The goal of obstetrical care is the delivery of a healthy newborn baby to a healthy mother. A major factor for the physician to consider is the protection of the infant’s brain as the baby makes the journey from in utero life to the outside world. The major injury that is the subject of litigation surrounds damage to the baby’s brain. Neurological injury is a disability that affects the Motor Ability of the child, called cerebral palsy and/or mental retardation and/or cognitive disabilities and/or a seizure disorder. All of these problems, individually or in combination, present a life-long impact on the child and the family of the infant.
Brain damage can be caused by a number of different mechanisms. Obviously, some injury to newborns is caused by genetic factors, such as Downs Syndrome; harmful exposures during the pregnancy, such as Fetal Alcohol Syndrome, or bacterial or viral exposure to the mother in the formation stage of the fetus in utero, such as German Measles.
There are mechanisms that cause brain damage that are predictable and therefore preventable. The term ASPHYXIA is a condition that that has a variety of definitions. Quite simply, it involves the absences of oxygen delivered to the baby. HYPOXIA, is a related term that involves a reduction in the amount of oxygen available to the baby. If there is a complete absence of oxygen or a prolonged reduction in available oxygen, the baby will suffer injury to the brain. The longer these conditions occur, the more damage will occur, resulting ultimately in the baby’s death. In addition, direct trauma to the baby from excessive mechanical force employed in the delivery will also result in permanent neurological harm. See Shoulder Dystocia.
The period of time during the transition from life in utero to life in the outside world is termed the PERINATAL PERIOD. If during the course of the delivery, there is a disruption in oxygen to the baby, then there is PERINATAL ASPHYXIA. The main focus of many cases is whether there was an opportunity to avoid the injury by proper obstetrical care.The best way to avoid injury to the baby’s brain during the perinatal period is to observe for the effect of diminished oxygen on the infant. This effect is termed, FETAL DISTRESS. While not all babies who have fetal distress become brain damaged, if fetal distress continues without obstetrical intervention, the baby’s brain will be damaged. Today ELECTRONIC FETAL MONITORING is the most effective and safest means available to observe the baby and to preserve the infant’s brain from harm. The monitoring consists of monitoring before labor begins (Non-Stress testing & Contraction Stress Testing) and monitoring during the labor process itself with either External Monitoring or Internal monitoring. See Electronic Fetal Monitoring,Ultrasound & Biophysical Profile.
Another readily available means of evaluating the infant’s well being while in utero is Ultrasound evaluation of the baby to establish the health of the infant. Both of these methods are readily available, harmless to mother and child and KNOWN TO BE EFFECTIVE IN IDENTIFYING POTENTIALLY HARMFUL CONDITIONS IMPACTING ON THE INFANT. Unfortunately, in many instances these tests are not used, improperly employed or, in the worst of occasions, the results ignored!
Remarkably, there is a movement in the medical community to STOP USING ELECTRONIC FETAL MONITORING COMPLETELY. The motivation for this seems to be more for the protection of the doctor from legal responsibility than the protection of the infant from harm.
The result of prolonged loss of oxygen to the baby’s brains damage. Medicine uses the term HYPOXIC-ISCHEMIC ENCEPHALOPATHY (HIE). This means that the baby’s brain has been injured as a result of lack of oxygen and the resulting destruction of brain matter. HIE is the most common cause of permanent neurological damage, loss of function and seizures.
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