$48 Million Prolonged Labor

$48.1M Verdict in Prolonged Labor Birth Injury Case

A jury awarded $48.1 million in a medical malpractice case to the parents of a child who sustained life-altering brain injuries during birth at a hospital. The lawsuit alleged that despite evidence of fetal distress, the doctor and the hospital staff allowed the mother to push for over twelve hours instead of performing an earlier C-section. Following the difficult delivery, the infant suffered seizures within 24 hours, spent over six weeks in the NICU, and was ultimately diagnosed with a cerebral palsy birth injury. The total verdict for birth injury in this prolonged labor case included $28.1 million in compensatory damages and an additional $20 million in punitive damages.

What is Prolonged Labor and What are its Dangers, Including Birth Injury?

Prolonged labor, also known as failure to progress, occurs when the process of labor takes significantly longer than expected.

• Definition 🕰️: Labor is generally considered prolonged if it lasts 20 hours or more for a first-time mother, or 14–20 hours or more for a woman who has given birth before. This stalled progression can happen in one of two stages:
  • First Stage: The cervix starts to dilate (open) but stops before reaching full dilation at 10 centimeters.
  • Second Stage: The cervix has fully dilated, but the baby stops moving down the birth canal.

Dangers to the Baby Prolonged labor, particularly in the second stage, can lead to serious complications for the infant. These risks are primarily due to the duration and stress of the labor:

• Oxygen Deprivation (Perinatal Asphyxia): The baby may not receive enough oxygen and blood flow, a condition called perinatal asphyxia.
• Fetal Distress: The sustained stress can lead to fetal distress (see below for more detail).
• HIE: Hypoxic Ischemic Encephalopathy: Oxygen deprivation and decreased blood flow can cause brain damage, known as HIE. This is a major cause of lifelong disabilities, including cerebral palsy and seizure disorders.
• Instrumental Delivery Injuries: Prolonged labor often necessitates the use of instruments like a vacuum extractor or forceps to complete the delivery, which can, in some cases, cause physical injury to the baby’s skull and brain.

Dangers to the Mother Prolonged labor also increases the mother’s risk of infection, extreme exhaustion, postpartum hemorrhage (severe bleeding after delivery), and the need for an assisted vaginal delivery or an emergency C-section.

What is Fetal Distress and What is the Response to It?

Fetal distress is a term used to describe when a fetus shows signs of being compromised. This is most often due to inadequate oxygenation during late pregnancy or labor. Medical professionals now commonly use the less ambiguous term non-reassuring fetal status (NRFS).

Signs of Fetal Distress The condition is typically detected by monitoring the baby’s fetal heart rate (FHR) using an electronic fetal monitor (EFM). Abnormal heart rate patterns that signal distress include:

• Tachycardia (abnormally fast) or Bradycardia (abnormally slow) heart rate.
• Late Decelerations: A drop in the heart rate that occurs after the peak of a uterine contraction.
• Decreased Fetal Movement: A change in the baby’s usual movement pattern is a critical sign.
• Meconium-Stained Amniotic Fluid: The presence of meconium (the baby’s first stool) in the fluid is another potential indicator of distress.

Medical Response to Fetal Distress When non-reassuring fetal status is detected, the immediate medical response is aimed at improving the baby’s oxygen supply. This process is intrauterine resuscitation.

• Initial Resuscitation Steps: Changing the mother’s position, administering oxygen through a mask, or giving fluids through an IV line may alleviate the distress. The medical provides also may give medication to slow or stop contractions if they are too frequent.
• Expedited Delivery: If the baby’s status does not improve, or if the heart rate pattern is dangerously abnormal (Category III tracing), the doctor must immediately deliver to prevent serious complications, such as permanent brain damage. The doctor achieves this either through an assisted vaginal delivery (using forceps or a vacuum extractor) or an emergency C-section.

Birth Injury Seizures, the NICU, and Cerebral Palsy

Birth Injury Seizures

Neonatal seizures are involuntary movements or behaviors caused by abnormal electrical activity in the newborn’s brain. They can occur within the first hours or days of life and are often the first visible clinical sign of a significant birth injury.

• Cause: The most common cause is Hypoxic-Ischemic Encephalopathy (HIE), which is brain damage resulting from a lack of oxygen and blood flow that occurred before or during delivery, often as a result of prolonged labor or untreated fetal distress.
• Treatment: Seizures in newborns are a neurological emergency. Medical providers must treat them immediately, as continuous seizure activity can worsen existing brain damage. The medical staff must quickly identify and address the underlying cause.

The NICU

The Neonatal Intensive Care Unit (NICU) is the hospital ward that treats newborns requiring intensive medical care, such as those with severe birth injuries.

• HIE Treatment: Infants suspected of having HIE are often candidates for therapeutic hypothermia (brain cooling). This specialized treatment involves carefully lowering the baby’s body temperature for a period. This is to slow down metabolic activity. Then limit the cascade of cell death, thereby minimizing the extent of permanent brain damage.

Cerebral Palsy (CP)

Cerebral Palsy (CP) is a permanent neurological disorder that affects muscle movement, posture, and balance.

• Cause: Damage to the developing brain that occurs before, during, or shortly after birth causes CP. A severe lack of oxygen to the brain (HIE) is one of the leading causes of CP linked to complications at birth, such as those that arise from unmanaged prolonged labor.
• Nature of CP: The disorder is static, meaning the original brain injury does not worsen over time. However, the resulting physical impairments may become more obvious as a child grows and fails to meet typical developmental milestones.
• Associated Conditions: Children with CP have a significantly increased risk of developing other neurological conditions. This includes epilepsy (a chronic seizure disorder), which can be another manifestation of the underlying brain damage.

Next Step: Call Baltimore Prolonged Labor Lawyer Mark Kopec for Your Child’s Birth Injury

If your child has a birth injury from prolonged labor, call Baltimore prolonged labor lawyer Mark Kopec now.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.