The Fetal Monitor Was Showing the Warning Signs. Was Anyone Acting on Them?
Umbilical cord compression occurs when the umbilical cord is squeezed or kinked during labor, restricting blood and oxygen flow to the baby. Unlike cord prolapse, which is a sudden, dramatic emergency, cord compression during labor often presents as a progressive pattern on the electronic fetal monitor: variable decelerations that appear with contractions, increase in depth and duration as labor progresses, and eventually become prolonged or fail to recover. When this pattern is recognized and appropriately managed, cord compression is often a manageable complication. When it is ignored or inadequately responded to, it can result in sustained oxygen deprivation and permanent brain injury.
Recognizing and Responding to Cord Compression on the EFM Strip
Variable decelerations are the characteristic finding of cord compression on electronic fetal monitoring. They are called “variable” because their timing relative to contractions varies. Isolated, brief variable decelerations in an otherwise reassuring tracing may be benign. However, the following patterns signal escalating concern that demands prompt action: prolonged decelerations lasting more than 2-3 minutes; variable decelerations with slow recovery, loss of shoulder, or loss of variability at baseline; repetitive severe decelerations that are becoming progressively worse; and late components, the deceleration has characteristics of both variable and late patterns, suggesting uteroplacental compromise in addition to cord compression.
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Clinical Interventions That Should Be Documented
When cord compression is suspected from the EFM pattern, the standard of care requires documented interventions including: maternal repositioning to relieve cord compression; amnioinfusion (infusion of fluid into the uterine cavity) when repetitive variable decelerations persist and other conditions are met; discontinuation of Pitocin if it is contributing to cord compression through excessively frequent contractions; assessment of cervical dilation, presentation, and cord position; continuous monitoring with escalating concern documented in the nursing notes; and physician notification and response, leading to delivery decision if the pattern does not improve.
When Inaction Becomes Negligence
In cord compression cases, medical negligence most often manifests not as a single error but as a prolonged failure to recognize and respond to a deteriorating fetal heart rate pattern. The medical record shows the progressive worsening of the tracing, the nursing notes that either document or conspicuously omit a response, and the absence of physician involvement until the baby is already severely compromised. The legal case is built on showing that competent providers would have acted earlier and acted more decisively, and that the delay in doing so caused the brain injury.
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.
Umbilical Cord Compression FAQs
What is a nuchal cord, and is it the same as cord compression?
A nuchal cord is a cord wrapped around the baby’s neck. It is present in approximately 20-30% of deliveries and, in most cases, does not cause harm. A tight or multiple-loop nuchal cord, however, can cause cord compression during delivery and result in variable decelerations on the fetal monitor. The management of a nuchal cord, whether to somersault it, cut it, or deliver through it, is a clinical decision that may be subject to scrutiny when injury results.
Can amnioinfusion help with cord compression?
Yes. Amnioinfusion, infusion of warmed saline into the uterus, can relieve cord compression by providing a fluid cushion around the cord. It is an accepted clinical technique for managing repetitive variable decelerations when cord compression is suspected. Failure to offer amnioinfusion when clinically appropriate, or performing it incorrectly, can be relevant in a cord compression negligence analysis.
If your child has cerebral palsy, HIE, or another brain injury that followed a labor complicated by abnormal fetal heart rate patterns, the Rasansky | McKenzie Law Texas birth injury lawyers team can review the EFM strips and records for free. No fees, unless you win.
