Cesarean Sections (“C-section”)
Pregnant women can expect to give birth to their babies either vaginally or by cesarean section (also widely known as “C-section”). While many prefer to use natural childbirth, sometimes C-sections become necessary to protect the mother, the baby, or both.
Women in labor should be closely observed by their healthcare providers, including doctors, nurses, midwives, and other staff. They should periodically take vital signs like temperature, respiration, pulse, and blood pressure. It’s also important to pay close attention to how the mother’s labor progresses.
The baby’s health is also recorded, usually with fetal heart rate monitors. Fetal heart rate monitors using electronic fetal monitoring can tell doctors and nurses whether a baby is healthy or at risk during labor and delivery.
Obstetricians must consider surgical intervention in the form of a C-section when labor complications arise, including warning signs from the electronic fetal monitor that may indicate a lack of oxygen being delivered to the baby.
What is a Cesarean Section Delivery?
Instead of being born vaginally, some moms need surgical intervention. In most cases, C-sections are done to protect the mother or the baby, or both, although they are sometimes performed at the mother’s request.
“Cesarean delivery (C-section) is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus.”
After deciding to deliver via C-section, the mother is taken to a surgical suite. Her abdomen is cleaned and prepped for surgery. The mother may also have a catheter to drain her urine. An IV line is inserted into her hand or arm to provide medications and fluids.
Anesthesia is administered. Most C-sections are done with regional anesthesia, usually called an epidural. This numbs the mother’s lower body during the procedure, but she can remain awake for the baby’s birth.
General anesthesia is used in emergency situations. This allows the surgery to begin more quickly. However, the mother will be unconscious and unable to see or hear the baby’s birth.
Then, the surgeon takes over, making an incision in the mother’s abdomen. There are three general types of incision:
- Low transverse: The incision runs horizontally across the mother’s lower abdomen.
- Low vertical: This incision goes from near the center of the mother’s lower abdomen toward the belly button.
- Classical: The classical incision runs across the middle of the mother’s abdomen.
The surgeon next makes an incision in the mother’s uterus. Amniotic fluid is suctioned, then the surgeon and other medical professionals pull the baby from the uterus.
The baby’s airway is suctioned to remove any remaining amniotic fluid. Babies born by C-section often need extra suctioning because the fluid was not expelled as the mother’s contractions moved the baby through the birth canal.
Other times a baby must be suctioned because they have inhaled meconium (the excrement released from the baby’s intestines if they are suffering fetal distress). Failure to suction a baby when meconium is present at birth can result in meconium aspiration syndrome (MAS).
When should C-sections be done?
Some expectant mothers are able to schedule their C-sections, especially if their pregnancy is high risk. Working with their doctor and hospital, they choose a date and time for their baby to be born. Here are some of the common reasons that a mother might have a planned C-section:
- The baby is in an abnormal position: For best results, babies should enter the birth canal in a headfirst position. Babies in a breech position (feet or buttocks first) or in a transverse position (side or shoulder first) make delivery more hazardous to mother and child.
For example, the umbilical cord could be wrapped around the baby’s neck (“nuchal cord). The cord becomes compressed (“prolapsed cord”), cutting off the flow of oxygen to the baby during delivery. - The mother has had a previous C-section: Mothers who have had a previous c-section usually need a C-section for subsequent babies.
In some instances, a trial of labor can occur to determine if the mother can have a Vaginal Birth After Cesarean (VBAC). However, VBACs can increase the risk for both mother and child. For example, the mother could have a uterine rupture during labor, which can cause excessive maternal hemorrhaging, fetal brain injury, or death. Doctors, nurses, and midwives must follow strict monitoring and preparation requirements for VBAC trials of labor and deliveries. - The mother is carrying more than one baby: Mothers with more than one fetus (e.g., twins, triplets, etc.) often have C-sections, especially if the lead baby is in an abnormal position. During vaginal delivery, the later delivered babies are at risk for brain injury. This includes hypoxic-ischemic encephalopathy from a lack of oxygen (anoxia) or decreased oxygen (hypoxia). Brain injuries can lead to other conditions, including cerebral palsy.
- A larger-than-average baby is expected: Doctors diagnose babies larger than 8 pounds 13 ounces (4,000 grams) as having fetal macrosomia. Labor complications can arise because the baby may be too large to fit through its mother’s pelvis. When a baby gets “stuck,” they can suffer a lack of oxygen or traumatic head and brain injuries.
- Problems with the mother’s placenta arise: Placenta previa means that the mother’s placenta covers part or all of the mother’s cervix. Vaginal delivery becomes more difficult and could harm the baby. Mothers with a placental previa in place when labor begins are at a higher risk of hemorrhage (bleeding). Excess bleeding can cause injuries, including cerebral palsy, hypoxic-ischemic encephalopathy (HIE), or other birth injuries.
of placenta problems - The mother’s current medical condition is of concern: Childbirth complications can arise when the mother has neurological or heart conditions, as well as infections. Also, older mothers and obese mothers are more likely to need a Cesarean birth.
- The mother might have preeclampsia: This condition is characterized by dangerously high blood pressure. The high blood pressure can then cause a constriction of the blood vessels in the placenta, cutting off or severely limiting the flow of oxygen to the baby. This is an emergency condition that can only be “cured” by delivering the baby. If doctors and nurses fail to intervene, this can cause a brain injury to the baby, including hypoxic-ischemic encephalopathy (HIE) and cerebral palsy.
- Mothers sometimes have physical obstructions that make vaginal birth difficult. For example, a large fibroid tumor or previous pelvic injury could make a C-section inevitable.
Other mothers do not have the luxury of a planned C-section. Instead, complications during labor and delivery drive the need to deliver via C-section.
When does the doctor need to do an emergency C-section?
Every minute counts when babies are at risk. An emergency C-section may be necessary to protect the baby from oxygen deprivation that can cause hypoxic-ischemic encephalopathy (HIE) and other types of brain damage. Common reasons for emergency C-sections include:
- Labor is not progressing: Signs of labor dystocia include slow dilation of the mother’s cervix and concern for shoulder dystocia. This occurs when the baby’s head has been delivered, but its shoulders cannot pass through the mother’s pelvis. At this point, it is too late to perform a C-section. Prolonged delivery with or without shoulder dystocia can put unacceptable stress on the fetus.
- The baby’s umbilical cord is compromised: A prolapsed umbilical cord means that the baby’s cord is slipping through the cervix before the baby. Compression of the umbilical cord can cause oxygen deprivation and fetal distress.
- Doctors suspect fetal distress: Abnormal fetal heart rate tracing can indicate that a baby needs to be delivered immediately by emergency C-section. The most common way to identify fetal distress is through the interpretation of electronic fetal heart monitor strips.
The strips may show prolonged fetal distress even after attempting other conservative measures (turning the mother, supplemental oxygen, or fluid support). If so, doctors and nurses must act quickly to perform a C-section. Otherwise, the baby will suffer from oxygen deprivation that can cause a brain injury, including hypoxic-ischemic encephalopathy (HIE) that further leads to complications such as cerebral palsy.
Physicians generally want to avoid unnecessary surgery. However, failing to act when serious health conditions signal potential complications can result in fetal brain damage, cerebral palsy, seizure disorders, hypoxic-ischemic encephalopathy, and even death.
When a doctor and/or nurse fails to perform a timely emergency C-section, the baby can sustain birth injuries. This can constitute medical negligence.
The American College of Obstetricians and Gynecologists (ACOG) recommends that emergency C-sections start within 30 minutes from the time the decision is made until the first incision. But ACOG recognizes that some C-sections must be performed faster depending upon the emergency condition. Such conditions can include fetal heart monitor strips showing a dangerous lack of oxygen to the baby, uterine rupture, umbilical cord prolapse, and placental abruption or previa.
What can go wrong before, during, or after a C-section?
When mismanaged or delayed, mothers and babies could suffer injuries, including:
- The baby suffers a lack of oxygen due to anoxia or hypoxia and suffers a brain injury including hypoxic-ischemic encephalopathy (HIE). This can cause permanent conditions, including cerebral palsy.
- The labor fails to progress to completion and delivery, and the baby is stuck either in the birth canal or suffers shoulder dystocia.
- The mother’s uterus could rupture, especially if the C-section was delayed. This complication is life-threatening for mother and child.
- A scheduled C-section could be performed before the baby is ready. Babies born more than two weeks early could develop respiratory distress syndrome that includes tachypnea (rapid breathing). This is often the result of failure to administer lung development drugs, including steroids like betamethasone and dexamethasone.
Even during an emergency C-section, doctors and nurses have a duty to protect the baby. However, babies can suffer injuries during the C-section, including:
- skin lacerations
- collar bone fractures
- brachial plexus injuries
- skull fractures
- facial nerve palsy
- cephalohematoma or bruising to the baby’s head
Delayed C-sections are a leading cause of birth injury. Once a mother’s doctors or nurses realize there are life-threatening complications like fetal distress, they must get the baby out as quickly as possible.
When doctors and nurses unreasonably delay or fail to perform C-sections, babies can end up with lifelong disabilities. Such failures can constitute medical negligence and malpractice on the part of doctors, nurses, and hospitals.
Did A Delayed or Lack of a C-Section Cause Your Child’s Birth Injury?
The parents of children who suffered birth injuries often want answers. They want to know what happened to harm their child’s brain. Was it preventable? Was a C-section called for and not performed? Was a C-section performed but delayed by either the doctors or nurses or both?
Our dedicated birth injury lawyers want to help you find those answers.
We diligently investigate the facts and review the medical records. We apply professional standards/guidelines to determine if doctors, nurses and/or hospitals violated the standards of care. If we determine that violations of those standards of care caused your baby’s birth injury, we will hold the responsible parties accountable by pursuing medical malpractice claims against them.
The compensation our clients receive helps them pay for their child’s current and future medical treatment, assistive technology and equipment, and the other expenses associated with caring for a child with brain injuries, seizure disorders, and cerebral palsy.
Sometimes families are afraid to talk to lawyers about their child’s case. Others may simply feel overwhelmed by their circumstances and unable to participate in a lawsuit involving their child’s birth injury.
Why Should You Talk with the Knowledgeable Attorneys at Miller Weisbrod Olesky?
The only way to find out if you have a birth injury case is to talk to an attorney who understands birth injury. We make it easy for you to receive answers to important questions if you have a baby that has cerebral palsy or any other birth injury. And we will never charge you a fee or expense unless we determine there is a case, and only then AFTER a recovery is made.
At Miller Weisbrod Olesky, a team of committed professionals uses our detailed case review process to assess your potential claim. They start by learning more about you and your child. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child’s injuries.
If we feel medical malpractice was present, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.
At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do.