They Knew the Baby Was Large. Did They Plan for It?
Macrosomia refers to a newborn with an estimated or actual birth weight above 4,000-4,500 grams (approximately 8 lbs 13 oz to 9 lbs 14 oz). Large babies present a recognized set of delivery risks, including shoulder dystocia, prolonged labor, operative delivery with forceps or vacuum, and, in cases of extreme macrosomia, cephalopelvic disproportion. When macrosomia is identified or strongly suspected on late-trimester ultrasound, particularly in the setting of maternal diabetes or obesity, the obstetric team has a responsibility to counsel the patient about delivery options, consider the timing of delivery, and prepare for the potential complications of a large-baby birth.
When macrosomia is present but not adequately communicated or planned for, and a shoulder dystocia or other delivery complication occurs that causes brachial plexus injury, fracture, Hypoxic Ischemic Encephalopathy (HIE), or other harm, the question becomes: Did the team do enough to anticipate and prevent the foreseeable risks associated with this large baby?
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Medical Negligence in Macrosomia Cases
- Failure to perform or interpret a late-trimester ultrasound biometry that would have identified suspected macrosomia
- Failure to counsel the patient about elective cesarean delivery when estimated fetal weight exceeds published thresholds in high-risk patients (e.g., diabetic patients with EFW ≥ 4,500g)
- Failure to document the macrosomia risk in the delivery plan and communicate it to the labor and delivery nursing team
- Proceeding with labor augmentation in a patient with suspected macrosomia without adequate preparation for shoulder dystocia
- Failure to perform or offer an appropriately timed cesarean section when macrosomia is strongly suspected, and labor is not progressing
- Poor management of shoulder dystocia when it occurs, specifically, using excessive fundal pressure or pulling the fetal head before the shoulders are released
Macrosomia FAQs
Is a large baby always a problem?
Not necessarily. Many large babies are delivered safely without complications. The concern arises when the size is not anticipated, when appropriate delivery planning is not done, and when the team is not prepared for the complications, particularly shoulder dystocia, which large babies make more likely.
Does diabetes increase the risk of macrosomia?
Yes. Both gestational diabetes and pre-existing diabetes are associated with fetal macrosomia because elevated maternal blood glucose leads to fetal insulin hypersecretion and accelerated growth. Diabetic patients with suspected macrosomia require specific management guidelines that differ from those for non-diabetic patients, including different EFW thresholds for elective cesarean counseling.
If your baby suffered a brachial plexus injury, Erb’s palsy, bone fracture, or newborn brain injury during a large-baby delivery that was not properly planned for, call our award-winning birth injury attorneys at Rasansky | McKenzie Law. Free consultation, contingency fee.
Frequently Asked Questions
What causes a birth injury?
Birth injuries can occur for a number of different reasons. In some cases the child’s head is too large to fit through the mother’s pelvis. Other times the placenta become detached prematurely or the umbilical cord is compressed or twisted. Also, when a physician uses forceps or a vacuum during a vaginal birth, injury to the brain can result. In many of these instances time is of the essence. The doctor is responsible for knowing when a cesarean section is necessary in order to avoid injury to the child.
There is no way to completely eliminate the risk of birth injury, but some risk factors that can lead to trouble during child birth are drawn out labor, atypical positioning of the baby, too much Pitocin given to the mother, larger than average sized baby, premature birth and the use of forceps or vacuum.
Expectant parents tend to anticipate a relatively smooth birth process and a healthy baby. In the majority of cases this will be the outcome. Sadly, there are some instances where birth injury and possible lasting effects will result. If you or a loved one has a child affected by a condition that was caused by birth injury and you believe it resulted from negligence on the part of the medical staff, we can offer a free assessment of your case. We have extensive knowledge in the areas of birth injuries and medical malpractice, and will be happy to advise you of your options moving forward.
What is birth injury malpractice?
Medical malpractice relates to birth injury in cases where the medical professional charged with you and your baby’s care fails to provide appropriate care during pregnancy, during the delivery process, or shortly after the child is born.
To better understand birth injuries and how they can be caused by medical and/or nursing mistakes, first you need to understand the concept of medical malpractice. The following will explain what medical malpractice means, statistics and some general tips for selecting the right doctor and avoiding medical mistakes.
A birth injury is an injury that can happen prior to birth, during the labor and delivery process, or in the neonatal or “newborn” period. Injuries that occur during the prenatal period can be attributed to untreated infection such as Group B Streptoccoccus, placental insufficiency or abruption, and preterm birth causing respiratory distress and brain hemorrhage.
Labor and delivery injuries can be caused from a health care provider failing to recognize fetal distress during labor signaling decreased oxygen being delivered to the baby’s brain resulting in injuries to brain structures responsible for movement, cognition, vision, swallowing, and coordination. Additional injuries that occur during labor and delivery can be related to CPD or “cephalo-pelvic disproportion” whereby the baby’s head is too large to fit through the mother’s pelvis during the birthing process.
Did you know?
Rasansky | McKenzie Law negotiated a settlement of more than $10 million on behalf of an infant who was diagnosed with cerebral palsy as a result of medical and nursing malpractice. We have also obtained numerous multi-million dollar settlements for children who suffered other types of birth injuries caused by medical malpractice.
What should I do if my child suffered a birth injury?
The first and most important issue to deal with after a birth injury is caring for the health of the baby and the mother. Get advice, treatment, and support from medical professionals you trust, and do not be afraid to get a second opinion. Also, be sure to take advantage of counseling and therapy options if you or your family needs help processing what happened.
After the health and well-being of your family is under control, you may wish to speak with a Dallas birth injury lawyer. A medical malpractice attorney can help you better understand what caused your baby’s injury, collect the evidence of the case, and enumerate your legal options if you choose to take action.
A birth injury is traumatic for the entire family – and one mistake in labor and delivery can lead to a lifetime of medical costs, nursing care, disability, and therapy. If you believe that your child’s injury was caused by negligence, you owe it to your family to ensure that the person or hospital responsible for your child’s injury pays for the consequences of their negligent actions. If someone else caused the injury, why should the financial burden be placed on your family?
Is my child entitled to compensation?
Typically, it is not the parent but the child who will be awarded compensation, as it was the child who was injured by the doctor’s negligence making the child entitled to compensation. If you win your birth injury claim/lawsuit against the doctor/hospital, compensation is usually delivered in the form of a trust. Keep in mind though that parents can sue for emotional distress—or if the mother was also injured because of the doctor’s behavior. If the child dies because of a doctor’s negligence, the compensation goes to the parents.
What are the main types of birth injuries?
There are many types of injuries that can occur during pregnancy and delivery, ranging from minor to severe. Among the most common types of birth injuries are:
- Cerebral palsy.
- Brachial plexus injuries (Erb’s palsy, Klumpke’s palsy).
- Infections (B strep, meningitis).
- Baby brain damage.
- Bruising and bleeding beneath the cranial bones.
- Bone fractures and nerve damage (often to the upper arm).
- Shoulder dystocia.
- Spina bifida.
- Folic acid deficiency, anemia.
- Persistent Pulmonary Hypertension.
- Blood flow and/or oxygen being cut off to the baby during delivery (causing anoxic brain injury, hypoxia, birth asphyxia, or perinatal asphyxia).
- Wrongful death.
Will my child's birth injury go away?
Birth injuries do not always lead to serious and lasting harm to the child. Many of them will heal on their own with no medical intervention. In some incidences, however, birth injuries result in chronic conditions such as cerebral palsy, Erb’s palsy, or Klumpke’s palsy.
Of these, cerebral palsy is probably the most concerning, as the others do sometimes improve or resolve. Cerebral palsy can affect coordination, reflexes, gait, muscle tone, and mental capabilities. In a study among six countries, the incidence of cerebral palsy was estimated to be between 2.12 – 2.45 cases per 1000 births.
If you’re concerned whether or not your child’s injuries will improve, the best course of action is to speak to your pediatrician. If you’d like to have an attorney look into the facts of your case, call us at (214) 651-6100.
