During childbirth, if getting the infant out of the mother's womb is a challenge, the doctors will sometimes use a vacuum to extract the child. Misused, a vacuum can cause lifelong injuries to the child. One of the potential injuries is a brain bleed called a subgaleal hematoma.Infant Hematoma During Delivery
A subgaleal hematoma is blood that accumulates between the skull and the scalp. The brain needs blood, of course, but this blood sits outside of the blood vessels. Every newborn faces a risk of a brain bleed. The risk is higher in premature babies and children delivered with a mechanical instrument.
A hematoma like this can happen from a lot of different things, but most subgaleal hematomas that occur within the first 72 hours of a child's life are caused by a birth trauma that can often be the result of medical malpractice.
What often happens in these cases is that the delivering doctor will misuse the vacuum extractors or forceps. Most of the time, the doctor gets it right. Hematomas result in only 1% of babies born where the doctor needed to use vacuum extraction or forceps but to a much smaller degree and for different reasons. What often happens is that it becomes apparent that a c-section is required because the vacuum is not working and the fetus is in real distress. But the doctor, particularly during what is called a high canal birth, just wants to give it one or two more tries with the vacuum than good medical care warrants.
There are also situations where the doctor uses a vacuum in cases where it is not warranted. For example, if the child is less than 34 weeks, the doctor knows there is a concern the child has bleeding or bone disease, or when multiple attempts have been made for fetal scalp electrode placement, vacuum use is not recommended. In all but the rarest of circumstances, using a vacuum under these conditions are a violation of the standard of care and constitute medical malpractice if the child suffers a brain bleed.
In other situations, it is not the choice of the vacuum that is the problem, but how it is used. For example, good medical practices require that the use of the vacuum should be stopped when there are three disengagements of the vacuum (called “pop-offs”). The vacuum should also be discontinued when more than 20 minutes have elapsed, or when three consecutive pulls do not get any result. Less frequently, some doctors, often inexperienced OB/GYNs, do not use the device properly or with the appropriate level of suction, that can put the scalp at risk for an injury that can cause a hematoma.
For parents, if you hear that your child had a subdural hematoma, cephalohematoma, or a subgaleal hemorrhage, your child has suffered a brain bleed. If you were not told your child has a brain bleed but received blood products, that order could have been the result of a brain bleed. Is the brain bleed a result of medical malpractice? It really depends on the specific facts of the case. There is no magic test. But the child's brain MRI will tell you a great deal.
- More about intracranial hemorrhages and settlement and verdicts in these cases
- More about intraventricular hemorrhages and settlements and verdicts
- June 2017, Florida: $33,153,912 Verdict. A child suffers a brain bleed during the birthing process which causes a lack of oxygen to the brain. The injuries are catastrophic: the child needs around the clock care for the rest of his life. Plaintiff's birth injury lawsuit alleges that the doctors and nurses should have initiated the delivery earlier with a c-section, that too much Pitocin was given, and child's fetal heart monitor provided ample evidence that this delivery was in trouble in time to avert the disaster that occurred.
- October 2011, New York: $4,600,000 Settlement: During a Caesarean section at Vassar Brothers Medical Center, a vacuum extractor was used after the physician rotated the infant from a transverse lie to a cephalic lie. Within the first day of life, the child was diagnosed with focal seizure activity, including a seizure that lasted almost six minutes. He sustained subdural and subarachnoid hematomas and consequently suffers from an ongoing seizure disorder and speech and language delays. His parents sued the physicians, their employers, and Vassar Brothers Medical Center for negligence. Plaintiffs claimed the Defendants were negligent in both the delivery of the baby and the post-delivery care. Plaintiffs alleged Defendant Physicians should not have used the vacuum extractor to deliver the child as it caused trauma to his head. Plaintiffs also alleged Defendant Vassar Medical Center’s staff wrongly placed the infant in the well-baby nursery. Defendants denied liability, claiming all actions were within the standard of care and that any brain injuries were not severe and would have a good recovery. The parties agreed to settle before trial for $4,600,000.
- April 2008, Massachusetts: $2,000,000 Settlement: A 30-year-old woman, pregnant with her first child, was taken by ambulance to a local hospital with a fully dilated cervix. During labor, the fetal heart rate decreased, and the woman was urged to push. After three hours of pushing the obstetrician advised the woman that a vacuum extraction and forceps would need to be used. The woman explained she was afraid of the use of forceps and continued to push for another 45 minutes until the obstetrician returned and performed a delivery using both forceps and vacuum. After three attempts to get the baby’s head into the perineum, he was delivered hypotonic and required resuscitation. The next day, after a series of seizures, he was transferred to another hospital where both a frontal and subdural hematoma was discovered. He was soon diagnosed with developmental delays. The woman sued the obstetrician and his nurse for failing to timely deliver the child. The parties agreed to settle before trial for $2,000,000.
- March 2007, New York: $1,100,000 Settlement: A pregnant woman, who was nine days past her due date, presented to North Central Bronx Hospital in mild labor. She was placed in a room, attached to a fetal monitor, and every so often hospital personnel would perform a perfunctory exam. After about two hours a nurse midwife took over. The woman’s water broke, and the infant was delivered. Four days into his life, the child appeared fine but was not feeding well. He was later admitted to the neonatal ICU with signs of abnormal extremity movement. A CT scan revealed a subdural hemorrhage, and he was soon diagnosed with cerebral palsy. The mother sued the hospital for negligence. Plaintiff claimed the nurse midwife constantly pulled and tugged during the birth. Plaintiff’s sister who witnessed the delivery testified the nurse midwife had difficulty during the delivery. Defendant denied Plaintiff’s allegations. The parties agreed to a $1,100,000 settlement during mediation.
- January 2007, California: $2,450,000 Settlement: After experiencing uterine contractions in the later part of her pregnancy, a woman presented to a local hospital’s emergency room. A vaginal exam revealed a complete dilation with an arm in view. The on-duty obstetrician opined the baby was indicating a footling breech and the woman was moved to the operating room for an emergency C-section. The obstetrician, however, ordered the child to be delivered vaginally. While they were able to complete the delivery, the child suffered cranial hematomas that left him with developmental delays and speech problems. The mother sued the medical group for malpractice, claiming the physicians were negligent in the child’s delivery. Defendants denied negligence and contended the extent of the infant’s developmental damages. The parties agreed to settle for $2,450,000 during mediation.
- February 2006, California: $1,600,000 Settlement: A soon-to-be mother arrived at Alta Bate Summit Medical Center in Oakland to give birth. It was observed that the fetus was high in the mother’s birth canal and the attending obstetrician elected to use a vacuum and pulling technique. The vacuum detached four times before they were able to fully deliver the infant. He was found to have a subgaleal hematoma which resulted in severe cognitive defects. He is in the lowest 10th percentile for IQ and will never be employable. His parents sued the obstetrician for medical malpractice. Plaintiffs claimed the fetus was too high in the birth canal for vacuuming and a C-section should have been performed. Defendants denied Plaintiff’s allegations. The parties agreed to settle before trial for $1,600,000.
Infants with intracranial hemorrhages (brain bleeds) from birth may display some of the following symptoms depending on the severity and location of the bleed:
- Soft spot or abnormal bulge on the head
- Feeding difficulties
- Breathing difficulty
Yes. Infant brain hemorrhages can be caused by the negligent use of birth-assistance tools such as obstetric forceps or a vacuum pump. Doctors sometimes utilize these tools to grip the baby’s head and maneuver them through the birth canal when normal labor contractions are not effective. When use with too much force or lack of skill, however, these tools can cause trauma to the baby’s head and lead to brain bleeds.
Infant brain hemorrhage can be definitively diagnosed through diagnostic imaging tests such as a CT Scan or MRI. Both of these imaging tools can give doctors a clear picture of the brain bleed and help identify the location of the burst blood vessels.
Treatment for an infant brain hemorrhage usually requires emergency neonatal brain surgery. Sometimes multiple surgeries may be necessary. The aim of the surgery is to stop the bleeding and protect the brain.
Brain bleeds in newborn babies can lead to lifelong injuries, including cerebral palsy. Not every brain bleed causes a severe injury or is the result of medical malpractice. But there are too many children harmed forever and killed because the OB/GYN delivering the child did not follow their training and went down a path that a reasonable physician just would not have chosen.
If you want a lawyer to fight for you and your child, call our Maryland medical malpractice lawyers at 800-553-8082 today or get a free, no obligation online consultation.More Birth Injuries
- Overview of birth injuries
- Malpractice during pregnancy causing injury to the child or the mother
- Settlement value of brain injury medical malpractice cases
- How birth injury cases are assessed for settlement -- get statistics and sample verdicts and settlements
- Financial assistance for victims in brain bleed birth injury cases