Labor and Delivery Overview
The United Nations World Population Prospects report estimates that a baby is born in the United States approximately every 8 seconds. Labor is a natural process, which has to occur for a child to be born. And yet, when complications during labor are not properly addressed or managed or when mother and child do not get necessary care, monitoring and treatment before, during and after the labor and delivery process, a resulting birth injury can happen with devastating consequences both for the child and the family.
Birth injuries during labor and delivery may occur as a result of diminished oxygen supply to the child, as a result of trauma from improperly-used birth-assistive tools such as forceps or vacuum extractors and from other problems and complications that go uncorrected or are mishandled by the medical team. If your child has suffered a birth injury as the result of negligence (carelessness) on the part of the obstetrician, medical team or the hospital, it is important that you contact an experienced New York City birth injury lawyer to obtain more information about pursuing your legal rights.
What is Labor and Delivery?
“Labor and delivery” is the term that is commonly used to describe the process by which a baby is born – from the time the body prepares itself to the time when the baby and placenta leave the womb. The earliest stage of labor essentially prepares the body for delivery. This is a time when the uterus regularly contracts and the cervix gradually thins out. Once her cervix has completely opened, the woman can begin pushing to deliver the baby. When the baby and placenta come out through the vagina, it is known as a vaginal delivery.
For most women, labor typically begins sometime between week 37 and week 42 of pregnancy. Labor that occurs before 37 weeks of pregnancy is considered premature or preterm. Labor may vary from woman to woman and from pregnancy to pregnancy. A number of factors affect the duration and outcome of labor. Uterine contractions usually signal the start of labor. A gush or trickle of fluid usually referred to as a “water break” also signals the start of the labor and delivery process.
Labor happens in three stages:
Early labor: During early labor, the opening of the uterus, also known as the cervix begins to thin and dilate. Contractions get progressively stronger lasting 30 to 60 seconds and come every 5 to 20 minutes. A woman may experience this stage of labor for up to 20 hours especially if it is a first birth.
Active labor: During this stage of labor, the contractions become stronger, longer and more painful. The contractions come closer together. The woman may also feel pressure in her lower back as the fetus starts to move into the birth canal. At this stage, the cervix reaches full dilation at 10 centimeters. The woman is told to push to help the baby through the birth canal. The health care provider guides the baby out of the vagina. This stage may last several hours. Once the baby comes out, the umbilical cord is cut.
Delivery of the placenta: This is the third stage. It takes about 30 minutes for the placenta to exit the vagina.
When a Cesarean Section Becomes Necessary
A cesarean delivery, which is also known as a C-section or cesarean birth, is the surgical delivery of a baby through a cut or incision in the woman’s abdomen and uterus. After the infant is removed from the womb, the uterus and abdomen are closed with stitches that dissolve. The U.S. Centers for Disease Control and Prevention (CDC) estimates about 32 percent of births in 2017 were by C-section.
A C-section may become necessary in the following circumstances:
- Labor is prolonged and not progressing. In certain cases, the contractions may not be strong enough to open the cervix enough for the baby to move into the vagina for delivery.
- The child’s health is in danger. In some cases, the umbilical cord, which connects the fetus to the uterus, may become pinched or the fetus may have an abnormal heart rate. Sometimes, oxygen supply to the baby may get cut off, which can prove dangerous or even fatal. In these types of situations, a C-section delivery is often the safest way for a baby to be delivered quickly.
- The baby is in breech position, meaning the baby is coming out feet-first instead of head-first. In some cases, the baby may also be in a diagonal or sideways position, which can make delivery very challenging.
- The woman is delivering multiple babies. There are several complications that may arise with multiple births, which may warrant a C-section.
- The baby is too large. Often, larger babies are at risk for complications during delivery. One such complication is shoulder dystocia, when the infant’s head is delivered through the vagina, but the shoulders are stuck in the birth canal.
- Placental issues may also require a C-section. If the placenta is located in the wrong place in the uterus or if it is implanted too deeply or firmly in the uterine wall, it may pose risks during birth.
- If the mother has an infection, it may be passed on to the child during birth, a dangerous event that may result in serious birth injuries. A C-section can help prevent the transmission of infections to the child.
- When the mother has a medical condition, a C-section enables the health care provider to better manage any maternal complications that present themselves.
What is Prolonged Labor?
Prolonged labor lasts for about 20 hours or more if the woman is giving birth for the first time and 14 hours or more if she has previously given birth. A prolonged latent phase happens during the first stage of labor. While this may be emotionally and physically exhausting, it rarely leads to complications. However, when the active phase of giving birth is prolonged, it may raise several concerns. If you show failure to progress, your healthcare provider should determine the cause.
There are a number of reasons why prolonged labor occurs. For example, a slow effacement or erosion of the cervix may cause the duration of labor to increase. Sometimes, when a baby is too large or if the birthing canal and/or the woman’s pelvis are too small, delivery may fail to progress. Carrying twins or multiples may also cause this situation. Research has also linked prolonged labor to psychological factors such as worry, stress or fear.
Sometimes, prolonged labor may require medical intervention. Some medical providers may recommend that you take a walk or a warm bath to help relax. But, a C-section may be the answer to many of the issues that cause prolonged labor. Nearly one-third of all C-sections are performed due to failure to progress.
If your baby is turned the wrong way, the head is too large or if the baby is in breech position, or if your baby is not receiving sufficient oxygen, a C-section might be the best choice to avoid further complications. C-sections are also extremely common for multiple births. Nearly 90 percent of triplets and 50 percent of twins are born by C-section. It should also be noted that C-sections are highly recommended to prevent serious birth injuries and are generally considered worthwhile in order to avoid critical issues caused by prolonged labor.
Complications That Cause Birth Injuries
There are a number of complications during birth that may result in severe birth injuries. Here are some of the most common birth injuries, which occur due to the medical team’s negligence (carelessness) including failure to perform a timely C-section:
An inadequate supply of oxygen to the baby may pose a significant risk for brain damage and even death. Hypoxic-Ischemic Encephalopathy (HIE) occurs when the baby’s brain doesn’t receive enough oxygen. This may result in cerebral palsy, which is a group of disorders that affect a person’s ability to move and maintain balance and posture. Cerebral palsy is the most common motor disability in childhood.
The word “cerebral” refers to the brain and “palsy” means muscle weakness. Low oxygen supply to the child’s blood and brain may also lead to developmental issues, learning disabilities, hearing impairment, loss of vision and epilepsy. Hypoxia may also result from the premature separation of the placenta; entanglement of the umbilical cord; inability of the baby to breathe on his or her own after birth; and when the contractions are too strong, too frequent or too long, often from improper use of Pitocin (a medication used to stimulate labor) by the medical team.
It is very important that the medical team use an electronic fetal monitor to keep track of the child’s heart rate. It also helps them see if the baby is experiencing any signs of distress such as an abnormal heart rate or low heart rate. When the fetus is not properly monitored, errors that occur may result in severe birth injuries such as brain damage.
Traumatic Birth Injuries
Here are some of the types of birth injuries that can be caused by trauma during labor and delivery:
Erb’s palsy: Brachial plexus palsy or Erb’s palsy can occur when the baby’s neck or shoulder is stretched during delivery. The brachial plexus is a network of nerves near the neck that give rise to all the nerves of the arm. These nerves give movement and sensation to the shoulder, arm, hands and fingers. Palsy means weakness, and brachial plexus birth palsy or Erb’s palsy causes arm weakness and loss of motion.
Birth-assistive tools: Vacuum extractors and forceps, when used improperly, can cause severe injuries such as brain bleeds, contusions, facial nerve damage that may result in paralysis, skull fractures and skin lacerations. Broken bones or fractures can also happen when an obstetrician applies excessive force and unnecessarily subjects a baby to trauma when a C-section delivery is the proper course of treatment.
Filing a Birth Injury Lawsuit
If you have prolonged labor or a complicated delivery, your doctor and medical team have the responsibility to help you make the safest and most effective choice. If your doctor had sufficient information to know that a C-section would have been less risky or if your medical team failed to take the necessary steps to promptly treat meconium (fecal matter) aspiration (a complication affecting the lungs of the fetus) and your child suffered birth injuries as a result, you may have grounds for a medical malpractice lawsuit. You may be able to seek compensation for damages including, but not limited to, medical expenses, lost income and wages, loss of future income, permanent injury, disability, past and future pain and suffering, etc.
The experienced New York personal injury attorneys at the Law Offices of Kenneth A. Wilhelm can help you better understand your legal rights and options, and also fight hard to recover just compensation for you. One of our clients secured a $43,940,000 verdict for a child who was diagnosed with cerebral palsy. The hospital failed to diagnose fetal distress, which led to brain damage and cerebral palsy from lack of oxygen supply to the brain. The delay in diagnosing the fetal distress and ordering a C-section delivery caused the child’s condition. Defense attorneys argued that the child’s injuries were caused by premature birth and that the obstetrical care was appropriate. The $43,940,000 verdict was eventually reduced on appeal, because the verdict was so huge.
In another case, our client obtained a $4,500,000 settlement where the doctor negligently (carelessly) used forceps to deliver a baby cutting oxygen supply to the child’s brain. The infant suffered from cerebral palsy as a result. We were able to prove that a C-section should have been performed, which may have prevented the cerebral palsy from occurring. Also, another client of ours got a verdict for $23,500,000 in a medical malpractice case.
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