Fetal Decelerations $29M
The Devastating Cost of Delay: $29 Million Verdict Exposes the Critical Need for Vigilance in Fetal Heart Rate Decelerations
A jury recently delivered a powerful message about accountability in the delivery room. It awarded a $29 million verdict to a family whose child developed cerebral palsy birth injury due to medical malpractice during birth. The case involved fetal heart rate monitor decelerations. The case serves as a solemn reminder of how quickly negligence can turn a moment of joy into a lifetime of specialized care.
The lawsuit centered on the actions of a Certified Nurse Midwife (CNM). According to the jury’s finding, she failed to recognize and act upon significant fetal heart rate decelerations. This delay in calling the on-call OB/GYN resulted in the infant suffering prolonged oxygen deprivation. This lead to severe and permanent neurological damage.
The massive $29 million verdict secures the child’s future. It covers past and future medical expenses, loss of earning capacity, and compensation for pain and suffering. It underscores the high financial and emotional toll of preventable birth injuries, emphasizing that holding healthcare providers accountable is crucial for securing the essential resources a child with severe disabilities will require throughout their life.
What is a Certified Nurse Midwife (CNM)?
A Certified Nurse Midwife (CNM) is an advanced practice registered nurse (APRN) who specializes in women’s health and childbirth. CNMs provide a broad spectrum of care, focusing on a holistic approach that includes gynecologic and family planning services, preconception care, and comprehensive care during pregnancy, labor, delivery, and the postpartum period.
CNMs are highly educated, typically holding a master’s or higher-level degree and passing a national certification exam. They function as primary healthcare providers for low-risk patients. Crucially, they train to independently provide care during labor, which includes monitoring the mother and fetus for fetal heart rate decelerations, assessing the progress of labor, managing common complications, and delivering the newborn. Their scope of practice requires them to possess the critical skill of recognizing signs of fetal distress and knowing when consultation, collaboration, or referral to an obstetrician or other specialist is immediately necessary. In the case of the $29 million verdict, the central issue was the CNM’s failure to perform this core duty—recognizing a crisis and escalating care.
Understanding Fetal Heart Rate Decelerations
Fetal Heart Rate (FHR) decelerations are temporary decreases in the baby’s heart rate recorded during labor monitoring. They are one of the most important tools healthcare providers use to assess fetal well-being. These drops categorize based on their shape and timing relative to the mother’s uterine contractions:
- Early Decelerations: These are symmetrical drops where the heart rate nadir (slowest point) occurs at the same time as the peak of the contraction. They are generally considered benign and are caused by compression of the baby’s head, which triggers a vagal nerve response.
- Variable Decelerations: These are abrupt, quick drops that vary in their onset, duration, and severity. They are usually caused by umbilical cord compression. While they can often be resolved by simply changing the mother’s position, recurrent or severe variable decelerations can be concerning signs of fetal distress.
- Late Decelerations: These are the most alarming pattern. They involve a gradual decrease in FHR that begins after the contraction onset, with the nadir occurring after the contraction has peaked. Late decelerations indicate uteroplacental insufficiency, meaning the placenta is not delivering sufficient oxygen to the fetus (fetal hypoxemia). Recurrent late decelerations, especially when coupled with absent FHR variability, are a Category III (abnormal) tracing and require immediate and urgent intervention, often expedited delivery, to prevent permanent brain injury.
How Does Oxygen Deprivation Occur During Birth?
Oxygen deprivation, medically termed birth asphyxia or neonatal asphyxia, happens when a baby does not receive enough oxygen or blood flow before, during, or immediately after birth. This can happen following fetal heart rate decelerations. A number of complications can cause this severe oxygen shortage:
- Umbilical Cord Issues: The most common mechanical cause is the compression or prolapse of the umbilical cord, which cuts off the baby’s blood and oxygen supply.
- Placental Problems: Conditions like placental abruption (early separation of the placenta from the uterus) or poor placental function (due to conditions like high maternal blood pressure) can drastically reduce oxygen circulation to the baby.
- Uterine or Maternal Issues: An inadequate relaxation of the uterus during labor, maternal low blood pressure, or maternal respiratory problems can also lead to insufficient oxygen in the mother’s blood, which then passes to the fetus.
- Prolonged or Difficult Labor: If labor is too long or complications arise, the chances of the newborn experiencing asphyxia increase.
In malpractice cases like the $29 million verdict, the lack of oxygen is often not an unavoidable complication, but a result of healthcare providers failing to properly monitor the FHR and missing or mismanaging the signs of distress (like recurrent late decelerations) that require immediate intervention.
The Critical Link: Oxygen Deprivation Leading to Cerebral Palsy
Following fetal heart rate decelerations, when a fetus or newborn is deprived of sufficient oxygen and blood flow, the brain is one of the first and most sensitive organs to be affected. This severe lack of oxygen quickly leads to a type of brain injury called HIE: Hypoxic Ischemic Encephalopathy.
Brain cells require a constant, abundant supply of oxygen and glucose (sugar) carried by the blood to function. If the oxygen loss is severe or prolonged—damage can begin in as little as four minutes—brain cells in critical areas begin to die. This damage often targets areas of the brain that control movement, posture, and muscle tone.
This permanent injury results in Cerebral Palsy (CP). CP is a non-progressive neurological disorder that affects a person’s ability to move and maintain posture and balance. The specific symptoms depend on which part of the brain was injured, but often include:
- Spasticity: Stiff or tight muscles and exaggerated reflexes.
- Ataxia: Lack of muscle coordination.
- Developmental Delays: Delays in reaching milestones like sitting, crawling, or walking.
The severity of the resulting cerebral palsy directly ties to the duration and intensity of the oxygen deprivation. This highlights why prompt recognition and delivery are essential when fetal distress is evident.
Lifelong Care Needs for a Child with Cerebral Palsy After Fetal Heart Rate Decelerations
The $29 million verdict reflects the extraordinary, lifelong care required for a child who has suffered severe neurological injury following fetal heart rate decelerations. Managing cerebral palsy is a complex, continuous process that requires a dedicated support team and specialized resources.
The core needs typically fall into three major categories:
1. Physical and Developmental Therapies
These therapies are essential for maximizing the child’s motor function and independence:
- Physical Therapy (PT): Focuses on developing stronger muscles for skills like walking, sitting, and balance.
- Occupational Therapy (OT): Helps the child develop fine motor skills and daily living tasks, such as feeding, dressing, and writing.
- Speech-Language Pathology (S/L): Addresses communication skills, as well as feeding and swallowing difficulties, which are common in children with CP.
2. Specialized Equipment and Assistive Technology
Children with CP often require a range of devices to improve mobility and communication:
- Mobility: Wheelchairs, walkers, canes, and ankle-foot orthoses (braces or AFOs) to stabilize the foot.
- Communication (AAC): For children who are non-verbal, devices like communication boards, tablets, or specialized computer programs allow them to express themselves.
- Home Adaptation: Installing handrails, ramps, and lifts to make the home environment fully accessible.
3. Education and Medical Oversight
From an early age, children with CP following fetal heart rate decelerations integrate into a system of specialized support:
- Early Intervention (IFSP) and Special Education (IEP): The public school system provides individualized education programs (IEP) that include specialized instruction and related services like PT, OT, and S/L.
- Medical Management: This includes ongoing appointments with neurologists and specialists, medications to manage muscle stiffness (spasticity), and sometimes surgical procedures.
The combined expenses for these lifelong needs—medical, therapeutic, and technological—often exceed $1 million over a child’s lifetime. This emphasizes why large medical malpractice verdicts are often necessary to ensure the child receives the care they desperately need.
You can read Blog Posts on other Verdicts.
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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.