The Potential Complications of Human Birth
The birth of a human being demands much of the mother. A woman's power of giving birthplaces on her one of the greatest responsibilities she will undertake in life. Birth is greatly complex, and over the years, medicine has tackled these complexities. In cases of birth "complications," which occur frequently, medicine now stands alongside the mother, shouldering part of the responsibility. Today, most birth complications do not lead to birth injury.
For example, regarding the common birth complication of Breech Position (feet-first fetal position), cesarean-section delivery has been medically safe for both infant and mother for several centuries. An early record of a mother and baby surviving a cesarean section concerns a birth in 1500, in Switzerland.
As regards Placenta Previa, in which the placenta blocks the neck of the uterus, safe delivery is medically likely when the following standard of care is followed: "Always anticipate massive hemorrhage and pre-term delivery" (methods exist reliably to stop hemorrhage) and "document adequate preparation, including transfer to a higher level of care, if necessary."
In cases of possible Meconium Aspiration (a fetus's first stool has leaked and has traveled to the lungs), birth caregivers typically proceed cautiously and methodically. Meconium is dangerous. It can deplete oxygen supply. Fortunately, birth safety typically can be achieved via the following methods:
- Previous to birth, a test can be given called in-utero cardiotocography (CTG) – to detect an irregular heartbeat, a caution sign for Meconium Aspiration.
- Following birth, a test is available called umbilical cord blood gas analysis (ABG). It can show whether pre-birth oxygen supply was sufficient and can reveal other symptoms of meconium aspiration. Developed in 1958, the ABG has become highly valued in birth caregiving. ABG is now recommended in all high‐risk deliveries by the American College of Obstetrics and Gynecology. Researcher B.J. Stenson writes,
"Analysis of paired arterial and venous specimens can give insights into the etiology of acidosis in the newborn.
It has become widely accepted that ABG can provide important information about the past, present, and possibly the future condition of the infant….It is therefore of increasing clinical and medico-legal importance that (birth caregivers know) the principles and practice of obtaining and interpreting cord-blood-gas values, and the underlying evidence base."
Most people know that quite commonly, an umbilical cord will loop itself around the neck of an unborn infant. In a worst-case scenario, oxygen supply could be affected during birth. Foreseeing this obviously is a critically important part of caregiver responsibility.
But case-by-case variation is quite great among nuchal cords. For example, there are more than half-a-dozen distinct ways a cord can wrap around a neck. Ultrasound diagnosis of a cord wrapped around the neck was first described in 1982, but some say it has proved of limited reliability.
Fortunately, some nuchal-cord variations pose little or no danger to a safe birth. For this reason, a caregiver needs to avoid or postpone invasive action, such as cutting and clamping a nuchal cord, for as long as it is safe to do so.
Clamping and cutting a nuchal cord during birth relieves whatever choking may have been affecting the infant, but it carries its own risk. The risk in cutting a cord occurs when a baby's head is born, but his or her shoulders do not quickly follow. The baby cannot yet breathe air to get oxygen – his or her oxygen would naturally still be coming through the umbilical cord, now cut. In cases of shoulder dystocia – birth progress stalled at the shoulder – some infants have been starved of oxygen and have been harmed seriously as a result, because a caregiver had cut and clamped a nuchal umbilical cord.
Read more at this link: (Iffy et al. 2001).
Overall, it is argued that much additional research needs to be done around nuchal cord birth safety. It is even argued that over the years in medicine, the subject has fallen into comparative neglect.
"The first edition of the Encyclopedia Britannica, from 1770, had 20 pages (on) umbilical cord pathology, with drawings of umbilical cord entanglement. By contrast, Williams Obstetrics (16th Edition, 1980) has only a single sentence regarding cords around the neck."
Cephalopelvic Disproportion (CPD)
The head of an unborn infant may be especially large in proportion to the pelvis of the mother. Test methods useful in determining this include radiological (MRI, X-ray, or CT), clinical (using the hands and a pelvimeter), and ultrasound.
Ultimately in such a case, a caregiver may recommend cesarean-section delivery. However, sometimes a mother's pelvis is able to separate and stretch, allowing safe birth of a large-headed child. Therefore, the medical standard after diagnosis of CPD is first to avoid C-section – to attempt labor and delivery – with C-section as a fallback option.
Even if no "complications" such as the above exist, birth is still a massive shared responsibility for mothers and caregivers. It is expected of a mother to follow instructions from a caregiver. It is expected of a caregiver that a) with adequate training and experience, she or he will b) execute, flawlessly, multiple practices crucial to infant safety. These practices include physical manipulation with hands or tools, monitoring for signs of distress, the use of medications, the maintaining of constant attention, and, if necessary, scheduling a cesarean delivery on time.
Caregivers are human – they are prone to error. Hospitals in this way are human too – whole shifts may become physically exhausted. A shift rotation may prevent the most experienced caregiver from handling a particular birth. It is even true that some hospitals have difficulty hiring enough experienced personnel, including birth caregivers.
With all this complexity, it is not surprising that in the unfortunate event of harm during birth to an infant or a mother, deciding what to do may be difficult. If you have any questions about any type of complication, feel free to call one of our experienced medical malpractice attorneys at no charge.