What are the most common causes of birth injuries that you encounter in your work? Are these most often caused by complications during pregnancy, labour or delivery? Common prenatal causes of birth injuries often involve the failure to diagnose or manage conditions that occur during pregnancy, such as gestational hypertension (high blood pressure) and gestational diabetes, which put the baby at risk at the time of delivery. Both conditions require screening and testing in order to make the diagnosis. Vigilant management of the condition is then required to make sure the mother and fetus do not suffer adverse effects. For example, gestational hypertension poses the risk of kidney and neurological damage to the mother and the risk of growth restriction and low weight at birth to the fetus, which can pose further risks for neurological injury. Failure to manage diabetes that develops during pregnancy also puts the baby at risk for macrosomia and shoulder dystocia during birth, as well as for hypoglycemia after birth. Common causes of birth injury during labour and delivery involve failure to recognise the signs of and relieve developing fetal hypoxia, which is a condition where the baby does not receive enough oxygen for a sustained period of time during labour. The underlying conditions causing the decreased oxygenated blood flow to the fetus include nuchal cords, premature placental separation, and uteroplacental insufficiency. Depending on the cause and the severity of the underlying condition, the failure to intervene in a timely manner can sometimes lead to brain injury in the baby. Bleeding under the scalp (cephalohematoma) and sometimes more serious bleeds inside the skull can occur from operative delivery with forceps or a vacuum. In some cases, neurological injury can result. Shoulder dystocia can occur during a vaginal delivery if the baby’s shoulder becomes stuck behind the pubic bone of the mother and the baby cannot slip under it. Providers are trained to perform various manoeuvres to dislodge the shoulder and safely allow the baby to be expelled by the mother. If dystocia is not recognised or if there is pulling on the baby’s head in an attempt to pull the baby out, the nerves in the neck can be stretched or ruptured with resultant injuries to the function of the arm. Remembering that most deliveries are carefully and skillfully performed by the obstetrical team and do not result in any harm to the mother or baby, if proper care is not followed during all stages of the pregnancy, labour, delivery and the neonatal period, serious injuries can occur to both mother and baby. In the event that a birth injury or defect is suspected to have been caused by medical negligence, what legal recourse is available in your jurisdiction? Medical negligence claims are usually brought in state court unless there is diversity of citizenship among the parties, which may then require adjudication in federal court. Next, there must be a medical basis for the negligence claim which establishes that there was a departure from the required standard of medical care. This requires an experienced birth injury attorney who can sort through the medical records and discern whether the injury was an unfortunate unpreventable injury or the result of potential medical malpractice. The next set of proofs require connecting the error to the injury that resulted. Once liability and causation have been established, the damages that can be recovered include the costs of past and future health care for the child, compensation for the child’s pain and suffering, as well as emotional damages for parents. When the injuries are severe and permanent, the cost of properly caring for these children can be in the millions of dollars. What first steps should a victim take in such a case? First, focus on getting the best care possible for the injured baby. Braininjured infants often need pediatric neurology care for brain cooling right after birth and seizure control later 52 LAWYER MONTHLY APRIL 2023
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