Fetal Distress

For many years, the term “fetal distress” has been used to indicate that a baby is not getting enough oxygen prior to birth. However, the American College of Obstetricians and Gynecologists recommends that physicians use the term “non-reassuring fetal status” instead. In this work, we will use the terms interchangeably.

Signs of Fetal Distress

• Abnormal Fetal Heart Rates & Rhythms
• Slow Fetal Heart Rate
• Decreased Fetal Movement
• Low Amniotic Fluid
• Excessive Amniotic Fluid
• Vaginal Bleeding
• Cramping
• Fetal Growth Restriction

Before birth, babies receive nutrients and oxygen from their mother’s body. During contractions, the amount of oxygen transmitted to the baby is temporarily blocked. When oxygen deprivation is prolonged, babies can go into fetal distress.

The conditions that lead up to fetal distress may be complicated, but the signs are well known to medical staff. Proper monitoring of both mother and baby should identify the danger and trigger medical staff to respond with swift, appropriate treatment.

But when medical professionals fail to diagnose, ignore or mismanage fetal distress, the result for the baby can be they suffer from:

• “Asphyxia” which means a lack of oxygen
• “Hypoxia” which means decreased oxygen
• “Ischemia” meaning oxygen is deprived from key organs leading to tissue death
• “Acidosis” this means high levels of acid in a baby’s blood. This is a result of the lack of oxygen or prolonged hypoxia. “Blood gas” tests after the birth of a baby are done to determine whether or not a baby is acidotic. Acidosis can cause brain injury and injury to other organs of the baby

As a result of fetal distress and acidosis a baby can suffer a birth injury including hypoxic-ischemic encephalopathy, cerebral palsy, seizure disorders, developmental delays, and even death.

Children can sustain birth injuries due to medical negligence or malpractice. They usually require expensive medical treatment, medication, surgeries, therapies, caregiving, and assistive technology. With the help of a skilled birth injury attorney, the parents of children who have incurred permanent injury from fetal distress may receive compensation from the medical professionals who failed their child.

Fetal distress encompasses a wide range of conditions, although everything relates back to fetal oxygenation.

Some risk factors are apparent early in pregnancy, requiring close attention and additional testing by doctors. Treatment could greatly reduce the chance of fetal distress. At the very least, the medical professionals caring for the mother can increase monitoring and treat the baby as soon as possible after birth.

Doctors (including obstetricians and maternal-fetal medicine specialists), midwives, nurses, and other people caring for the mother should pay close attention to the following:

• Current medical conditions: The babies of mothers with conditions like diabetes, heart disease, and high blood pressure are more at risk for fetal distress.
• Symptoms of preeclampsia: With this life-threatening pregnancy complication, expectant mothers develop high blood pressure and other severe symptoms.
• Abnormal fetal presentation: The baby’s breech or face presentation can endanger the baby during delivery and cause a lack of proper oxygenation.
• Cephalopelvic disproportion: This means that the baby’s head is too large for the mother’s pelvis during childbirth. This condition places additional stress on the baby during delivery. Head compression can cause a lack of oxygen (“asphyxia”) or decreased oxygen (“hypoxia”)
• Umbilical cord problems: Compression of the baby’s umbilical cord can occur during labor and delivery. The umbilical cord is how the baby receives oxygen prior to birth via the mother’s oxygen carrying blood. Umbilical cord compression deprives the baby of oxygen carrying blood, which can cause fetal distress and brain damage. Other problems involve cords that are too short, too long, or wrapped around the baby.
• Uterine rupture: When the uterus tears during delivery, both baby and mother are endangered. The tears can completely cut of oxygen to the baby leading to asphyxia.
• Prolonged labor: Also known as failure to progress, prolonged labor can put more stress on the baby. The longer a baby has to endure contractions which cause a temporary blockage of oxygen, the more at risk the baby is for losing the necessary reserves of oxygen to tolerate the labor. Prolonged labor can lead to less oxygen getting to the baby or cause the baby to endure fetal distress.
• Uterine Hyperstimulation/Tachsystole: If a mother is having too many contractions in a short period of time this can cause fetal distress because the mother’s placenta from which the umbilical cord flows and the baby do not have enough time to recover from the temporary cessation of oxygen during a given contraction. If there are six or more contractions over a ten minute time period contractions lasting longer than 2 minutes or contractions of normal duration within 1 minute of each other this is known as “tachysystole” or “uterine hyperstimulation”.
  
  Oftentimes, tachysystole is caused by drugs given to the mother to increase her contractions or promote her contractions. The common drug given for this purpose is Pitocin. The contractions must be monitored closely when a mother is given Pitocin to assist in her contractions
• Arrested labor: Sometimes labor does not progress because contractions weaken or stop altogether.
• Misuse of medical equipment: During difficult deliveries, doctors may use forceps or vacuum extractors. Babies can sustain traumatic brain injuries when these devices are used improperly or negligently.
• Placental abruption: This childbirth complication occurs when the placenta detaches from the uterus before the baby is born. Since the placenta is the source of oxygen for the baby, when an abruption occurs the flow of oxygen to the baby stops. This is a medical emergency that must result in immediate delivery of the baby.

Properly managing a pregnant mother’s medical condition could eliminate or minimize the baby’s risk for fetal distress.

The doctors and nurses caring for an expectant mother may increase their monitoring when faced with the following symptoms:

• The mother’s belly isn’t growing enough. Measuring the mother’s belly can indicate that the baby has fetal growth restriction (FGR) or is not growing at a normal pace.
• The fetal heart rate is too slow. A decreased fetal heart rate can indicate fetal acidosis and other conditions that lead to non-reassuring fetal status. The fetal heart rate is monitored by using a device called an electronic fetal monitor. A slow heart rate is called “bradycardia”.
• Fetal heart monitoring indicates abnormal rates and rhythms. Alarming patterns of variable decelerations and late decelerations of the baby’s heart rate can appear during labor. Late decelerations are ndicators of fetal distress because the baby is not recovering from the temporary blockage of oxygen during a contraction.





• Lack of variability of the fetal heart rate. A healthy baby in utero has moderate variability of their heart rate where it varies from 6 to 25 beats per minute. If the fetal heart monitor strips do not show that the baby’s heart rate has good variability (meaning there is a pattern showing the heart rate moving up and down by an average of 6-25 beats per minute) then this is a sign of fetal distress. These conditions are known as minimal or absent variability. Loss of variability especially in the presence of other periodic patterns during labor is the most sensitive indicator of metabolic acidemia resulting from fetal distress.
• Fetal movement decreases or stops. Changes like this can indicate that the baby could be in serious trouble.
• The mother’s amniotic fluid level is too low. Low amniotic fluid levels (known as oligohydramnios) can reduce the baby’s protection and lead to umbilical cord compression.
• There’s too much amniotic fluid, which is called polyhydramnios. Women with this complication might have gestational diabetes. Among other things, this condition can occur simultaneously with fetal macrosomia, which means the baby is very large. Also, the baby could have developed a condition that impedes the ability to swallow.
• Mom experiences excessive vaginal bleeding or cramping. In early pregnancy, mild bleeding and cramping are common. However, later these symptoms can indicate complications like uterine rupture, placental abruption, or preterm labor.
• Amniotic fluid contains meconium (the baby’s first bowel movement). Meconium should be discharged after the baby is born. When it is expelled in utero during the labor process, the baby can breathe it into their lungs (aspiration). Meconium Aspiration Syndrome (MAS) can cause serious illness and death.

Failing to notice and address the potential for oxygen deprivation and fetal distress leads to metabolic acidosis and brain damage, hypoxic-ischemic encephalopathy, seizure disorders, cerebral palsy or even death.

Doctors, nurses, midwives, and medical facilities owe their patients a standard of care. Breaching that duty is considered medical malpractice.

Obstetricians have a duty to keep an eye on expectant mothers throughout their pregnancy and during labor. So, they first look to the mother’s health.

Specifically, they must watch for conditions that a woman has before becoming pregnant or develops during pregnancy.

What health problems can develop during pregnancy?

• Iron Deficiency Anemia
• Gestational Diabetes
• Depression and Anxiety
• Fetal Problems
• High Blood Pressure Related to Pregnancy
• Infections
• Hyperemesis Gravidarum
• Miscarriage

Mothers with the conditions listed below should be closely monitored and tested during pregnancy due to the increased potential for fetal distress:

• Diabetes
• Anemia
• Excess or minimal pregnancy weight gain
• Pregnancy Induced Hypertension or high blood pressure

Medical professionals are not just looking for potentially serious medical consequences for the mother. The fetus could also be at risk. So, monitoring the baby’s health is also a critical component of prenatal care. Obstetricians routinely measure the mother’s stomach, monitor the baby’s heart rate, and do ultrasounds to confirm the gestational age and condition of the fetus.

The tests and monitoring devices used vary based on symptoms and where the mother is in her pregnancy.

Once labor commences, fetal heart rate monitors track the baby’s heart rate and rhythm. Changes in the heart rate during and after contractions could indicate the baby is in distress due to oxygen deprivation.

There are several ways to observe and track a baby’s heart rate:

• Fetal auscultation can be done with a small handheld transducer attached to a fetal heart monitor.
• External fetal monitoring records the baby’s heart rate using two belts wrapped around the mother’s abdomen. One belt tracks the mother’s contractions. The other belt records the baby’s heart rate.
• Internal fetal heart monitoring involves running a wire through the mother’s cervix. It is then attached directly to the baby’s scalp. However, this method can only be used when the mother’s cervix is already open and her waters have broken. This provides the most accurate monitoring of the baby’s well-being and whether or not fetal distress is occurring.

As medical personnel analyze a baby’s fetal monitoring results, they could become concerned about its status.

A normal fetal heart rate usually falls between 110 and 160 beats per minute. However, the rate can vary as the fetus responds to internal and external conditions.

For example, the baby’s heart rate is affected by its mother’s contractions during labor. A contraction will cause a slight and short-term decrease in the heart rate, but it will quickly return to normal (“baseline”) after the contraction. So, some variation in rate and rhythm is normal.

When reviewing the fetal heart rate monitor, the following changes require close attention, diagnosis, and intervention:

• Fetal tachycardia
• Fetal bradycardia
• Repetitive variable decelerations
• Late decelerations
• Minimal or absent variability
• Marked variability
• Low biophysical profile

When medical professionals suspect non-reassuring fetal status, they conduct tests to confirm their diagnosis. Performing these tests and correctly interpreting their results can protect the mother and baby from developing serious, sometimes life-threatening complications.

Once monitoring and tests indicate fetal distress is a possibility, medical professionals responsible for the mother’s and baby’s care must act quickly. Failing to do so can cause permanent damage to the baby.

Some treatments for oxygen deprivation include:

• Intrauterine resuscitation
• Giving fluids to the mother
• Changing the mother’s position
• Providing supplemental oxygen to the mother
• Amnioinfusion to increase amniotic fluid if oligohydramnios is a problem

If the above measures do not show an definitive improvement of the fetal heart monitoring strip, the baby must be delivered by Cesarean section (C-Section) or an emergency C-section in order to prevent damage or continuing brain injury. Failure to conduct a timely c-section to address fetal distress can cause a birth injury including hypoxic-ischemic encephalopathy (HIE), cerebral palsy and other injuries to the brain due to metabolic acidosis.

Birth injuries caused by fetal distress are life-changing. The parents of injured children might seek compensation from negligent healthcare providers. The money they receive cannot take away the birth injury, but it can provide the money needed for medication, surgery, therapy, assistive devices, and caregivers.

Medication

• Anticonvultions
• Baclofen pumps
• Botox
• Nerve Blockers
• Muscle Relaxants
• Antidepressants
• Anticholinergics

Surgeries

• Neurosurgery
• Hearing correction
• Orthopedic surgery
• Spinal surgery
• Vision correction
• Gastroenterology surgery

Therapy

• Occupational therapy
• Speech therapy
• Physical therapy
• Recreational therapy
• Music and art therapy
• Hippotherapy
• Stem cell therapy

Caregivers

• Parents
• Trained aides
• Nurses
• At-home therapists
• Rehabilitation caregivers

Assistive Devices

• Wheelchairs
• Braces and crutches
• Orthotic shoes
• Scooters
• Rolling walkers
• Computers
• Communication Devices
• Cochlear implants
• Glasses
• Special keyboards, pencils, and writing boards
• Adaptive art supplies
• Vehicles with adaptive technology
• Installation of ramps
• Bathing benches and lifting devices
• Adaptive eating utensils

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?

Our dedicated birth injury lawyers want to help you find those answers.

If your child is not meeting developmental milestones and you suspect this may have been caused in part by medical mistakes, Miller Weisbrod Olesky will thoroughly investigate the facts and hold responsible medical providers 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, therapy, equipment needed to help cope with disabilities, and the other expenses associated with caring for a child with brain injuries, seizure disorders, and cerebral palsy.

Sometimes families are hesitant to reach out to a medical malpractice attorney or law firm. Other parents feel overwhelmed by their circumstances and worried that they will not be able to help out in a lawsuit involving their child’s birth injury.

The only way to find out if you have a birth injury case is to talk to an attorney who understands birth injuries leading to a delay in developmental milestones.

At Miller Weisbrod Olesky, a team of committed attorneys, nurses and paraprofessionals uses our detailed medical negligence case review process to assess your potential claim. We start by learning more about you and your child and the status of meeting/missing developmental milestones. 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 negligence caused or contributed to your child’s injuries, 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.