As most people know, uterine activity – or contractions – is a normal and necessary part of childbirth. In the vast majority of cases, both mom and baby tolerate the contractions without incident; however, in rare cases, uterine activity poses a serious threat to fetal wellbeing and requires healthcare providers to act diligently and decisively before permanent harm results. Birth injuries can result from complications during childbirth, emphasizing the importance of monitoring and intervention. Certain birth injuries, such as cerebral palsy, can be considered birth defects potentially linked to obstetric malpractice. The reason for this requires some understanding of what exactly happens to your baby during a uterine contraction. Failure to act appropriately can be considered medical negligence, especially if it deviates from the standard of care expected during pregnancy, childbirth, or gynecological visits, potentially causing harm or injury to the mother or child.
The Central Role of Monitoring Uterine Activity in Preventing Birth Injuries During Parturition
There is an obvious and intuitive relationship between contractions and labour, but you may not know that labour is often defined as a process that includes regular uterine contractions causing both dilatation and effacement of the cervix. These contractions also cause the baby to descend through the birth canal.
There are numerous forces and functions at play at the onset of labour. Given the complexity of this subject, some authors have more recently defined labour as simply being the last few hours of pregnancy, since “the current understanding of labor incudes a wide spectrum of preparedness even before the first regular contractions.” Some of this preparation happens early. For instance, during the first months of pregnancy, the cervix undergoes a series of important changes while maintaining structural integrity that is ultimately lost during labour. In short, the body prepares for labour and childbirth throughout the prenatal period.
Labour itself is now seen as encompassing three interrelated processes. One is a loss of what has been called “pregnancy maintenance factors.” This includes hormonal changes brought about at the onset of gestation. A second process involves a host of factors that induce childbirth, including the onset of uterine activity together with necessary cervical changes. A final consideration focuses on the fetus and the fact of the mature fetus’ role in inducing parturition.
Many of the important changes in preparation for labour begin to occur in the final weeks of pregnancy, a period critical for monitoring the gestational age to manage and anticipate any complications. Maternal age is a significant risk factor for preterm birth, emphasizing the need for careful monitoring of pregnant patients to manage and anticipate complications. Some of these events – which are normal – have been shown to contribute to premature labour in rare cases. When this occurs, and a baby is born before reaching full gestational age, medical interventions may be required to protect the baby from complications, which can result in serious and lifelong injuries. When serious injuries occur to the preterm baby, it is very important to consult with a medical malpractice lawyer who has experience with obstetrical negligence litigation to determine whether a civil action, or lawsuit, may be appropriate.
The changes that spur active labour and contractions are complex, including a rise in myometrial oxytocin receptor levels, and cervical ripening. The fetus also contributes, at least according to more recent studies that suggest a mature fetus gives signals through blood-borne agents. Fetal growth is also thought to cause uterine stretching, which causes chemical changes and cell signaling. Parenthetically, this is why twin pregnancies have a greater risk of premature labour. Again, where this results in injury, an obstetrical malpractice lawyer can help you understand legal rights for the benefit of the child who suffered harm as a result of obstetrical malpractice.
In terms of active labour, this is achieved where uterine contractions occur often and long enough to affect cervical effacement. The first stage lasts until the cervix is fully dilated. The second stage of labour begins with full dilatation and ends with the birth of the baby. If complications arise during this stage, a cesarean section may be necessary to expedite delivery and prevent injuries. The third and final stage of labour then begins and ends with delivery of the placenta.
Throughout this process, doctors and nurses must monitor fetal well-being to ensure the baby is getting enough oxygenated blood from their mother. They do this primarily by monitoring the fetal heart rate. Some patterns of the fetal heart rate are associated with insufficient fetal oxygenation, which requires the obstetrical team to expedite delivery by performing a C-section. This must happen quickly and before the lack of oxygen causes a permanent brain injury to the baby.
The Relationship Between Uterine Contractions and the Flow of Oxygen to Your Baby
The first thing to understand – and the first thing a medical malpractice lawyer will consider in a case that may involve obstetrical malpractice – is the concept of fetal oxygenation. It is the primary objective of nurses and physicians caring for the fetus to ensure it is adequately oxygenated. In the womb, the fetus “breathes” through an exchange of gases, oxygen and carbon dioxide, between mother and baby. Oxygen is transferred from the mother to her baby through the uterus to the placenta for transport to fetal circulation via the umbilical cord. A single umbilical vein carries oxygenated blood to the baby. Two smaller umbilical arteries return carbon dioxide and other waste products to the mother for elimination.
Any pathological process that interferes with this gas exchange risks injuring the baby by way of asphyxia. A contraction substantially impairs the gas exchange between mother and baby because the increased intrauterine pressure impairs circulation in the intervillous space of the placenta. Placental abruption is a particularly concerning complication that can severely impair gas exchange, posing a significant risk of injury to the baby.
Oxygenated maternal blood enters the placenta through maternal arteries and then “pools” in the intervillous space, which is the space in the placenta between the maternal blood vessels and the fetal “chorionic villi” (i.e., a network of fetal capillaries). This allows oxygenated blood to diffuse into the villi where it can be delivered to the fetus through the umbilical vein. This is also the space where deoxygenated blood and waste products are carried by the umbilical arteries and then taken by the uterine veins into maternal circulation for elimination.
During a normal contraction (i.e., not more than 90 seconds long and not more than five every 10 minutes), the healthy fetus tolerates the transient disruption of oxygenated blood occasioned by intrauterine pressure exceeding that of the intervillous space. The fetus has an impressive capacity to withstand periods of impaired oxygenation without injury; however, this capacity is finite. If impaired fetal oxygenation lasts too long, the fetal ability to compensate can be overwhelmed and lead to brain injury. It is therefore crucial for nurses and doctors to respond with appropriate urgency where there is the potential for, or evidence of, impaired fetal oxygenation. Uterine contraction monitoring is an essential tool in this regard, helping healthcare providers detect potential complications such as preterm labor, fetal compromise, and notably, placental abruption following trauma. In the third trimester, close monitoring becomes even more critical, especially using vaginal ultrasound to assess fetal heart rate, which is vital in cases where vaginal delivery is planned, to ensure the safety and well-being of both the mother and the fetus.
The risk of overwhelming fetal reserves increases with the severity and duration of the event impairing gas exchange – here, excessive uterine activity. This depletion of fetal reserves can be conceptualized as an oxygen debt. Earlier delivery allows repayment of the oxygen debt – without harm – if it occurs in an appropriately timely way.
The Importance of a Reliable Legal Opinion on OB-GYN Malpractice Claims
This can all sound technical, and the complexity of this subject matter is one reason why hiring a knowledgeable malpractice lawyer is so important when labour and delivery are mismanaged and result in a serious injury to the baby. Malpractice lawyers are not only adept at navigating the intricacies of the legal system but also specialize in the analysis and pursuit of malpractice claims, focusing on securing compensation for families affected by obstetric malpractice. Understanding the ‘risk factors’ associated with obstetric malpractice, such as geographic region, hospital level, liability degree of the hospital, injury outcome, and causative domain, helps lawyers in securing compensation for affected families. This includes reviewing and analyzing outcomes of malpractice claims, indemnity payments, and the distribution of lawsuits in different regions to better understand the burden of malpractice lawsuits on healthcare systems and the causes of malpractice. Their efforts are crucial in minimizing serious injury outcomes and improving obstetric care in risky domains.
The medical malpractice lawyers at Wagners devote 100% of their practice to representing people harmed by these types of errors. They are constantly working to understand and engage with current guidelines and literature to help families of babies harmed by obstetrical negligence recover money from the doctors’ and hospitals’ insurance companies to make sure these babies have the care they need for the rest of their lives.
If you have questions about how your labour and delivery were managed, you should speak with a lawyer. At Wagners, we will meet with you for free, review the facts of your case, and provide a free, no-obligation opinion on whether legal action may be a means of providing for an injured child or loved one.
