there is no clear answer here. Birth injuries vary from mild to severe cases, from curable injuries to lifelong struggles, and with injuries both internal and external.
Whether your child will get better or not depends greatly on the injury at hand, how quickly it was caught, and what kind of medical care is available.
You may have heard the term and are now asking “what does HIE stand for?” HIE stands for hypoxic ischemic encephalopathy.
HIE is a type of brain injury that occurs when there is inadequate blood flow and oxygen to the baby’s brain. It is often caused by problems with the placenta or umbilical cord, maternal oxygenation issues or prolonged labor. HIE is a dangerous condition and can have long-term health impacts, including cerebral palsy, developmental delays or epilepsy.
There are two HIE stages. The first stage begins immediately after oxygen deprivation occurs. The second stage begins as oxygenated blood begins to return to the brain. This process is called “reperfusion injury” and can cause toxins to be released from damaged cells.
An umbilical cord collapse occurs when the cord is prolapsed and becomes compressed between the cervix and the part of the baby that is presenting (exiting the birth canal). An umbilical cord collapse can cause oxygen deprivation and, in severe cases, can be fatal.
What is umbilical cord compression? Umbilical cord compression is the medical term for the umbilical cord becoming flattened due to pressure. This can happen if the baby is laying on the cord or squeezing it, or during birth due to pressure from the birth canal. Though it is less common, a prolapsed cord can also cause compression.
What is shoulder dystocia? It is a complication of delivery that occurs when one or both of the infant’s shoulders become stuck behind the mother’s pelvis. This is often due to the infant being too large for the birth canal.
The effects of lack of oxygen at birth vary depending on how long the infant was deprived of oxygen, and how severe any related injuries are. Oxygen deprivation is a common cause of disorders like cerebral palsy, seizures, autism and poor growth.
The placenta is an important organ to a developing fetus. Placenta issues can cause a host of problems, and can even be life-threatening. Some of the more common placenta issues women experience include:
- Placental insufficiency
- Placental abruption
- Placenta previa
Brain Damage Questions
Infant brain damage can happen during pregnancy, during delivery or after birth. During delivery and shortly after birth, head trauma is one of the leading reasons for infant brain damage. Oxygen deprivation and loss of blood flow to the brain may also cause injury during delivery. There are also medical conditions that can cause brain damage, such as jaundice, kernicterus and infections.
Brain damage symptoms will vary according to each infant as well as the severity of the injury. Some of the most typical symptoms include:
- Abnormal Temperament
- Abnormal Physical Appearance
- Sensory Problems
- Missed Milestones and Developmental Delays
Head injuries and brain injuries aren’t always the same thing despite a common misconception. An infant can have a head injury that doesn’t necessarily lead to brain damage. For example, if a baby falls and bumps, bruises or cuts his head, this doesn’t necessarily mean that brain damage has occurred. The head injury must impact the brain in some way in order to be a brain injury.
It is more difficult to diagnose infant brain damage as opposed to injuries in older children and adults. The Pediatric Emergency Care Applied Research Network (PECARN) created a method that is widely used in children under two years of age. Infants are first assessed using the Glasgow Coma Scale, a test that determines an individual’s conscious state. The test determines if additional testing is needed, such as:
- CT scan is a detailed imaging test that allows physicians to get a detailed image of the brain. CT scans often uncover bleeding in the brain, blood clots, contusions and/or swelling.
- Magnetic resonance imaging (MRI) may also be helpful, which creates an in-depth view of the brain via magnets and radio waves.
There are many treatment options for infants who suffer from brain injuries. Treatment will depend on how severe the injury is, as well where the injury is in the brain. Some treatment options include:
- Therapeutic Hypothermia
- Physical Therapy
- Occupational Therapy
It is more difficult to assess symptoms in infants than it is in adults. Adults are able to convey what they are experiencing. Infants, on the other hand, must rely on caregivers to recognize symptoms. So, what are the signs of a brain bleed in a newborn? Some things that parents can watch out for include lethargy, feeding problems, irritability, seizures, or loss of consciousness.
Cerebral Palsy Questions
Cerebral palsy is a birth injury that develops as a result of brain damage. Often, the infant suffers brain damage due to oxygen deprivation or birth trauma. For more information about the causes of cerebral palsy, see “Birth Injury Causes”.
It is possible that your child’s cerebral palsy could have been prevented. Cerebral palsy often develops as a result of an injury. No child is genetically predisposed to get cerebral palsy. Sometimes it is a matter of what measures the medical staff took, and sometimes it is other conditions or complications with pregnancy that should have been diagnosed and treated before delivery.
Only an expert can decide if your doctor is responsible for your child’s cerebral palsy. Generally, an expert witness is called upon to determine if medical negligence caused your child’s injury. An expert witness is someone who can critique your doctor’s work and report whether he or she upheld the standards of accepted medical care. Expert witnesses are qualified healthcare providers and specialists.
In severe cases of cerebral palsy, symptoms are usually immediate. In mild cases of cerebral palsy, however, it may take months or even years before you’ll be able to notice symptoms.
No matter whether you think what you’ve seen is a symptom or not, the fact that you’re doubting the normalcy of what you’re seeing in your child is grounds enough to call your physician and get a medical opinion. Be sure to track what you perceive as a list of symptoms so that you can be specific with your doctor and approach the subject knowledgeably. Doctors have a hard time speaking to parents who “just know something is wrong” because without specificity, they can’t treat your child. Keep a detailed list of what you’ve seen and how often you’ve seen it if it’s performance-related, and if what you’re seeing is something muscle-related, take your child in to see your doctor immediately. The sooner you treat a child with symptoms of cerebral palsy, the less severe the case of cerebral palsy may be.
A birth is considered premature when it occurs before 37-39 weeks gestation. Premature birth itself is not a cause of cerebral palsy, but it increases the risk for several conditions that are known to cause cerebral palsy, such as oxygen deprivation, bleeding in the brain, jaundice and infections.
Spastic cerebral palsy is the most common type of the disorder. Only your child’s doctor can tell you if he or she has cerebral palsy. Talk to your doctor if you notice that your child is moving abnormally, has poor reflexes and muscle tone, or does not meet developmental milestones like crawling and walking.
Severe hypoxic ischemic encephalopathy, or HIE, can lead to significant brain damage. As a result, it can also lead to cerebral palsy.
Cerebral palsy life expectancy varies based on factors like the child’s overall health, additional medical conditions, lifestyle and treatment plan. There is no “set” life expectancy for someone with cerebral palsy. Overall, it is the quality and timeliness of treatment and ongoing therapies that promotes health and longevity.
Although there have been no general studies of life expectancy in people with cerebral palsy, most children affected by CP live between 30 and 70 years, depending on the severity of the condition. In general, a child with a mild case of CP usually lives longer than a child with mobility and intellectual limitations. Children who respond well to physical and occupational therapy, have no intellectual development problems, and can function with little or no assistance lead longer lives than those with severe disabilities caused by CP.
Does cerebral palsy get worse over time? Not necessarily. According to the Centers for Disease Control and Prevention (CDC), cerebral palsy does not get worse over time. However, the symptoms can change over time, especially as the individual ages. Also, additional medical conditions can cause symptoms to worsen or become more prominent.
Your child’s cerebral palsy prognosis will depend on a variety of factors, including the underlying causes of the disorder, any additional medical conditions, the type of cerebral palsy and the severity. Many children with cerebral palsy go on to live full and productive lives.
Is cerebral palsy fatal? Generally, the disorder on its own is not fatal. It is a permanent disorder that is non-progressive, and the symptoms vary from one person to the next. Cerebral palsy is generally only life-threatening when it is accompanied by other serious medical problems.
A hypertonic muscle is one that is stiff and difficult to move. This happens when the pathways between the brain and spinal cord are blocked or damaged. A child with hypertonia will have limited mobility because the joints and muscles are stiff and it is difficult to move and balance.
Erb’s Palsy Questions
If your baby’s arm seems weak or your baby cannot move it properly, you should talk to your doctor right away. Your baby may have Erb’s palsy, a type of birth injury caused by damage to the brachial plexus nerves.
Erb’s palsy is a type of birth injury resulting from damaging, fraying, separating, moving or completely severing the brachial plexus nerves connecting the arm and the shoulder. Such an injury occurs when a doctor or nurse yanks, pulls or tugs unnecessarily on the infant’s arm. It can also happen if the infant becomes stuck in the birth canal and the doctor has to use force or delivery-assisting tools (forceps or vacuum) to pull the infant through.
A doctor can’t control the position that the baby is in, the position of the mother’s pubic bone or the proportions of the infant and birth canal. However, the doctor can take measures to assess risks and use alternative means of delivery if necessary.
Sometimes therapy for Erb’s palsy is expedited so that the child can continue through his or her developmental stages without having long term effects. To that end, therapy can sometimes feel rushed, especially when the family can’t afford the therapy at this current date.
Some parents think “I’m still paying for the cost of having the baby, and now I have to pay for the cost of giving the baby therapy, too.” That is how the settlement from a birth injury can help. You can move through your child’s recovery making the environment and relaxing and soothing as possible, and thereafter move on to happy, healthy, normal lives.
A doula is a woman who is professionally trained to help new mothers. Doula’s help mothers with everything related to the birth of their baby and life as a new mother. Some doulas assist before pregnancy, during delivery and after the baby is born.
For many women, having a doula is a way to help them enjoy their new baby without the stress of needing assistance or juggling their new role. A doula is trained and experienced in providing emotional support as well as their knowledge of childcare.
Your doctor’s primary focus is on your health. A doula focuses on you as a whole. She is an additional guide and support for you and your family as you transition with a new baby.
While you can’t control things like a misdiagnosis or other medical mistakes that are out of your control, there are a few things you can do to help prevent medical malpractice, and potentially prevent a birth injury from happening to your baby.
Never feel afraid or anxious when asking your physician or anyone on the medical staff any questions or concerns you have. Always trust your instincts, and if something just doesn’t feel right, be certain to speak up. Keep in mind that have you the legal to be informed of what’s going on during your pregnancy, delivery, and you have the right to be made aware of any associated risks.
Educate yourself beforehand regarding the risks associated with common delivery techniques, such as using birth-assisting tools, C-section deliveries, and more. In addition, research the use of medications during pregnancy, including the types of birth defects associated with drugs taken while an infant is still in utero.
Your baby’s head may be misshapen due to the natural pressure applied to his or her head during delivery. If you had a particularly difficult delivery, you may notice a more significant deformation. Depending on the severity, your doctor may recommend letting your baby’s head reshape itself over time. If it is more severe or is caused by caput succedaneum or cephalohematoma, your doctor will assess the best treatment options.
A c-section (Cesarean section) is the surgical delivery of a baby. During a c-section, the doctor makes incisions in the abdomen and uterus, and delivers the baby through the incision.
C-sections are incredibly common in the United States. Estimates suggest that around one million c-sections are performed each year.
A c-section is ordered when vaginal delivery is too risky to the mother or child. It is also ordered as an emergency alternative to vaginal delivery if labor and delivery become complicated. Some of the most common reasons why you may need a c-section include:
- Prolonged labor – if labor stops progressing or there is a risk of infant oxygen deprivation
- Abnormal fetal vital signs
- Abnormal fetal position making vaginal delivery dangerous
Yes! Your baby’s vital signs will be monitored during either a vaginal or c-section delivery. Your medical team should consistently monitor your baby’s vital signs throughout the c-section process.
Delivering vaginally after a c-section (VBAC) is a decision that you and your doctor must make together. Your ability to have a VBAC will depend on your health, possible risk factors, and the health and position of your baby.
Yes, forceps can cause birth injuries. Forceps is a useful and common tool in exam, delivery and operating rooms. Forceps used during delivery are specially shaped to cup the sides of the baby’s head. When used properly, there is only a small risk of injuries like bruising. If forceps are used improperly, they can cause birth injuries like brain damage, bleeding in the brain, subconjunctival hemorrhage and cerebral palsy.
If your baby is red around the eyes or has a bright red spot on the white of his or her eye, your baby may have a subconjunctival hemorrhage. A subconjunctival hemorrhage occurs when the tiny blood vessels under the sclera of the eye rupture. This is an injury that occurs when too much pressure is applied to the baby’s head during labor and delivery. It can result from natural pressures, or forceful use of birthing tools like forceps.
A subconjunctival hematoma, also called a subconjunctival hemorrhage, is a birth injury that occurs when the small blood vessels just under the surface of the eye rupture. Often, this is due to birth trauma, use of forceps, or too much pressure during labor and delivery.
Vacuum extraction during delivery can be dangerous if the doctor applies too much pressure, or if the baby is stuck in the birth canal. In such cases, the baby may suffer from bruising, bleeding in the brain, brain damage, cerebral palsy or seizures.
Gestational diabetes is a type of diabetes that only develops during pregnancy. In most cases, it resolves after delivery. Gestational diabetes causes blood sugar levels to increase, which can be dangerous if it is not controlled.
Risk factors for gestational diabetes include:
- Abdominal fat
- Previous pregnancies with gestational diabetes
A high risk pregnancy is any pregnancy where the mother is at risk for complications that could injure her or the baby. Only your doctor can determine if your pregnancy is high risk. Talk to him or her if you meet any of the following risk factors:
- Under 20 or over 35 years old
- Medical conditions like hypertension, diabetes, obesity, infection or preeclampsia
- You are pregnant with multiples
- You have a history of pregnancy-related complications
The signs of placental abruption include severe back and abdominal pain that comes on suddenly. Generally, bleeding follows this pain. The amount of bleeding varies, and some women do not bleed at all. Many women experience a tender uterus and uterine contractions. Abnormalities in fetal heart rate are also a sign of placental abruption.
If you heard what sounded like your baby’s shoulder popping during or after delivery, it could be a sign of a shoulder injury, such as a brachial plexus injury. This is more likely to occur in infant’s with shoulder dystocia, which occurs when the baby’s shoulder gets stuck behind the mother’s pelvic bone.
It can be very difficult to recognize the signs of internal bleeding in babies. Because babies cannot express what they are feeling, parents and caregivers must be on the look out for certain symptoms. These include:
- Nausea and vomiting
- Fever over 100.4
Developmental Delay Questions
In order to tell if an infant is just moving at his or her own pace, or is falling behind the developmental milestones most pediatricians follow, it is important to understand what constitutes developmental delays. The Centers for Disease Control and Prevention (CDC) has an established list of developmental milestones that help parents and healthcare providers ensure that infants and children are developing well. These developmental milestones include a baseline age range for target behaviors like crawling, walking, saying a certain number of words, identifying body parts, pretend play, etc.
It is also important to note that developmental delays can occur in any of the five traditional areas of development, being:
- Social and Emotional
- Language and Speech
- Gross Motor Skills
- Fine Motor Skills
The CDC’s list of developmental milestones begins at six weeks and continues up until age seven. Parents will likely also discuss milestones and development at their regular pediatrician check-ups.
Every child is different, and what works for one family to master a skill may not work as well for another. Comparing one child to another is not generally an accurate way of measuring development. One of the fantastic elements of parenthood is the uniqueness of each child. The CDC’s milestone guide presents the expected behaviors in a window of time, such as walking between nine to 15 months. That is not to say that a 16-month old infant who is not crawling with proficiency is delayed, however. At this point, a simple conversation with a pediatrician can assess the situation with ease.
There are, however, some warning signs that can alert parents to a deeper issue than just a child that moves at his or her own pace. Some “warning signs” include:
- Behavioral: Signs of aggression toward others, self-harm, repetitive body movements, lack of social interaction, does not make eye contact
- Gross Motor Skills: Clumsy, does not develop hand-eye coordination, stiffness or floppiness of arms and legs
- Vision: Stares at unusual objects, turns head to one side while looking at something, places objects very close to face, does not pick up objects
- Hearing: Does not respond to verbal or visual prompts, does not begin speaking or speech digresses, preference to listening with one ear, talks very loud or yells
While some of these signs could indicate a minor issue, illness, or simple defiance, others could indicate a serious underlying developmental condition.
Developmental delays can be the result of various factors. Some of the most common factors include:
- Developmental delays can be caused by genetics (Down Syndrome, fragile X syndrome)
- Medical conditions can also result in developmental delays. Common factors in this category include prematurity, fetal alcohol syndrome, medical conditions affecting the eyes, ears, or muscles
- Developmental delays can also be caused by trauma, such as injuries to the infant before, during, or shortly after birth
Children who suffer from cerebral palsy and other medical disorders sometimes skip certain developmental milestones. These milestones include:
- Rolling over as an infant
- Sitting up as an infant
- Potty training as a toddler
- Dressing as a toddler
- Independent feeding
In fact, the aforementioned milestones are things that physical and occupational therapists focus on teaching. The goal is to help infants and children experience a richer, more independent life. Sometimes they struggle with these milestones because they have an intellectual disability as a facet of cerebral palsy. But sometimes cerebral palsy limits muscle movement and they don’t have enough control over their muscles to perform these tasks.
Some physicians consider growth problems as part of skipping developmental milestones. Sometimes infants develop disorders and disabilities due to low weight as part of the disease. Common disorders include:
- Spasticity in the digestive tract preventing natural digestion
- Problems with spastic movements
- Trouble swallowing or eating based on oral muscular disabilities
Because the growth problems are in direct relation to disabilities, growth problems are sometimes considered a skipped developmental milestones.
Sometimes oxygen deprivation at birth causes brain damage from anoxia, hypoxia, Hypoxic Ischemic Encephalopathy (HIE), birth asphyxia, or perinatal asphyxia. These various forms of oxygen deprivation can cause a brain hemorrhage, brain ischemia, cerebral palsy, or general brain damage.
Cerebral palsy is a disorder that has been linked to oxygen deprivation, but it differs from other brain injuries due to different responses from the brain.
For example, in a brain hemorrhage the response from the brain is to flood it with more blood and kill more brain cells. The response from the brain in brain ischemia is to deprive the brain of blood. This suffocates the brain cells.
In cerebral palsy, the brain’s response is an electrical response that often results in intellectual disability. However, it may also result in the abnormal elimination of natural neural pathways that would connect messages from the brain to muscle groups. This is how children with cerebral palsy skip developmental milestones. Cerebral palsy disrupts the neural pathways that naturally communicate these messages, sometimes for that child’s lifetime.
What age do babies sit up on their own? That often depends on the baby. However, a general developmental goal is for the baby to sit up with assistance by three to five months. By the time the baby is six months old, he or she should be able to sit up on their own without assistance or support. Babies can pull themselves into the sitting position usually by around 11 months old.