During labor and delivery, and even in the immediate period after delivery, a baby can receive life threatening or life changing injuries. There can be infections or metabolic, chemical or blood related disorders that go undiagnosed. There can be paralysis from a baby’s shoulder being stuck in the birth canal and improper excessive force used to free the shoulder.
But most life changing injuries that can often be prevented are those where the baby, during final labor through to delivery, does not get enough oxygen. This occurs for various reasons when the maternal-fetal blood exchange is deficient or interrupted. This ischemia (lack of blood flow) or hypoxia (lack of oxygen) can lead to hypoxemia (low oxygen content in the blood) and if prolonged, leads to metabolic acidosis which damages the brain.
The acidosis can then cause hypoxic-ischemia encephalopathy which may affect the child in many different ways from motor function abnormalities, cognitive and mental function problems or both, which may include cerebral palsy.
The key question is whether or not the injury could have been prevented. In order to know that, an investigation through reviewing all the records of delivery and of the baby’s initial health in order to time the injury and identify the mechanism of the injury. Fetal heart rate recordings during labor, the condition of the baby at delivery and in the first week are telling. Blood testing, including tests of umbilical cord blood provide evidence. MRI and CT scans are extremely important. Acidosis produces changes in brain cells within 24 to 48 hours. Whether the baby had seizures and when they occurred is important to know.
In other words, what kind of brain injury occurred and from what insult, and when did it occur? There are a host of pre-natal factors that can provide evidence that the fetus was healthy before labor even started. Were there risk factors to consider and were they considered.
The key to proper delivery practice is to consider all factors and properly use all the monitoring tools available to determine the well-being of the baby during labor. If the baby is in trouble, delivery must occur unless measures such as decreasing the level of the labor induction drug Pitocin, delivery of oxygen to the mother, or a change in mother’s position can be taken to relieve the maternal-fetal blood oxygen deficiency.