The connection between the maternal death crisis and birth injuries
In 2018, several media outlets, including USA Today and CBS News, began reporting on the maternal mortality crisis (or maternal death crisis). The reports were startling. According to the reports, wide disparities in health care, were leading to thousands of unnecessary deaths of mother’s after childbirth. The disparities included race and socioeconomic status. Basically, minorities, people of color and lower income mothers are much more likely to die after childbirth because of delayed care (i.e., medical negligence).
These reports led to widespread recognition by the American College of Obstetrics & Gynecology and the Society for Maternal Fetal Medicine that they were failing a large segment of their patient population. After years of denying any role in causing harm caused by medical malpractice, these medical societies, and others, became a voice of change. Large task forces were created to begin working on critical legislation to fix this health care crisis.
On December 21, 2018, the Preventing Maternal Deaths Act was signed into law. The law mandated that each state setup Maternal Mortality Review Committees (MMRCs) to being fixing the problem. Despite these efforts, there is still a long way to go.
In May of 2020, the National Institutes of Health (NIH) concluded that a whopping 60 percent of these deaths are preventable. The main cause of these deaths was denial, delay, and dismissal.
Cases of cerebral palsy and brain damage linked to maternal mortality
To date, no peer-reviewed study has looked at whether there is a link between the maternal death crisis and birth injuries. This is unfortunate. Sadly, most of the obstetrical community is still in denial about medical malpractice and birth injury caused by medical error. Going back decades, obstetricians and maternal-fetal medicine specialists have placed more emphasis on defending lawsuits than on patient safety.
Notice a common theme here. As the NIH concluded in 2020, a contributing factor to preventable maternal deaths was denial. It is that same denial that has resulted in tens of thousands of babies being unnecessarily injured during the birthing process. Hopefully, it does not take another round of investigative journalism to unmask the problem to the masses.
Anecdotally, Birth Injury Cold Case has found that there is a clear link between birth injuries and the maternal death crisis. We have investigated and solved dozens of cases involving negligent medical care that caused injury to both the baby and the mother. An example of such a case is below.
Prolonged second stage of labor, postpartum hemorrhage and hypoxic-ischemic encephalopathy (hie)
One of the leading causes of preventable maternal deaths is postpartum hemorrhage. Postpartum hemorrhage is when there is excessive bleeding from the uterus after childbirth. As state above, postpartum hemorrhage can lead to death when the mother loses too much blood and becomes unstable and dies.
Incidentally, one of the leading causes of postpartum hemorrhage is a prolonged second stage of labor. The second stage of labor begins when the mom is fully dilated and pushing begins. In a first-time mom the second stage of labor should last no longer than 2 to 3 hours. With a mother who has previously delivered a baby vaginally, the second stage of labor should be no longer than 1 to 2 hours. When obstetricians let their patients push longer than these time limits there is a higher incidence of postpartum hemorrhage.
A prolonged and excessive second stage of labor has also been linked to an increased risk of hypoxic-ischemic encephalopathy or HIE. HIE occurs when there is a lack of oxygen and blood flow to the baby during the labor and delivery process that causes brain damage. Therefore, a prolonged second stage of labor is connected to maternal issues (i.e., postpartum hemorrhage) and newborn issues (i.e., HIE and brain damage)
Five-hour second stage of labor causes postpartum hemorrhage, hie, death and cerebral palsy
In 2015, the lawyers at Wais, Vogelstein, Forman & Offutt, LLC were contacted by a family in the Midwest. The situation was tragic. The mother had died after childbirth from postpartum hemorrhage. Furthermore, the child had suffered HIE, brain damage and had been diagnosed with cerebral palsy. Of course, the family wanted answers.
WVFO investigated the case. Prior to the pregnancy at issue, the mother had previously delivered a healthy baby girl by normal vaginal delivery. Accordingly, the second stage of labor should have gone no longer than 2 hours. In this case, the second stage of labor lasted 5 (!) hours. The obstetrician failed to diagnose a condition called cephalopelvic disproportion or CPD. The baby was stuck in the birth canal and was never going to be delivered vaginally.
At birth, the baby was essentially lifeless. He was vigorously resuscitated. Terribly, he suffered HIE, brain damage and was later diagnosed with a severe form of cerebral palsy. In the postpartum period, the mother began bleeding excessively from her uterus. She was diagnosed with postpartum hemorrhage. Her blood counts dropped dangerously low and she went into shock. Her organs started to fail, and she eventually slipped into a coma. She died 4 days after giving birth, at the age of 31.
Like many of the preventable deaths identified by the media and the NIH, the mother in the above case was African American. This story is a tragic example of how there appears to be a clear connection between the maternal death crisis and birth injuries. Perhaps we need a Preventing Child Injuries Act.
