Understanding the cause of a child’s cerebral palsy and whether or not it was preventable with appropriate medical care are questions often in the minds of parents of a child whose birth may have been traumatic, or who has been diagnosed with hypoxic ischemic encephalopathy (“HIE”) or brain injury. The causes are rarely addressed by the child’s treating physicians. Understanding the cause that led to the diagnosis of cerebral palsy and whether or not it could have been avoided involves bringing together the opinions of a variety of carefully selected medical specialists who must each contribute their opinion on discrete areas of the medical care provided or the injury suffered by the child. Since often this does not impact upon the medical treatment being provided to the child, this typically does not occur in the clinical setting. One exception is when the hospital performs a Quality Assurance Review in response to a baby dying or suffering a brain injury during delivery or shortly following birth; however, the results of these investigations are kept confidential and are not disclosed to the parents of the child with cerebral palsy.
This leaves many parents with unanswered questions about why their child has been diagnosed with cerebral palsy. While they may receive fragments of information from various treating physicians, over the years an exhausted parent’s battle for answers quickly becomes displaced by the daily battle for resources such as therapy, support and equipment. The unanswered questions, however, continue to weigh on the parent’s mind, resurfacing from time to time, only to be buried again by the weight of the day-to-day needs of their child.
It is understood that cerebral palsy can occur as a result of various medical conditions that are well-known and preventable with appropriate medical care. Some examples include:
During Labour and Delivery:
In these circumstances, if it can be shown that a child’s cerebral palsy was preventable with appropriate medical care, the child is entitled to receive fair and reasonable financial compensation to allow the parents to provide for their child’s care, support and therapy, to help their child reach their full potential in life.
It is also understood that cerebral palsy can occur for reasons that are not (yet) understood by modern medicine and in circumstances in which it was not predictable and not preventable. These cases include congenital brain malformations, genetic abnormalities and other conditions. In these cases, knowing the child’s injury was nobody’s fault and could not have been avoided can help relieve any anger or guilt a parent may be feeling, and help parents put the circumstances of their child’s birth behind them, and focus on their child’s future.
Either way, parents often feel it is better to know, rather than to continue to wonder.
Do you have questions about the cause of your child’s cerebral palsy? Please contact us – we would like to help. Our team of experienced lawyers and medical specialists can review the medical care you and your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
We will provide you with the information and advice you need to make informed decisions that affect your child’s future and ensure that your child’s rights are protected. Contact Pacific Medical Law Today | Free Consultations
A caesarean section involves delivering a baby through an abdominal incision. In some cases, a caesarean section is planned (often referred to as ‘elective’). The reasons for a planned caesarean section include:
In some circumstances a caesarean section is not planned and is performed on an emergency basis. The reasons for an emergency caesarean section include:
In Canada, approximately 28% of all births are performed by caesarean section. This rate is increasing every year.
Like any surgical procedure, there are risks to the pregnant woman, which include:
There are also risks to the baby including:
The decision as to whether to proceed with a caesarean section should balance the risks and benefits of a caesarean section as well as the woman’s wishes. A caesarean section may reduce the risk to a baby and/or a pregnant woman from continuing in labour or delivering vaginally. For example, if a baby is showing early warning signs of potential fetal distress, delivering urgently by caesarean section may help to avoid a significant brain injury to the baby. Safe obstetrical care involves responding to potential concerns of fetal distress before they evolve into an obstetrical emergency.
The discussion about how to deliver – vaginally or by c-section, should occur during pregnancy, at the beginning of labour and again during labour if there are any early warning signs of potential fetal distress, so that the pregnant woman can reassess her risk tolerance and her decision on how she wishes to deliver her baby. It is important to remember that a woman does not have to “qualify” for a caesarean section and the physician or midwife does not have to agree with her decision to have a caesarean section. The notion of patient autonomy has become well entrenched in medicine and in the context of labour and delivery means that the pregnant woman has the right to make decisions which are right for her.
An emergency caesarean section is higher risk than a planned (‘elective’) caesarean section because it often has to be performed very quickly due to fetal distress and also because the surgery is more complicated with greater risks the farther the baby progresses down the birth canal. For this reason, planned caesarean sections are scheduled to take place a week or two before the expected delivery date to avoid these additional risks associated with labour.
The primary risk associated with an emergency caesarean section when it is done in response to potential fetal distress relates to delay in delivering the baby. The delay can be:
During labour, there may be warning signs that the baby is not getting enough oxygen such as decelerations in the baby’s heartrate or an elevated heartrate. Another reason for an emergency caesarean section is if the baby is not moving down the birth canal as expected due to the size of the baby, the position of the baby’s head (such as occiput transverse “OT”), the size or shape of the mother’s pelvis or the adequacy (strength and frequency) of the contractions. Health care providers are required to carefully monitor the baby during labour and watch for warning signs of potential problems. These warning signs include changes in the fetal heart rate such as repetitive or complicated decelerations or an increasing heart rate, an abnormal contraction pattern, or failure to progress in the expected manner. It is important that these early warning signs are detected, communicated to the pregnant woman and responded to before they progress to an obstetrical emergency. Timely and clear communication amongst all members of the team, including the specialists required to intervene if an emergency arises (the anesthetist, obstetrician, pediatrician and operating room nurses), is critical. Many hospitals have communication protocols that are used to quickly assemble all required staff such as calling a Code Pink over the intercom system. Not all hospitals are equally equipped to respond to the need for an emergency caesarian section. Health care providers are required to understand the resources available to them in the hospital setting, to anticipate potential emergencies that may arise for the pregnant woman and her baby and plan accordingly. A scramble at the last minute, once the baby is clearly in distress, creates unnecessary risks to both the pregnant woman and her baby.
The pregnant woman also has a right to be informed of all warning signs that her baby may be in distress or if her labour is not proceeding normally and has a right to participate in the decision-making process.
A planned caesarean section may be the safest option in response to risk factors in the pregnancy. It will also be the appropriate mode of delivery if it has been requested by the pregnant woman for personal reasons.
An emergency caesarean section may be the safest option for delivery if there are concerns about the health and wellbeing of a pregnant woman and/or her baby. This is the scenario where minutes matter, and delay can have devastating results. Hospitals have protocols that must be followed to perform an emergency caesarian section as quickly and safely as possible. The surgery itself is rarely the cause for delay; rather, the delay is usually caused by poor communication in assembling the various health care providers required to perform the caesarean section, such as the anesthetist, obstetrician, pediatrician and operating nurses.
Do you have concerns about how you and your child were cared for during your pregnancy or labour and delivery? We would like to help. Our team of experienced lawyers and medical specialists can review the medical care you and your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
We will provide you with the information and advice you need to make informed decisions that affect your child’s future and ensure your child’s rights are protected. Contact Pacific Medical Law Today | Free Consultations
Fetal distress is a medical term used to describe a condition where a baby is not receiving sufficient oxygen during labour and delivery.
During normal labour, the mother’s contractions temporarily interrupt the blood and oxygen supply being delivered to the baby through the umbilical cord. A healthy, term baby will typically have sufficient capacity to tolerate these brief interruptions in oxygen supply, without any concerns.
There are, however, various complications that may occur during labour that may interrupt or decrease the oxygen supply to the baby’s brain causing fetal distress, such as:
An early warning sign that the baby may not be receiving sufficient oxygen during labour and delivery is changes in the baby’s heart rate. This is why there is so much emphasis on monitoring the baby’s heart rate during labour and delivery with either continuous electronic fetal heart monitoring or intermittent auscultation (listening with a handheld doptone device) – it is the only way of monitoring how the baby is tolerating the stress of labour.
Some babies may be more vulnerable to the stress of labour than others and may require closer monitoring of their heart rate pattern. Examples include:
A baby may also show signs of stress by releasing meconium (or poo) before they are born. A pregnant woman may pass greenish or brown stained fluid vaginally when this happens or this may be seen when a baby is delivered.
Fetal distress, typically shown as changes in the baby’s heartrate pattern, is a warning sign that there may not be enough oxygen reaching the baby’s brain. The longer this continues, the higher the risk of the baby suffering from a brain injury, called an hypoxic ischemic brain injury.
The risks of brain injury to the baby increase if the baby’s heart rate is not carefully monitored during labour and delivery and if early changes in the baby’s heart rate pattern are not responded to in a timely and appropriate way. Safe obstetrical care requires that early signs are responded to before they evolve into obstetrical emergencies.
In response to changes in the fetal heart rate, the attending nurse should communicate these changes to the responsible health care provider (the obstetrician, family physician or midwife) who must assess the changes in the heart rate pattern and the progress of the labour and any risk factors that may be present, in order to determine whether continuing with vaginal delivery is reasonably safe. This information should also be communicated to the pregnant woman. If the healthcare provider cannot obtain reassurance for safe vaginal delivery, delivery of the baby should be expedited by c-section or by way of instrumental delivery using a vacuum or forceps, depending on how far down the birth canal the baby is.
In assessing how to proceed, the health care provider may obtain more information about fetal well-being by doing scalp stimulation (tickling the baby’s head to elicit an increase in the baby’s heart rate) or doing scalp pH or lactate sampling which is a blood test to assess oxygenation of the baby’s blood.
There are also interventions to alleviate signs of potential fetal distress which include:
If these interventions do not, or are not reasonably expected to improve the fetal distress, intervening to expedite the delivery is important to avoid the risk of brain injury. Expedited delivery can be accomplished in the following ways:
The safest method of expediting the birth of the child depends on the circumstances of each individual delivery including any risk factors that may be present, the progress of the labour (how far down the birth canal the baby has descended), the skills of the treating health care provider as well as the available resources in the hospital.
When early warning signs of potential fetal distress are promptly recognised and responded to, damage to a baby’s brain can be avoided. If you have concerns about whether there were early warning signs of potential fetal distress during your labour or whether or not your baby’s brain injury could have been avoided, then please contact us – we would like to help. Our team of experienced lawyers and medical specialists can review the medical care you and your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
We will provide you with the information and advice you need to make informed decisions that affect your child’s future and ensure your child’s rights are protected. Contact Pacific Medical Law Today | Free Consultations
Fetal growth restriction is the term used to describe where a baby does not grow as expected in the womb. It is also referred to as intrauterine growth restriction. A health care provider can assess fetal growth with ultrasound scanning. During an ultrasound scan, measurements are taken of parts of the unborn baby’s body and an estimated weight is calculated for the baby. This weight is then compared to the measurements of all babies for that stage of pregnancy.
Not all babies grow at the same rate in the womb, but where a baby has an estimated weight that is less than 9 out of 10 babies, or less than the 10th percentile, a baby will be described as having fetal growth restriction.
Fetal growth restriction is caused by a baby not receiving enough oxygen and essential nutrients during pregnancy. This can be related to:
Fetal growth restriction is important as it may indicate that the baby is not receiving sufficient oxygen and nutrients for growth. This places the baby at an increased risk of health conditions involving the heart and blood vessels later in life. Depending on how many weeks into the pregnancy fetal growth restriction is detected, a baby may need to be delivered early.
Being born with a low birth weight and/or prematurely can place a baby at an increased risk of many complications including distress during delivery, difficulties with breathing and feeding and an increased risk of infections following delivery. These complications can place a baby at an increased risk of a brain injury during or following delivery.
Depending on the underlying cause of the fetal growth restriction, there may also be other associated complications for the baby before and after birth. For example, where the pregnant woman has diabetes, the baby will be prone to having low blood glucose or hypoglycaemia following delivery, which can increase the risk of harm to a baby who may also be struggling to feed in the first hours or days of life.
Some of the risk factors described above can be picked up in early pregnancy or prior to pregnancy. For instance, a pregnant woman who is found not to have immunity to rubella during one pregnancy can be advised to have a rubella vaccination following delivery, and so can protect the baby in subsequent pregnancies from suffering from the harmful effects of a rubella infection. Medications that a pregnant woman takes during pregnancy can often be optimized to reduce the risk to the unborn baby. Pregnant women are also screened for high blood pressure and diabetes during pregnancy and treating and managing these conditions carefully can also help to reduce the risk to the unborn baby.
Once fetal growth restriction has been detected, additional tests can be done to establish any potential cause and it may be possible to make changes to help with the growth of the baby; for example, providing support with quitting smoking or recreational drug use or providing dietary support.
At the point fetal growth restriction has been diagnosed, the baby needs to be monitored closely. This monitoring can include:
In some circumstances, the treatment plan may be to deliver the baby early by caesarean section. This should be a decision made both by the health care professionals involved and the pregnant woman. If the plan is made to deliver a baby early then it should be planned so that it can take place in a hospital with the facilities and staff to care for a premature baby.
If your baby was affected by fetal growth restriction and has suffered a brain injury, and you have concerns over how you or your baby were cared for then please contact us – we would like to help. Our team of experienced lawyers and medical specialists can review the medical care you and your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
We will provide you with the information and advice you need to make informed decisions that affect your child’s future and ensure your child’s rights are protected. Contact Pacific Medical Law Today | Free Consultations
Herpes simplex virus type 2 (HSV-2) is a common viral infection of the genital area also known as genital herpes. HSV-2 is passed on through sexual contact and can cause small blisters on the infected area.
Most people with HSV-2 do not have symptoms from the infection or only very mild symptoms. The first time the blisters appear, the woman can also feel unwell with fever, aching muscles and/or headache. The blisters last about 2 to 4 weeks and then heal but then they can reappear at a later time. The first time the symptoms are normally more severe and then the following episodes are generally milder. HSV-2 can be diagnosed by sending a swab of the blister for testing. There are also blood tests which can detect HSV-2.
The virus can be transmitted from a pregnant woman to her baby during pregnancy or during delivery. If a pregnant woman has her first episode of HSV-2 during the last trimester of pregnancy then the chances of passing on the infection to her unborn baby are over 30%, whereas if the episode is not the first one then there is a 3% chance of passing the infection on.
A pregnant woman with genital herpes can also pass on the infection to her unborn baby during vaginal delivery if she has an outbreak around the time of labour.
When HSV-2 is passed on to the unborn baby during pregnancy or during labour and delivery, the baby may suffer from the following medical conditions:
The key to reducing the risks associated with transmission of HSV-2 to the baby is in clear communication. It is important that the pregnant woman share details of her medical history and any signs and symptoms of HSV-2. It is also important that the health care provider asks specific questions about signs and symptoms of HSV-2 and informs the pregnant woman of the risks of HSV-2 transmission to her baby and provides appropriate treatment to reduce the risks.
All pregnant women should be asked if they have had HSV-2.
If a pregnant woman has not had HSV-2, her physician should discuss with her practices to avoid acquiring HSV-2 during pregnancy. A pregnant woman who has not had HSV-2 but has a partner with HSV-2 should be advised to avoid infection by either using condoms or abstaining from sex and should be offered a blood test to check for HSV-2 and to be checked again at between 32 and 34 weeks of pregnancy.
If a pregnant woman has had an episode or episodes of HSV-2 before her pregnancy, then she can be offered antiviral medication late in pregnancy.
At the time labour begins, or when planning for delivery, a pregnant woman with a history of HSV-2 should be asked about any current symptoms. If any blisters are present or the woman has the warning signs of a new episode, then a caesarean delivery is recommended as this reduces the chance that the infection will be passed on to the baby at the time of delivery. There are other precautions that should be taken during delivery as well, including avoiding taking a blood sample from the baby’s scalp or performing an instrumental delivery.
After birth, the baby should be monitored closely for any signs of infection and should have their nose, eye and mouth swabbed to test for HSV-2. If a baby tests positive then they should be treated with antivirals even if they appear well and are feeding normally. Where a pregnant woman has had her first episode of HSV-2 during pregnancy, has symptoms at the time of delivery and whose membranes have ruptured before delivery, then her baby should be started on antiviral treatment after birth.
If your baby developed HSV-2 infection in the first days or weeks of life and has a brain injury and you have concerns over how your pregnancy and delivery were managed or about the care provided to your baby after birth, then please contact us – we would like to help. Our team of experienced lawyers and specialists can review the medical care you and your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
Induction of labour is the process of stimulating labour contractions before labour commences naturally. Often this is done when a pregnant woman is overdue.
Augmentation of labour is the process of stimulating labour contractions during labour, often when contractions have started but are weak, irregular or have stopped entirely.
There are different ways of inducing labour.
Labour can be induced in a number of ways:
Labour may be induced for a number of reasons including when:
In these circumstances, the pregnant woman and her baby may be at risk if her baby is not delivered promptly. The risks of the induction of labour should be discussed with the pregnant woman so that a joint decision can be made about the delivery.
There are risks associated with the induction or augmentation of labour:
There are guidelines available to health care providers who care for pregnant women who undergo induction or augmentation of labour. The guidelines set out which patients may benefit from induction or augmentation of labour and when it is not safe to proceed in this manner.
Induction should be avoided where:
Once induction has started, a pregnant woman should be monitored carefully. If she has received the tablet or gel (ie. Cervadil) then she may, in certain circumstances, be able to go home. She should be provided with clear advice on when to return and the need to monitor baby’s movements and to call if there are any concerns.
Where medication is administered via a line into the vein (ie. oxytocin or Pitocin), the baby and pregnant woman should then be monitored closely in hospital. The dose should be carefully increased and the heart rate of the baby should be monitored with continuous electronic fetal heart monitoring. There should be a prompt assessment and intervention if the pregnant woman develops an abnormal contraction pattern or if the baby shows any signs of distress. The medication may need to be stopped immediately and a joint decision should be made between the pregnant woman and the health care team on how to best deliver the baby. This may involve restarting the medication at a lower dose or considering a caesarean section urgently if the baby’s heart rate pattern does not improve with stopping the medication. This can be a sign that a baby is not tolerating the induction process.
Once labour commences, contractions should only be augmented with medication if the contractions are weak, irregular or have stopped. Augmenting contractions which are already effective can increase the risks to both the pregnant woman and her baby.
If you were induced during your labour or if your labour was augmented with medication and you have concerns about the care provided, or whether this may have caused distress to your baby, then please contact us – we would like to help. Our team of experienced lawyers and medical specialists can review the medical care you and your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
An instrumental delivery (also referred to as an operative delivery) describes a vaginal delivery that is assisted by the use of an instrument such as forceps or a vaccum/suction device. Between 5% – 20% of all births are instrumental or operative vaginal deliveries.
Many instrumental deliveries take place in a hospital delivery room but around 1 in 20 will take place in an operating theatre. Both devices can also be used to assist during a caesarean section delivery.
Forceps are metal instruments which are shaped like large spoons and cradle a baby’s head. Vacuum or suction devices look like cups and are placed onto a baby’s head and a vacuum is created. Both devices help guide the baby through the birth canal during the contractions, while the pregnant woman continues to push.
A decision may be made with a pregnant woman for an instrumental delivery when the baby is not moving down the birth canal as expected, if the pregnant woman has a medical problem which may place her at risk of complications if she keeps pushing, or where a baby is showing signs that they are not receiving enough oxygen such as worrisome decelerations in the baby’s heart rate or elevated heart rate (tachycardia).
Instrumental or operative delivery does have risks which can cause harm to the baby, or the pregnant woman. However, an instrumental delivery can help expedite delivery and thereby avoid serious injury to a baby who may be in distress due to not receiving enough oxygen.
The risks to a pregnant woman include injury to the vagina and surrounding structures, causing urinary and other problems after delivery.
The risks to the baby include minor injuries to the face or scalp, bleeding (which can make the baby more vulnerable to developing jaundice), temporary weakness of the muscles of the face and, rarely, a skull fracture which can cause permanent brain injury. The use of forceps to deliver a baby when the baby has not yet descended far enough down the birth canal can also cause a cord prolapse which can result in compression of the umbilical cord, which can result in permanent brain injury due to oxygen deprivation.
The risks of instrumental delivery need to be balanced against the risks of not delivering the baby promptly or by delivery by caesarean. The pregnant woman should be informed of any warning signs that her baby is not tolerating the stress of labour and of the risks associated with trying to expedite labour with vacuum or forceps so that she can participate in the decision-making process and provide informed consent to the plan.
An instrumental delivery is not always appropriate and should not be used in some circumstances such as:
In these situations, attempting an instrumental delivery may cause injury or may delay the decision to proceed with a caesarean section which can in turn cause an unborn baby to be deprived of oxygen for a longer period of time and potentially suffer a brain injury. It is also not safe to continue to attempt to expedite delivery with an instrument after initial attempts have failed.
During labour, when it is not progressing as expected, the pregnant woman may feel that she was not fully informed of how her labour was managed by her health care team and that she was not given the opportunity to participate in the decisions made and provide informed consent, including any decisions to expedite labour with an instrumental delivery. If you experienced an instrumental delivery and your baby has suffered a brain injury, you may have concerns over how your labour was managed. Please contact us – we can help. Our team of experienced lawyers and medical specialists can review the medical care you and your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
Hypoglycaemia is a condition where there is a low level of glucose, or sugar, in the blood. This can be dangerous for a newborn baby. Some newborns are more at risk than others for developing hypoglycaemia after birth such as babies born prematurely, as well as babies whose mother had gestational diabetes or who encountered distress during labour and delivery. These babies may need close monitoring after birth with blood tests. Some may show signs of having a low level of glucose and require prompt and repeated testing and treatment. Without treatment, very low levels of glucose can stop the brain from functioning normally and this can cause seizures and permanent brain injury.
Warning signs that a newborn may have hypoglycemia include:
Difficulty with feeding.
Glucose is the main fuel for all of the cells in the body. In the womb, a baby receives glucose from the placenta. After birth, a baby has to maintain a normal glucose level using glucose from feeding and stores in his or her body.
The cells in the brain rely upon a continuous supply of glucose to function normally and are more sensitive to low levels of glucose than other cells in the body. Hypoglycaemia can affect the way that the brain works and, if the level of glucose falls very low or stays low for a long period of time, then this can cause seizures and potentially a permanent brain injury.
Most babies have a drop in their level of glucose in the blood in the first hours of life as they adapt to life outside of the womb. However, below a certain level, hypoglycaemia can become harmful, particularly if it is not corrected quickly. To know whether a baby is hypoglycaemic, health care professionals should be alert to the signs of hypoglycaemia and test if they suspect a baby has a low level of glucose. Testing involves using a tiny spot of blood from a skin-prick and the result is available within seconds.
There are also babies who should be tested in the hours following birth automatically as they are more at risk of developing hypoglycaemia. These include:
If hypoglycaemia is detected on testing then the treatment will depend upon how low the glucose level is. It may be sufficient to increase the frequency of feeding. Sometimes, it may be necessary to use a gel containing another form of glucose called dextrose to rapidly increase the glucose level. It may be necessary to place a line into a newborn’s vein to give glucose directly into the blood to avoid hypoglycaemia causing harm to the baby. Whatever treatment is used, regular checks of the blood glucose level are required to ensure that the level is increasing to normal and may be as often as every 30 minutes.
Hypoglycaemia in newborns is easy to treat if detected, and treatment can help avoid a brain injury. If your baby suffered from hypoglycaemia in the hours or days following birth and may have suffered a brain injury then please contact us – we would like to help. We have a team of experienced lawyers and medical specialists who can review the medical care your baby received and help answer your questions. We understand this initial call can be daunting. Rest assured your consultation with us is confidential and free of charge.
Neonatal meningitis is where the lining of the brain, the meninges, becomes inflamed in the first 28 days after a baby is born. Neonatal meningitis is most commonly caused by a bacterial infection but can also be the result of some viral infections. Infection can be passed on to the baby before delivery via the amniotic fluid, during delivery when passing through the birth canal or after delivery through contact with persons and medical devices.
Newborn babies are especially vulnerable to bacterial infections as their immune system has not fully developed and also because they do not receive their first immunizations until 2 months of age. Some of these immunizations protect against the types of infections which can cause meningitis.
The newborn babies who have the highest risk of meningitis include:
Neonatal meningitis is a medical emergency. The sooner it is diagnosed and treated, the better the outcome for the baby. Up to 4 out of 10 newborn babies who have meningitis die in the first month of life. Babies who survive meningitis may still suffer from a permanent brain injury and can suffer from seizures, learning difficulties, as well as visual and hearing difficulties.
Pregnant women are screened during pregnancy for certain infections which may cause neonatal meningitis. An example of this is Group B Streptococcus (GBS). Where a pregnant woman tests positive for GBS on vaginal swabbing, a routine test during pregnancy, she can then receive antibiotics during labour which reduces the risks of passing on an infection to the unborn baby.
Giving antibiotics promptly to a pregnant woman who has a fever during labour can also help reduce the risk of causing in infection to her baby. Similarly, starting antibiotics and antiviral treatment promptly after a baby shows signs of meningitis offers them the best chance at avoiding a brain injury. These babies may also require urgent support with their breathing and circulation and prompt efforts to do this can also help to avoid injury.
The signs of meningitis in a newborn baby are sometimes subtle and can include:
If your baby suffered from meningitis in the first days or weeks of life and has a brain injury and you have concerns over how your baby’s care was managed, then please contact us – we would like to help. Our team of experienced lawyers and medical specialists can review the medical care your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
Newborn jaundice is the yellowing of the skin and the white areas of the eyes of a newborn. It is common in the first few weeks of a baby’s life. Jaundice is caused by bilirubin, a waste product from the breakdown of red blood cells. Prior to birth, the bilirubin in a baby’s blood is removed when it passes into the mother’s blood and is broken down in the mother’s liver. After being born, a baby’s liver is immature and cannot always break down enough bilirubin. A baby may also have higher levels of bilirubin in his or her blood as a result of having an infection, bruising or an incompatibility with the mother’s blood type. These higher levels of bilirubin in the blood cause a yellowing appearance of the skin and the white areas of the eyes.
Newborn jaundice is a normal physiologic condition in many babies. In fact, around 6 out of 10 babies will have some degree of jaundice in the first few weeks after being born.
For some babies, however, the level of bilirubin reaches abnormally high levels – called hyperbilirubinemia. If a newborn develops hyperbilirubinemia, this can lead to damage to the baby’s brain and nervous system. This is called kernicterus.
Kernicterus is a permanent brain injury caused by hyperbilirubinemia, which can lead to difficulty with controlling movement (cerebral palsy) and hearing loss.
Kernicterus has been described as a “never event” by the Canadian Patient Safety Institute. This means that brain injury due to elevated levels of bilirubin is entirely preventable with appropriate medical care and should never occur.
Jaundice is not dangerous for your baby if your baby is otherwise healthy and the level of bilirubin in his or her blood remains within normal limits. If the level of bilirubin begins to rise above safe levels (hyperbilirubinemia), prompt treatment is necessary to bring the bilirubin back down to safe levels. If the levels are not being properly monitored or if timely treatment is not provided, the baby may be at risk of suffering brain injury (kernicterus).
Who is at risk?
In order to protect babies from the risk of brain injury, babies with risk factors need to be identified and carefully monitored after birth, often in a hospital setting, to ensure their bilirubin levels do not rise to a dangerous level (hyperbilirubinemia). This includes babies who:
How can the level of bilirubin be measured?
A baby’s bilirubin level can be measured instantaneously by a small device called a bilirubinometer, which shines light onto your baby’s skin. It can also be measured by a pin prick blood sample sent to a lab. Assessing the level of jaundice simply by looking at the colour of a baby’s skin is not as reliable as assessing it with a bilirubinometer or blood sample.
What is the treatment for high levels of bilirubin?
The treatment for high levels of bilirubin (hyperbilirubinemia) depends on the specific level of the bilirubin and risk factors for the baby, and may include:
If your child experienced high levels of bilirubin (hyperbilirubinemia) in his or her blood which was not properly monitored and treated in a timely way, he or she may have suffered a brain injury. This type of injury is called kernicterus and can be seen on brain MRI imaging.
Do you wonder if your child’s jaundice was properly managed, or are you concerned that your child may have suffered a brain injury (kernicterus) related to high levels of bilirubin (hyperbilirubinemia)? We would like to help. Our team of experienced lawyers and medical specialists can review the medical care your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
Upon birth, most babies will start breathing on their own. Crying is a reassuring sign as it indicates the baby is breathing well and that their heart is beating. When babies do not appear to be breathing normally or appear very floppy and pale at birth, then urgent assessment and intervention is required. Every minute matters. For this reason a healthcare provider qualified to provide newborn resuscitation must be present at every birth to avoid delay in providing the required interventions.
Newborn or neonatal resuscitation usually involves moving a baby to a resuscitaire radiant warmer. This is a special bed that can warm a baby and has breathing equipment to help support resuscitation efforts. A baby may initially be dried and stimulated and then breaths can be given via a mask. The breaths provide a small amount of positive pressure to help open up the baby’s airway and lungs.
In some cases, these efforts to establish effective ventilation are not effective, and the health care team must place an endotracheal tube or laryngeal mask to provide effective ventilation into the baby’s lungs. The standards for newborn resuscitation require that this be done within the first 2 minutes of the baby’s life.
Additional support may also be required if the baby does not respond to effective ventilation, including chest compressions and the administration of certain medications.
Newborn or neonatal resuscitation is a lifesaving treatment and helps to provide essential oxygen to a baby’s brain in the seconds and minutes after birth. Some babies who are born initially not breathing normally or floppy and pale may need only minimal support before they perk up. Others will require extensive resuscitation. It is critical that all the steps of resuscitation are performed in the correct order and within the correct timeframe. These are all set out in the Neonatal Resuscitation Program, which has been developed by the American Academy of Pediatrics and adopted by the Canadian Pediatric Society. Every healthcare provider involved in labour and delivery (nurses, midwives and physicians) is required to take this education program at the outset of their clincial practice, and then get recertified every year or two.
The condition of these babies at birth may be due to inadequate oxygenation during labour, infection, or congenital heart/ respiratory problems. The need for resuscitation should be anticipated and the healthcare team should be prepared to resuscitate the newborn immediately after birth without any delay. Babies requiring extensive resuscitation may require transfer to another hospital for a higher level of care and admission into the Neonatal Intensive Care Unit (the “NICU”) for continued support and investigation.
It may be possible to predict which babies may require resuscitation following delivery and the team best able to provide this treatment should be present at birth and prepared to resuscitate the newborn baby without delay.
Babies who are more likely to require newborn resuscitation include:
Where a baby is born not breathing and does not receive effective and prompt resuscitation after birth, he or she may go without oxygen and this places him or her at risk of a permanent brain injury. Every minute that goes by without sufficient oxygen increases the risk of permanent injury and potentially, death.
Where a baby is born and fails to breathe for longer than a few minutes, he or she is at risk of developing a permanent brain injury. If your baby has suffered a brain injury and had difficulties breathing following birth then please contact us – we would like to help. We have a team of experienced lawyers and medical specialists who can review the medical care you and your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
During pregnancy, an unborn baby receives blood containing oxygen and nutrients through the umbilical cord, which forms an attachment to the uterus, or womb, through the placenta. The placenta allows the pregnant woman to supply her baby with all it requires to grow and develop.
Placental abruption is where the placenta separates partially or fully from the wall of the uterus, thereby disrupting this supply of blood and nutrients to the unborn baby. Placental abruption affects about 1% of all pregnant woman.
Types of Placental Abruption
Broadly speaking, there are two types of placental abruptions:
Placental abruption may occur suddenly during a normal pregnancy. When this occurs, it typically happens in the last few weeks of pregnancy. The pregnant woman may experience:
It is worth noting that while vaginal bleeding is a classic sign of a placental abruption, vaginal bleeding is not experienced by all pregnant women who suffer abruption as the blood may be trapped within the uterus.
In some cases, placental abruption may develop slowly, with smaller amounts of blood loss between the placenta and wall of the uterus. This is known as a chronic abruption. Chronic abruption can occur any time after 20 weeks of pregnancy. During a chronic abruption, a pregnant woman may experience light vaginal bleeding that happens on and off. There may also be signs on ultrasound that the amount of amniotic fluid is low or that the baby is not growing as expected. These signs must be carefully monitored by your health care provider.
While placental abruption can occur unexpectedly in an otherwise normal and healthy pregnancy, the following risk factors have been identified:
The risks of a placental abruption to the pregnant woman include significant blood loss, the need for a blood transfusion and the need for a hysterectomy if the bleeding can’t be stopped.
The risks of a placental abruption to the unborn baby include oxygen deprivation leading to permanent brain injury or death in the absence of urgent delivery.
If the blood loss is slow and in smaller amounts, then it is important that the baby is monitored closely for growth and development. A chronic abruption can affect how an unborn baby grows and may indicate that early delivery may be safer for the baby than continuing with a pregnancy.
The risk of brain injury to an unborn baby due to severe placental abruption is high. It is well-understood in medicine that placental abruption presents a true obstetrical emergency where the unborn baby’s life depends on being rescued via urgent caesarian section delivery. Once born the neonatal team, or team of doctors and nurses who care for newborn babies, will also need to be called and ready to immediately provide resuscitation to the newborn. The baby may need extra help with breathing during the first minutes of life and may need to be admitted to the neonatal intensive care unit (the “NICU”) for support.
If you suffered a placental abruption during your pregnancy causing your baby to suffer a brain injury and you have concerns about how you were cared for then please contact us – we would like to help. Our team of experienced lawyers and medical specialists can review the medical care you and your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
Where a pregnancy is longer than 294 days, or 42 weeks, it is described as a post-term pregnancy. It may also be described as a post-dates or prolonged pregnancy.
Dating a pregnancy is not an exact science. A due date (which is the beginning of the 40th week of pregnancy) is calculated from the first day of a pregnant woman’s last menstrual period or from the information provided on an ultrasound scan in early pregnancy. While these methods are both still estimates, the most reliable assessment of the estimated due date is by an early ultrasound performed in the first trimester – between 7 – 14 weeks.
Generally, being born after 42 weeks does not harm a baby. However, a small percentage of babies who have not been born by 42 weeks die before being born. The small percentage is significantly higher than the chance of a baby dying when born before 42 weeks.
There are risks to both the pregnant woman and her baby when the pregnancy continues beyond 42 weeks.
The risks to the pregnant woman include injury to the perineum and increased chance of an instrumental delivery or caesarean section delivery.
The risks to the baby include:
The dating of a pregnancy is important as it helps avoid the complications from unknowingly going beyond 42 weeks. An early pregnancy ultrasound scan can help identify a due date where a pregnant woman has an irregular menstrual cycle or has bleeding in early pregnancy which makes timing of the last menstrual period unclear. A post-dates pregnancy is less common where a pregnant woman has an ultrasound between 7 – 14 weeks of pregnancy.
Membrane sweeping, where a midwife or obstetrician sweeps the inside of the cervix, can be done on or around the due date and this may encourage a pregnant woman to go into labour and so not go beyond 42 weeks. A sweep is not suitable for every pregnancy, but is generally considered to be safe for the pregnant woman and the baby and is also not too uncomfortable.
A pregnant woman may be offered induction of labour following 40 or 41 weeks of pregnancy. This can be done using medication placed close to the cervix in the form of a gel or pessary (ie Cervadil), or can be done by giving medication through a line into a vein (ie oxytocin or Pitocin).
Beyond 40 weeks, a pregnant woman should be closely monitored. Monitoring cannot necessarily prevent complications including a brain injury but there may be signs which indicate that expediting delivery would be beneficial to the pregnant woman and her baby. The pregnant woman should be included in the decision-making process about when and how to deliver her baby so that she can provide informed consent to the plan.
If you delivered your baby post-term and your baby has a brain injury and you have concerns about how you were cared for in your pregnancy or delivery then please contact us – we would like to help. Our team of experienced lawyers and medical specialists can review the medical care you and your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
Preeclampsia is a condition which can develop in pregnancy, usually after 20 weeks of pregnancy. The causes of preeclampsia are not well understood. It is thought that it may be related to how the blood vessels develop in the placenta during pregnancy. Often times the pregnant woman may be unaware of this developing condition until it is picked up by her health care provider during routine prenatal visits.
The typical signs and symptoms of preeclampsia include:
When a pregnancy is affected by preeclampsia, the unborn baby may not receive enough oxygen and glucose through the placenta and may not grow as expected. This can be seen on ultrasound scans performed during pregnancy.
HELLP syndrome is a life-threatening liver disorder thought to be related to severe preeclampsia. Severe preeclampsia can affect the way the blood clots, causing a breakdown of the oxygen carrying cells in the blood and injury to the liver. HELLP syndrome can occur silently, meaning without the pregnant woman being aware of it. It is therefore important to attend regular prenatal visits with your health care provider to ensure your pregnancy is progressing normally, and any potential signs and symptoms are picked up early.
Typical signs and symptoms of HELLP syndrome, in addition to the above, include:
Preeclampsia and HELLP syndrome during pregnancy need careful monitoring and treatment. Left untreated, preeclampsia and/or HELLP syndrome can lead to serious – even fatal – complications for both the pregnant woman and her baby.
The pregnant woman is at risk of:
The baby is at risk of suffering a permanent brain injury before or during delivery, or in rare cases, death.
The following should be carefully monitored in all pregnant women with signs or symptoms of preeclampsia and/or HELLP syndrome:
If signs or symptoms of preeclampsia arise, the main treatment for preeclampsia is delivering the baby. For some mild cases, a pregnant woman may be advised to rest and only stand when needed. Others may be advised to be monitored in hospital until labour begins or labour is induced. In severe cases, expediting delivery by way of urgent caesarian section is necessary to protect the pregnant woman and her baby’s health.
Prior to delivery, medications may also be used such as:
If you developed preeclampsia or HELLP syndrome in your pregnancy and feel you were not monitored closely or treated promptly, or if you have concerns about how you were cared for during your pregnancy and delivery, then please contact us – we would like to help. Our team of experienced lawyers and medical specialists can review the medical care you and your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
The length of a pregnancy is on average 266 days, or around 38 weeks long. A baby that is born before 37 weeks of pregnancy is described as having been born prematurely. During pregnancy, a baby grows and the organ systems develop. The more prematurely a baby is born, the more likely that he or she will be born small with a low birth weight, with low muscle tone (floppy), have little body fat and with organ systems that have not developed as much as those of a baby who is born at full term. Premature babies are also at risk of periventricular leukomalacia (“PVL”), a type of brain injury specific to premature babies.
Around 8% of babies are born prematurely. A baby may be born prematurely because of a medical condition affecting the pregnant woman, or because of factors related to the pregnancy or baby. In many cases there are no apparent risk factors for the premature birth.
Being born prematurely makes a baby more at risk from medical complications including:
Some babies born prematurely will not suffer with any of these conditions. However, babies born prematurely should be carefully monitored after birth. By looking at how premature a baby is and how well he or she is after birth, health care professionals can be guided on how intensively the baby should be monitored and for how long.
When making a decision to deliver a baby prematurely, one must ensure the baby’s gestational age has been correctly assessed and weigh the benefits of delivery against the risks associated with being born before term. There are medications, called tocolytics, which can be used in certain circumstances to delay delivery where a pregnant woman has contractions before 37 weeks. This can help avoid the risks associated with the baby being born too early, including the risk of brain injury.
The potentially harmful effects of being born prematurely can also be reduced by medical care before and after birth. Medical care for babies born prematurely has significantly changed in the last 15 years. Some of the changes that can impact upon a baby’s health include:
When babies are in the intensive care unit, supporting families in the day-to-day care of their baby has also been shown to positively impact on the health of babies born prematurely.
Not all complications of being born prematurely can be avoided. However, if you have concerns over how your pregnancy was managed prior to giving birth prematurely or concerns over the care of your premature baby following birth then please contact us – we would like to help. We have a team of experienced lawyers and medical specialists who can review the medical care you and your child received and help answer your questions. We understand making the initial call can be daunting. Rest assured – the consultation is confidential and free of charge.
We will provide you with the information and advice you need to make informed decisions that affect your child’s future and ensure your child’s rights are protected.
Uterine rupture is the catastrophic tearing open of the uterus within the abdominal cavity, most commonly during labour and delivery. It is an obstetrical emergency which puts the life of both the pregnant woman and her baby at risk.
In order to understand uterine rupture, it is useful to consider the structure and function of the uterus. The uterus has muscular walls. This allows the uterus to increase in size during pregnancy and to create room for the growing baby. The walls also become thinner with this process and, rarely, this means that it can tear. There are some pregnant women who are more at risk of uterine rupture than others.
The risk factors for uterine rupture include:
Uterine rupture is a medical emergency. For this reason it is critical to detect early warning signs of an impending uterine rupture and respond immediately. Once a uterus has ruptured, the area which has ruptured will bleed heavily. This will decrease the pregnant woman’s blood pressure significantly over the following minutes and this will then affect the blood supply to the unborn baby. The baby can also be extruded out of the womb (or uterus) into the abdominal cavity, further compromising the blood supply to the baby.
The risk of uterine rupture to the baby is brain injury or possibly death, if not delivered quickly.
The most common warning signs and symptoms of uterine rupture are:
It is important that health care providers listen to their patient if she is complaining of either sudden acute pain or constant pain, or pain between contractions.
When uterine rupture has occurred, the baby needs to be delivered urgently and usually this means by emergency caesarean section. While different hospitals have different resources and facilities, each hospital has an obligation to organize the way it provides obstetrical care in a way that protects patients’ safety.
When an urgent caesarian section is required due to concerns of uterine rupture, the neonatal team, or team of doctors and nurses who care for newborn babies, will also need to be called and be prepared to resuscitate the newborn according to the resuscitation protocol set out in the Neonatal Resuscitation Program (“NRP”). The baby may need extra help with breathing during the first minutes of life and may need to be admitted to the neonatal intensive care unit for support.
The pregnant woman may need to have a hysterectomy as bleeding can be difficult to control otherwise. This should be discussed ahead of the procedure and may be needed to save the pregnant woman’s life.
If you suffered from uterine rupture during pregnancy or labour and have concerns over how you or your baby were cared for then please contact us – we would like to help. Our team of experienced lawyers and medical specialists can review the medical care you and your child received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.
Twin-to-twin transfusion syndrome (TTTS) is a rare condition which can affect pregnancies where there are multiple babies. The affected babies share the same placenta which is the point of contact between the umbilical cord and the uterus (womb). Through the placenta, oxygen and nutrients pass via the blood vessels from the pregnant woman to the unborn babies.
In TTTS there is an uneven sharing of the blood vessels between the unborn babies, and this can develop to a point where one baby receives too little blood and so can struggle to grow and develop normally. The other affected unborn baby receives too much blood and the baby’s heart will find this hard to pump around the body. The baby’s heart can begin to fail and this can also affect his or her growth and development.
The risks to the babies affected by TTTS depends upon whether they are the baby which receives too little blood (the donor twin) or too much blood (the recipient twin). The donor twin will have less blood circulating over time and this means that the baby’s kidneys produce less urine. This results in low levels of amniotic fluid around the baby (oligohydramnios) or potentially no amniotic fluid (anhydramnios) and affects the development of the bladder. Amniotic fluid is essential to the development of a baby in the womb as swallowing the fluid and bringing the fluid into its lungs helps the baby develop its digestive tract, lungs and urinary system. Low blood volume can also affect the heart of the donor baby and this increases the risk of the baby dying before birth or suffering a brain injury.
The recipient baby has an increasing blood volume over time and this results in more urine production and more amniotic fluid than normal (polyhydramnios). The increased blood volume is difficult for the heart to pump around the body and, over time, the recipient baby may develop heart failure and may die before birth.
Pregnancies where there is more than one baby need to be monitored closely, to ensure that the babies are growing as expected and also to look for signs of possible TTTS. TTTS can occur where there is one placenta shared between the unborn babies and this should be picked up on ultrasound scans before 14 weeks of pregnancy. There are other signs which can be picked up on routine antenatal ultrasound scans and more detailed testing can be done using ultrasound by fetomaternal specialists. Key measurements include the volume of the amniotic fluid, how well the bladders of the babies fill and the blood flow measurements of the babies’ umbilical blood vessels.
Where the amniotic fluid increases in volume rapidly, this can cause the cervix to shorten and make the pregnant woman more likely to go into early labour or for the membranes to rupture. All pregnant women who are assessed for possible TTTS should therefore be checked for the length of their cervix and whether there are signs of early labour or rupture of membranes.
The hearts of both babies should also be examined as this will indicate whether TTTS is affecting their ability to pump blood around their bodies.
A pregnancy affected by TTTS can be managed in different ways. Close monitoring may be enough for some pregnancies where the TTTS is not severe, and information from ultrasound scans can help the fetomaternal specialist grade the severity according to the Quintero grading system.
Where TTTS is considered more severe, treatments are available. Amnioreduction is a process whereby the excess amniotic fluid is removed from the space around the recipient baby and can help reduce the risk of the mother going into early labour and help reduce the chances of either baby dying before birth. Fetoscopic laser is a surgical procedure which can stop the abnormal flow of blood between the affected babies. There are risks associated with this procedure and it can only be performed before around 26 weeks of pregnancy. However, it remains the only treatment which can cure TTTS.
TTTS, if not detected early and appropriately managed, can result in brain injury to one or more babies in a twin or multiple gestation pregnancy. If you had a pregnancy affected by TTTS and one or more of your babies suffered a brain injury and you have concerns over how your pregnancy was managed then please contact us – we would like to help. Our team of experienced lawyers and medical specialists can review the medical care you and your babies received and help answer your questions. We understand that making the first call can be daunting. Rest assured, a consultation with us is confidential and free of charge.