Meconium occurs when a newborn inhales amniotic fluid and meconium (the baby's first poop) before, during, or after childbirth.
Our birth injury lawyers handle meconium aspiration syndrome lawsuits for babies who were injured by medical malpractice because meconium aspiration was mismanaged during childbirth. This page is about what gives rise to these lawsuits and delves into expected settlement compensation amounts for babies and families who have suffering harm unnecessarily.What is Meconium?
Meconium is the odorless, greenish-colored bile-stained contents of the fetal bowel intestine that are passed before childbirth. Meconium develops in the fetal bowel between the 10th and 16th weeks of gestation.
Meconium is a risk factor not for the fetus, but the newborn. What it indicates is that you better take special care when that baby is born to make certain there is no aspiration of meconium. This means the baby takes a breath and inhales meconium into its airways.
There are two main issues with meconium that lead to birth injury medical malpractice lawsuits: (1) meconium aspiration syndrome (MAS) and, (2) failure to appreciate the increased risk to the baby that comes with meconium exposure.Meconium Aspiration Syndrome
Meconium is involved in about 7% to 20% of live births. About 10% of the time when meconium is present in the amniotic fluid, meconium gets into the baby's lungs causing meconium aspiration syndrome. More technically, MAS is meconium below the vocal cords in the baby's tracheal bronchial tree. It is lung failure due to having meconium in the chest, airway, and lungs.
So when a newborn breathes in too much meconium that is in the amniotic fluid, it enters the infant's lungs. Meconium can be ftoxic and can also obstruct the child's airway or overinflate the lungs.
So, brutally for the baby, this is both a chemical and an obstruction of breathing problem for the newborn. The result can be immediate or slightly delayed respiratory distress.
Lack of oxygen for a newborn can lead to damage to all of the baby's vital organs, including the brain. The most common injury that you see in birth injury cases involving meconium is hypoxic-ischemic encephalopathy.
If there is meconium in amniotic fluid (MSAF) before delivery, the obstetrician should consider the possibility of aspiration (MAS) and monitor the baby closely. Obstetricians and midwives can be found liable for not intervening when there is fetal distress and preventing the meconium aspiration. Early identification and intervention of meconium aspiration are essential in preventing severe aspiration problems.Meconium as a Marker for Fetal Distress
A baby that is born vigorous at birth with spontaneous respiration is very unlikely to every aspirate meconium. But meconium fluid, particularly thick, dark liquid, is a harbinger of possible coming fetal distress even without. Meconium is a marker for anemia, sepsis, or a fetal neurological injury.
Too many OBs and pediatricians fail to put up their antenna after finding thick meconium in the amniotic fluid because often meconium does not come with complications. With the stakes as high as they are with the neonate and newborn's brain, increased risk has to be met with increased diligence.
Meconium aspiration sneaks up on doctors because two of the leading causes of concern -- low Apgar scores or high or low cord blood gasses -- are not always helpful in determining the status of the fetus when meconium is involved. Because they reflect the condition of the baby at delivery. So the health care providers are lured into a false sense of security if they are not diligent.Risks Factors for Meconium Exposure
The obstetrical risk factors for meconium exposure are a fetus that is over 40 weeks in gestational age of the fetus and an abnormal fetal heart rate during the labor.
A distressed baby is a big risk factor. Late decelerations in the heart rate are of particular concern as are decreased fetal movement, hemorrhage on the part of the mother, or low Apgar scores.
Other factors that increase the risk of MAS include high blood pressure and diabetes in the pregnant mother.Defense of Meconium Birth Injury Cases
The background of the defense is that meconium in amniotic fluid occurs in 11% to 22% at birth. So the defense lawyers try to set the stage that meconium is not the cause for alarms to be set off.
The doctors' primary argument in these cases is that the meconium could be aspirated in utero long before the birthing process. The fetus can aspirate thick meconium before childbirth which would mean that the damage from the meconium exposure may not be preventable.Meconium Aspiration Birth Injury Claims
There are two main issues with meconium that lead to birth injury medical malpractice lawsuits: (1) meconium aspiration syndrome (MAS) and, (2) failure to appreciate the increased risk to the baby that comes with meconium exposure.Meconium Aspiration Syndrome (MAS)
Meconium Aspiration Syndrome (MAS) refers to respiratory problems that occur when a baby inhales its own poop (meconium) inside the womb before birth. Meconium is present in the amniotic fluid in about 7% to 20% of all live births. About 10% of the time when meconium is present in the amniotic fluid, the baby inhales it into the lungs. MAS technically occurs when the meconium gets inhaled below the vocal cords and into the baby's tracheal bronchial tree. This is what causes meconium to get into the chest, airway, and lungs.
Once inhaled into the lungs, meconium can be very dangerous for a newborn baby. First, the meconium can physically obstruct the baby's air pathways or overinflate the lungs. This can make it very difficult for the baby to breathe normally and get enough oxygen. If doctors are not able to restore the supply of oxygen quickly enough, the baby can suffer permanent brain damage. The most common injury that you see in birth injury cases involving meconium is hypoxic-ischemic encephalopathy.Treatment and Management of Meconium Aspiration Syndrome
Proper medical care for MAS is a multi-layered process that involves reducing the risk of MAS through careful monitoring, promptly diagnosing and treating MAS after birth to restore oxygen, and diligent neonatal monitoring and care.
Meconium may be present in the amniotic fluid as much as 20% of the time. MAS occurs when the deeply inhales amniotic fluid containing meconium. Deep inhalation of meconium in the amniotic fluid generally occurs when a baby is under duress from oxygen deprivation. This type of stress prompts the baby to take hard gasps and inhale large volumes of amniotic fluid deep into the airways. Doctors and nurses can therefore minimize the risk of MAS by carefully watching for early indications of fetal distress and intervening before the baby starts gasping amniotic fluid.
If MAS cannot be prevented, the delivery team needs to promptly identify the signs of MAS. A diagnosis is usually made when the baby is having breathing difficulties and there is meconium staining in the amniotic fluid. Once MAS is diagnosed, doctors must take immediate treatment steps to ensure that the baby is getting enough oxygen. Treatment of MAS usually involves the following steps:
- External suctioning of the baby’s nose, mouth, and airways to clear out meconium and fluid.
- Internal suctioning of the baby’s airway with a tracheal suction tube.
- Using a face mask and ventilator bag to inflate the baby’s lungs and deliver oxygen.
- Insertion of breathing tube and hooked up to a ventilator.
In many cases, the hospital will have a special neonatal resuscitation team to perform these treatments. Time is critical when it comes to responding to MAS. The doctors need to restore the baby’s supply of oxygen as quickly as possible to avoid any long-term brain or organ damage. If doctors or nurses fail to promptly identify MAS and take immediate action in response, they can be liable for medical malpractice.
Once the baby’s oxygen supply is restored, doctors must continue to carefully monitor MAS. Continued neonatal care is very important because even if a baby’s airways are cleared, MAS can lead to delayed complications such as anemia or infections.
These complications can result even with minor cases of MAS. Too many OBs and pediatricians fail to put up their antenna after finding meconium in the amniotic fluid because often meconium does not come with complications.
With the stakes as high as they are with the neonate and newborn's brain, increased risk has to be met with increased diligence.
Birth injury malpractice cases involving meconium aspiration syndrome usually fall into one of two categories. The first category of MAS malpractice cases involves situations where doctors fail to promptly diagnose MAS and/or fail to take immediate actions in response resulting in oxygen deprivation and injury. The second category of MAS malpractice involves cases where the baby develops delay complications from MAS because doctors did not provide diligent neonatal monitoring and care.Settlement Value of MAS Malpractice Cases
If your child has suffered a birth injury and failure to properly manage meconium was the cause, your family has one chance to get compensation for the injuries your child suffered. So it is a very reasonable question to ask what the average settlement value of meconium-related birth injury cases is and what your case might be worth.
The average settlement or verdict in meconium-related birth injury cases in the ten example cases below is over $5 million. Setting aside how unscientific this study is, the average verdict or settlement is of little interest to you. The question you want to know is the value of your child's birth injury case.
Below are summaries of settlements and verdicts from birth injury malpractice cases involving meconium aspiration syndrome. These cases will help give you an idea of the kinds of medical mistakes involved and the amount of compensation awarded in MAS cases.
- 2017, New York: $1,000,000 Settlement (policy limits): mother alleged that doctors misdiagnosed fetal weight via a misread sonogram and then failed to properly suction and perform chest physical therapy after a prolonged, difficult birth. As a result of these mistakes, she claimed her baby suffered Meconium Aspiration Syndrome, resulting in brain damage and leaving him with impaired speech and cognitive delays. The parties settled the case out of court for policy limits of $1,000,000.
- 2017, Pennsylvania: $14,484,490 Verdict. A 24-year-old pregnant woman goes to the hospital and she is admitted and she is dilated. To induce her labor, defendants rupture her membranes. This reveals thick meconium stained amniotic fluid and a high dose of Pitocin is administered to increase the strength of her contractions. During the delivery process, the fetal heart rate drops extremely low. A surgical cut is done and the baby is born. At delivery, his vital signs are very low and he is unresponsive. He suffers severe brain damage. The infant's parents file this claim and allege that the Pitocin administration was improper and that the staff failed to properly monitor the woman's labor. The defendants allege that the brain injury was due to the infant having a bowel movement in utero and being exposed to meconium for over 24 hours. This "the baby was already hurt" argument is very typical. But it failed miserably here. The jury awarded the plaintiff $14,484,490.
- 2017, New York: $4,098,267 Verdict. Plaintiff goes to the hospital as she feels her fetus has stopped moving. She is examined and electronic monitoring of the fetus's heart is non-reactive. A biophysical profile is done and the results warrant immediate induction of labor. A profile is done by another doctor, which reads that the infant is safe and the woman is discharged. The next day, she is transported to a hospital and her fetal heart monitoring results are non-reassuring. She delivers her infant via Caesarean section. The infant is bluish due to a lack of oxygen. Meconium has filled his lungs and he is not breathing. This is removed and he begins breathing again. The woman claims that her infant should have been delivered when she first went to the hospital and that a hypoxic injury to the child's brain would have been avoided. A jury agreed with the woman and awarded her $4,098,267.
- 2016, Pennsylvania: $7,270,000 Settlement. A woman gives birth to her first child via emergency C-section due to a prolonged labor stage. Two years later, she becomes pregnant with her second child and seeks care from the same obstetricians. Her prenatal course is uncomplicated. She goes to the hospital to have her labor induced and to have a vaginal birth attempted. Her fetal heart rate is monitored and is reassuring. Once her membranes rupture and she is fully dilated, she attempts to deliver her infant for five hours. The infant's head is finally delivered, but the nasal passages and airway are filled with thick meconium. The rest of the infant is delivered without respiratory effort, suffering birth suffocation. He is diagnosed with a lack of oxygen to the brain and suffers permanent brain injury and neurological problems. The defendants denied any negligence but settled for $7,270,000.
- 2014, New York: $3,065,899 Settlement. A woman is under the care of defendant midwives. While giving birth to her baby, the defendants fail to convert the vaginal birth to a Cesarean section, despite signs of fetal distress including meconium staining and non-reassuring fetal heart readings. The infant suffers cerebral palsy due to oxygen deprivation as well as neurological injury. The parties settle for $3,065,899.
- 2014, $200,000 Settlement: The baby's mother claimed she received negligent prenatal care when doctors misread her sonogram and negligently sent her home despite indications that her amniotic fluid was very low and other warnings that should have prompted an emergency delivery. The following day mother had severe preeclampsia and emergency delivery was performed. The baby suffered meconium aspiration syndrome that caused damage to his brain. The case was settled for $200,000.
- 2014, Massachusetts:$3,250,000 Settlement. A woman goes to the hospital in labor. Upon admission, her infant's heart rate is normal. Three hours later, it is persistent but shows mild decelerations. The woman has a fever but the doctors do not order antibiotics or initiate a Cesarean section. Eight hours after her admission to the hospital, the woman's infant is experiencing an accelerated heartbeat, the membrane is ruptured, and there is thick meconium present. Despite these signs, an emergency delivery is not done. The infant is not delivered via Cesarean section until 24 hours after the woman gets to the hospital. The baby suffers a lack of oxygen to her brain and her mom files this case alleging negligence in the delay in delivery of the child with fetal distress. During mediation, the parties resolved the woman's claim for $3,250,000.
Meconium Aspiration Syndrome occurs when the baby takes its first poop while still inside the womb and then inhales that feces (meconium) into the lungs along with amniotic fluid. When this occurs before birth in can cause the baby to suffer neonatal respiratory problems.
Meconium aspiration is usually caused by fetal distress factors such as oxygen deprivation that causes the baby to take deep, gasping breaths and inhale amniotic fluid containing meconium.
Doctors can reduce the potential for meconium aspiration by carefully monitoring for signs of fetal distress from oxygen deprivation and taking decisive action when these signs occur. The longer a baby is under duress the more likely they are to gasp and inhale any meconium in the womb.
If MAS is immediately diagnosed after birth, doctors must take steps to clear the meconium from the airways. This starts with manual external suction of the airways. If this is not successful, the next step involves the insertion of a suction tube into the windpipe. In the most severe cases, the baby may need to be put on a ventilator.
If your child has suffered a birth injury and you believe meconium exposure may have been the reason for the harm, call Ron Miller or Laura Zois today and let's talk about your options.
We have a track record of success in wrongful death and catastrophic injury cases. We can help you and your child get the compensation you need and deserve. Call Miller & Zois today and speak to our birth injury medical malpractice attorneys at 800-553-8082 or get an online case evaluation.Meconium Aspiration Medical Literature
These are some of the journal articles we use in this article or our medical experts have relied upon to formulate their expert opinions:
- Desai D, et. al: Fetal heart rate patterns in patients with thick meconium staining of amniotic fluid and its association with perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2017;6(3):1030-1035.
- American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Committee Opinion No. 689: Delivery of a newborn with meconium-stained amniotic fluid. Obstet Gyneol 2017;129: e33-e34.
- Swarmam K, et. al: Advance in the management of meconium aspiration syndrome. Int J Pediatr 2012:1-7 (induction for pregnancies at or beyond 41 weeks has led to a reduction in the incidence of MAS)
- Velaphi S, Vidyasagar D. Intrapartum and post-delivery management of infants born to mothers with meconium-stained amniotic fluid: evidence-based recommendations. Clinics in Perinatology. 2006; 33(1):29–42.