to a healthy pregnancy understanding birth injuries · you get pregnant, but you will definitely be...

A GUIDETO A HEALTHY PREGNANCY

& UNDERSTANDING BIRTH INJURIES

I N G E R M A N & H O R W I T Z L L P

Foreword by a Board-Certified Obstetrician

A GUIDE TO A HEALTHY PREGNANCY & UNDERSTANDING BIRTH INJURIES

CONTENTS

1. Foreword by a Board-Certified Obstetrician

2. Introduction

3. Cerebral Palsy

4. Erb’s Palsy

5. Infant Brain Damage

6. Infant Wrongful Death

7. Defective Products




FOREWORD

Have a Healthy BabyA Candid Foreword by a Board-Certified Obstetrician

So you want to have a baby. A big decision and a wonderful one. You want to know

everything you can do to assure that you will have a normal pregnancy and a healthy baby. There are many easy first steps that you can take to get you on the right path to a wonderful and successful outcome for you and your child –these start before you become pregnant.

Pre-pregnancy planning

Before you get pregnant, there are several important steps to take to get you on the right track that can decrease many of the risks of pregnancy. First, you want to get your weight where it is

comfortable for you. You will gain weight during pregnancy and this is normal. But afterwards you will want to get back your girlish figure. Starting overweight is never a good idea. Exercise is healthy and is absolutely safe both before and during pregnancy. There have been many myths about pregnancy and exercise but using common sense will prevail. Hydration is very im-portant during exercise whether you are pregnant or not. A good rule of thumb is 40 ounces of wa-ter for every 40 minutes of aerobic exercise. Using common sense when exercising is very important. If it hurts don’t do it.

Next is good dental health. If you have not been to the dentist in a while try to go before you get

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pregnant in case any x-rays are needed. Flossing is important during pregnancy as there can be a tendency for gums to bleed.

There is great evidence that women on a vitamin that has folic acid, sometimes called folate, in it. It has reduced several birth defects in the baby. Try to be on this before you conceive. There are numerous over-the-counter prenatal vitamins that have this in it. Most vitamins however, even though they are not marked prenatal, have this folate in it. Usually it is measured as .4 mg or 400 μg. This is actually exactly the same amount. Once you are pregnant, your provider will start you on a prescription strength of your prenatal vitamin.

If you are on medications, you should certainly check with your primary care and your OB/GYN as to what you can continue and what might be problematic for the pregnancy. There are some

medications that carry some risk, but it may be more risky to go off of these. It is always a balance. It is best to check with your providers about your medications before you become pregnant. The internet can be a good source of information on your medications, however, always ask your provider first.

It takes the normal average healthy couple 4 to 10 months to get pregnant. Women are very smart and know their bodies. Most women often know that they are pregnant even before they take their first pregnancy test. It is not uncommon for women not to trust the results of the first one and do several more pregnancy tests just to verify. Pregnancy test nowadays are extremely accurate and easy to use. Once you find out you are pregnant you should make your first prenatal visit with your obstetrician at about 6 to 8 weeks after the first day of your


last period. If there are any problems such as bleeding, cramps, or other medical issues, never hesitate to call your doctor right away.

If you are in the season for a flu shot, be sure to get this. Flu is NOT just a bad cold-it is dangerous. The current recommendations are to have this vaccine. You can, and should, get this even when you ARE pregnant. You cannot get the flu from the shot. The vaccine protects against the most common flu types, but not all of them, so it is possible to get the vaccination and still get a different flu type, but this is rare—get vaccinated and tell all those around you to be vaccinated.

Whooping cough has increased greatly in this country. If you hav-en’t been vaccinated, try to do this before you are pregnant. It is also very important to encourage those around you, and those who will be around your newborn child, to be vaccinated as well. If you have not

been vaccinated, this will be offered to you after you deliver. Another issue may be German measles. Ask your provider to test you before you get pregnant, but you will definitely be tested during pregnancy. If you are not immune you will be offered the vaccine in the hospital after you deliver.

It is great to know your blood type for many reasons including accidents, donations of blood, and certainly in pregnancy. If you do not know your blood type, you will be tested at one of your first visits to your provider.

Some of the early common signs of pregnancy are of course a missed menstrual cycle. Pregnancy tests that are available over-the-counter are very sensitive and can even pick up a pregnancy as early as 1 week after a missed cycle. Some of the signs you can also look for are breast tenderness, or even a slight increase in size, possibly nausea, and often fatigue. Some women in

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early pregnancy may even notice some light vaginal spotting of blood. This can be consistent with the pregnancy setting up shop in the uterus and occasionally some blood can get loose as this occurs. Even though it may be light, you should call your provider if you notice any blood. Some mild cramping is also common, but if this is of concern be sure to have this checked out.

If you are a smoker, this is a great time to give it up. Smoking has been associated with several problems during pregnancy. You and your baby will benefit from stopping. If your partner smokes, this may be an opportunity for them to give it up as well. If they cannot, asked him not to smoke around you as secondhand smoke also carries some dangers. If you do stop, think how much richer you’ll be as well. I hope it goes without saying that many of the “recreational drugs” are not good for developing babies. Protect your unborn child and stop using these drugs. If addiction is a

problem for other cigarettes or for drug use, your provider can recommend programs to help. Do not be afraid to ask. Remember your providers are on your side.

A good rule of thumb is the healthier that you are, the much better chance you have to not only conceive, but to have a successful, healthy and great outcome for you and your child.

Now that you are pregnant.

You want to do everything right. You want to eat healthy, maintain a good body weight and your obstetrician will tell you about how much to gain for the entire pregnancy. Remember you’re eating for two, but the baby in the early pregnancy is the size of a walnut not the size of the center of a professional football team. Remember the more extra weight you put on during pregnancy the more you have to take off


afterwards to get back to the weight you desire. Excess weight can create several problems that you want to avoid. These include large babies, the possibility of gestational diabetes, and the possibility of high blood pressure.

The worst thing you can do for any pregnancy is for you to have a problem. Women always ask when they have an issue if the treatment will harm the baby. This is an appropriate question and one that should be asked. To put it in perspective, many medications can cause potential harm, but not treating a serious issue can be much more devastating for both the mother and the baby. So, always, always, always wear your seatbelt in the car. In your diet you will want to avoid several of the fish that are mercury containing. It is a good idea is to probably avoid eating raw fish and certain sushi. Cook sushi for the most part can be safe, but check with your doctor as to what fish are an issue, or just use Google

for a comprehensive list. Try not to listen to well-meaning friends who often confuse their Google search with the doctors’ medical degree. If you have a concern, or you heard something that upset you, you should call your obstetrician and voice your concerns. Don’t let these emotions get out of control as many are not a problem as you will find out.

You will have blood work done at one of your very early visits. These tests usually include a blood type and are RH factor. You will be checked for anemia, rubella witchy German measles, often for sexually transmitted diseases, and other tests that you and your provider feel are appropriate. Urine is checked at each visit for sugar and protein. At each visit, you will have your weight and blood pressure evaluated. The uterus is checked for appropriate growth of the pregnancy, and any concerns will be addressed.

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Let’s look at a practical matter about miscarriage. Miscarriages occur in about 20%, or one in five pregnancies. This is an outrageously large number. In the first trimester (which is the first 12 weeks of pregnancy), this is when the majority of miscarriages occur. There is nothing you can do to prevent a miscarriage either, and essentially there’s nothing you can do to cause one. If it were that easy to lose a baby, before abortions were legal, women would

have run in a marathon, would go skydiving or anything else that they thought would help terminate their pregnancy. Unfortunately there’s no stitch, shot or meditation to prevent a miscarriage (there are however some strategies and medications if there are multiple miscarriages in a row). But look on the bright side, 80% of all pregnancies wind up with a perfectly normal and healthy outcome. Please report any bleeding or abnormal cramping to your doctor and they will evaluate you.

Early in pregnancy, usually between six and nine weeks pregnant, an ultrasound (often called a sonogram), will be ordered. If everything is normal, these are a lot of fun, and you will often be given a picture- your first baby picture for your album. There will also be an ultrasound in the second trimester. This looks for the normal growth and development as well as evaluation of the baby’s internal


organs. Many times this ultrasound can determine the sex of the baby. If you do not want to know, please tell the technician not to tell you. Likewise if you want to know, let them know as well at the time of your ultrasound. The sophisticated ultrasounds that are available now can pick up on many abnormalities very early. Ultrasounds can also help you determine a more accurate due date. They become more accurate in the second trimester then in the first trimester. It is not unusual for the first day of the last menstrual cycle to have some inaccuracies as to your due date. Some women will have a longer menstrual cycle than others, and dating a pregnancy by the last menstrual period it is an estimation. The majority of women do not deliver on their exact due date and if you go overdue, your provider will be testing you to make sure that it is safe and healthy for the pregnancy to continue or to determine if delivery should take place sooner rather than later.

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Usually in the second trimester you will be tested for pregnancy related diabetes, or as it is called “gestational diabetes”. Also, in the second trimester or earlier, there are certain genetics testing that are available in the appropriate circumstance. This is something that you and your provider should discuss at your first visit.

You will be prescribed a prenatal vitamin at your first visit with your doctor or midwife. This has a higher dose than the over-the-counter that you were taking up to this point. Medications will be discussed and their safety for you to either discontinue or continue depending on the circumstances.

There are many wonderful books available that talk about your pregnancy and giving wonderful hints. Your provider will probably recommend one or more of these. I’m sure you have friends that will be more than happy to share theirs with you as well.

This is a wonderful time in your life and you should enjoy every second. It is frightening how fast this will go for you.

Enjoy and good luck!A.L.


INTRODUCTION

The birth of your child should be the happiest moment in your life.

You’ve been preparing for your baby for ages; you’ve religiously attended check-ups with a provider you trust, picked out paint for the nursery, bought a crib, and had a baby shower. You cried when you saw your first ultrasound, and now, after waiting for nine months, your precious bundle of joy is finally arriving.

The excitement and wonder you feel for your baby can quickly turn to confusion and fear when something goes wrong during your pregnancy or delivery, or when your child begins to show worrisome symptoms at home. Many parents lovingly, if unnecessarily, fret over the health and development of their baby, and panic at the first sign that something is wrong, even though

many odd behaviors are completely normal, and many children meet developmental milestones at different times. Sadly, sometimes a parent’s worst nightmare turns out to be true; something did go wrong during pregnancy or delivery, and your infant’s abnormal behavior is symptomatic of something much worse.

This book is a resource for parents who are afraid, confused, and worried about the health of their infants. Did something strange happen during your delivery? Have you noticed that your child isn’t smiling? Are they moving strangely or failing to meet developmental milestones? Your child may have suffered a birth injury during pregnancy or delivery, which could lead to serious health issues.

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At Ingerman and Horwitz, we’re here for parents and infants who are struggling to come to terms with birthing injuries. The pain of realizing that your child is different and may struggle with life-long disabilities is devastating and realizing that the healthcare providers you trusted injured your child is a deep betrayal. The grief these families suffer is unimaginable, but we do our best to help them understand their child’s injury, plan for their future, and hold the responsible parties accountable.

About Birth Injuries

A birth injury is damage that occurs to infants before, during, or just after the birthing process, usually while the baby passes through the birth canal. Many infants have minor birth injuries that resolve themselves without treatment, while other injuries are much more serious, and require life-saving intervention and life-long treatment. Serious birth injuries include brain damage, nerve damage, Erb’s Palsy, and Cerebral Palsy. Some birth injuries are fatal.

Injuries vs. Defects

Birthing injuries and birth defects are two very different things. An injury specifically refers to the mechanical harm suffered during delivery, like nerve damage.


A birth defect, or a congenital disorder, refers to damage that happens while an infant is still in the womb. Birth defects have genetic and environ-mental causes, such as infection, chromosomal abnormality, or exposure to toxins like alcohol or smoke. Types of birth defects include heart mur-murs, cleft palates, or Down Syndrome.

What Are The Consequences of Birth Injuries?

The type and severity of birth injury will determine the extent and intensity of care your child will need. Sometimes, an infant may eventually live a normal life. Other times, families need to make drastic changes at home and plan for life-long medical, educational, and social adjustments.

Some children may require Life Care Plans, which estimate costs and accommodations for your child’s injury. Life Care Plans can be necessary and empowering, but expensive. A team of experts, including attorneys, doctors, therapists and financial advisors will determine what physicians and healthcare programs are best suited for your child, educational needs, adaptive equipment, home modifications, necessary medications and medical procedures, applicable therapies, respite care, transportation needs, and more. A Life Care Plan will determine these life-long costs and set goals for your child’s treatment.

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Medical Negligence

We want to trust the experience, knowledge, and responsibility of our healthcare providers, especially those entrusted with the care of our children. Our physicians and nurses do incredible work, but they are human and make mistakes, just like every other professional. These errors may grievously and permanently harm your child. Some preventable mistakes doctors and delivery teams make are:

• Failing to bring in an experienced physician who can handle high-risk pregnancies

• Incorrectly interpreting ultrasounds or other images • Neglecting to monitor the size of an infant in relation to

the size of the birth canal • Failing to recognize and treat maternal infections • Not assuring that the umbilical cord and placenta were

healthy and in their proper positions • Using excessive force during a difficult delivery • Using or prescribing defective medical products


Our doctors are familiar with the causes of birth injuries and have undergone extensive training to both avoid and appropriately respond to them. They are capable and fully responsible for delivering a healthy, happy baby. When a doctor or hospital fails to provide appropriate care, and your child is injured or even dies, your doctor’s actions may be considered medical negligence.

Unfortunately, some hospitals and doctors don’t want to be held accountable for medical negligence and try to sweep birth injuries and wrongful infant deaths under the rug. In the event of medical malpractice, a hospital representative may approach you and offer a settlement, hoping to make the issue go away as quickly and quietly as possible. Do not, under any circumstance, accept such a settlement offer without consulting an attorney. In more extreme situations, hospitals may deny any wrongdoing, and not reveal the real cause of your child’s injury.

Legal Concerns

Who Can File Birth Injury Lawsuits?

The parents or legal guardians of the impacted infant can sue for damages. Some states allow adults who suffered injuries as children to file claims after their 18th birthday. Furthermore, the injured child can personally file a claim until the age of 21.

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When To File

Deciding to file a birth injury or wrongful death lawsuit is a big decision, but you’ll want to as soon as possible, as birth injury and death cases must be filed within each state’s statute of limitations. Statutes of limitations are laws that set the period during which you can file a legal claim, and each state has different statutes depending on the type of case. Some states allow a discovery rule for medical malpractice lawsuits, meaning that the time frame in which you must file a lawsuit began when the birth injury was discovered.

Generally, in Maryland, the statue of limitations is three years. In Pennsylvania, West Virginia and Virginia, it’s two years. Your attorney will be able to determine if your claim falls within your state’s statute of limitations, and will make sure to file on time.

Further, it’s key to file your lawsuit as soon as possible, as waiting to start the legal processes may increase the risk of losing valuable evidence.

What If I Can’t Afford An Attorney?

Most birth injury lawyers work on a contingency fee, meaning you don’t have to pay anything upfront, nor are you responsible for any associated case costs. In fact, your attorney doesn’t get paid until your case is won.


Compensation

Financial support is crucial for families struggling with birth injuries or infant death. Wondering what your compensation will be and when you will receive it is at the top of everyone’s mind when considering a lawsuit. Unfortunately, there is no way to estimate the amount of compensation you may receive. Each case is unique and must be reviewed by experts before an estimate can be made. Fortunately, in most cases, compensation can cover hospital bills, medications, physical and behavioral therapy, coun-seling, special education, and emotional pain and suffering, as well as any future costs or expenses. Do not cease to provide care for you injured child when the lawsuit commences, as compensation may retroactively pay any associated costs.

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What is Cerebral Palsy?

Cerebral Palsy, commonly referred to as CP, is a neurological disorder caused by a brain injury or abnormality that occurs during early childhood brain development. CP causes loss or impairment of motor functions, mainly body movements and muscle coordination.

Cerebral Palsy affects about 500,000 people in the United States and about 17 million people worldwide. The Centers for Disease Control and Prevention (CDC) estimates that 1 in every 323 children in the U.S. have CP. As it is a very complex disorder, no case of CP is alike; there are a variety of types, different symptoms, and signs that range from mild to severe. Each individual with CP experiences unique impairment; the location, number of body parts impacted, the type of movement loss and the extent of disability may all be different.

It is a non-life-threatening condition, and most children live into adult-hood. CP is not contagious and non-communicable, as it’s a one- time injury. It will not cause further brain degeneration, but some symptoms may worsen over time. Unfortunately, there is no cure for CP, so a child will have the condition for the rest of their life.

CEREBRAL PALSY


What Causes CP? Cerebral palsy happens when a child’s brain develops abnormally, or damage occurs during development. This can occur during pregnancy, during delivery, or immediately following birth.

Most cases develop during pregnancy. Any infection in the mother that could interrupt healthy growth and normal development of the brain can triple the risk of a child developing CP. Intrauterine and neonatal injuries, the death of an identical twin, and blood type incompatibility may cause CP. 40-50% of children who develop CP were born prematurely. Multiple-birth infants or babies who are underweight or are more likely to have CP.

Birthing complications account for 10% of CP cases. Usually, these cases are caused by the following birthing injuries:

• Hypoxia (oxygen deprivation)

• Instrument injuries from forceps, vacuum extractions, etc.

• Physical injuries: being dropped, forcefully removed

• A long labor, lasting more than 18 hours.

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Medical Negligence How can you tell if medical negligence caused Cerebral Palsy? Sometimes, medical staff should have taken greater measure to protect an infant during labor. Other times, they should have caught and treated conditions or complications with a pregnancy long before delivery. Frequently, doctors and nurses fail to:

• Monitor and evaluate infant’s heart rate before and after labor and birth

• Detect and correct a prolapsed umbilical cord

• Plan and schedule necessary cesarean sections

• Correctly utilize instruments like forceps and vacuums

Only experts can determine if medical negligence caused CP. Cerebral palsy lawyers, expert witnesses who saw anything peculiar during pregnancy or delivery, and qualified physicians who can testify to the standard of care given to you and your child may determine if your doctor is responsible. If medical negligence caused your child’s CP, you have the right to secure compensation to help you and your child live with the lifelong complications.


Symptoms of Cerebral Palsy

It is important to recognize symptoms of cerebral palsy as quickly as possible. As CP primarily impairs movements, telling symptoms are:

• Poor muscle coordination

• Overly stiff or loose muscles

• Difficulty controlling certain limbs or movements

• Poor posture and balance

• Struggle to sit, crawl, roll over, or walk

• Delayed development in sitting, crawling, rolling over, or walking

• Impaired fine motor skills, such as gripping or picking up objects

Children born with CP may have irregular posture, a small jawbone, spinal curvature, and suffer from seizures. Drooling is common, and may lead to issues with speech and oral infections.

Intellectual disabilities also occur in CP, though the severity changes child to child. Some symptoms include a below average IQ and missing developmental milestones. Remember, every child reaches development milestones at different times, so this symptom alone isn’t enough to accurately diagnose CP.

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Diagnosing Cerebral Palsy

Diagnosing CP takes time; a child could be diagnosed soon after birth, but as symptoms may be delayed, the majority of diagnoses are usually made in the first two years. Milder cases may not present until a child is 3-5 when the brain is more fully developed.

It is crucial that parents understand the potential symptoms of CP and take note. Parents are the most likely to notice issues in their day-to-day care. If you’re worried about your child showing symptoms of CP, observe and record your concerns. Ask yourself:

• When is my child hitting development milestones?

• When does my child reach growth chart standards for height and weight?

• How do their reflexes react?

• Can they focus on and hear caregivers?

• Does their posture and movement seem abnormal?

If your child is exhibiting CP symptoms frequently, call your pediatrician immediately for an assessment. Your doctor will perform a variety of tests. To receive treatment and assistance from benefit programs, an official diagnosis must be made.


Treatment and Assistance Programs

Unfortunately, cerebral palsy has no cure, but there are a variety of treatments that can help manage CP. Much like every case of CP, every treatment plan will be different and adapted to the concerns and needs of each child, which is why it’s so important to seek legal advice. The overarching goals of treatment are to:

• Control pain

• Improve mobility

• Improve communication

• Increase learning capabilities

• Boost independence

• Encourage community engagement

Therapy and adaptive tools are the most common treatments for CP. Behavioral, massage, music, recreational, respiratory, and speech and language therapies are all used to foster functionality, fitness, mobility, and independence. Adaptive tools are proving to be remarkable aids for improving the lives of individuals with CP, and new technology is always emerging. From simple devices such as orthotic devices, walkers, and wheelchairs, to complex technology like eye tracking communication tablets, can help your child thrive.

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Occasionally, surgery is helpful to manage pain and improve mobility. Hearing surgeries may prevent infection and blockage, as well as treat inner ear nerve damage. Children who need consistent pain medication may benefit from a Baclofen pump inserted into the abdominal area. Orthopedic surgery may help control pain and improve mobility for multiple parts of the body. Vision surgery can help repair vision impairment or damage and could improve control over eye movements. Several medications are helpful for a variety of CP complications. Anti-convulsant medication helps control seizures, and anticholinergic medication helps manage drooling and uncontrollable body movements. Muscle relaxants are frequently used to soothe muscle spasms and aches. Assistance programs are incredibly beneficial for children and families living with CP. When your child is diagnosed with CP, ask your doctor about organizations, resources, and support teams that can help you and your child.

Teams of doctors, nurses, lawyers, therapists, and financial advisors can help create a life care plan, which will detail what assistance you and your child need to manage CP throughout their lifetime. An attorney can en-sure that those responsible for causing your child’s CP will be held financially accountable and pay to support your child’s life care plan. Government programs offer resources for child care, education, employment, nutrition, health insurance, and housing. Organizations such as United Cerebral Palsy and the Cerebral Palsy Foundation offer local and national resources, such as information on medical and financial assistance, scholarships, community meetups, reviews for adaptive devices, travel, and transportation, and support groups for caregivers.


Erb-Duchenne Palsy (Erb’s) is a paralysis of an infant’s arm caused by injury to the nerves in their upper arm. The damage caused to an infant’s arm is extensive and complex.

Nerves that join at a point near the baby’s neck - called Erb’s Point - create feeling and movement in a baby’s fingers, hand, and arm. Erb’s Palsy occurs as a lesion at Erb’s point, impairing the spinal cord’s capability to relay messages to the baby’s fingers, hand or arm. There are four types of nerve injuries that may cause Erb’s Palsy, and all of them can occur at the same time. The symptoms are similar for each injury, but the severity of them will powerfully affect treatment and possible recovery.

Avulsion: An avulsions is the most serious type of nerve injury. The nerve is torn completely away from the spinal cord. The body cannot heal this injury, and the nerve cannot be surgically reattached to the spinal cord. Avulsions occur 1-2 times out of every 1,000 births.

Neurapraxia: This is the most common type of neural injury, and occurs when a nerve is stretched and damaged, but not torn. A baby will experience a shock of pain that fires up and down the arm. Luckily, these injuries normally heal themselves within three months.

ERB’S PALSY

What is Erb’s Palsy?

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Neuroma: This stretch injury is more serious than neurapraxia; stretching will damage nerve fibers and healing may cause scar tissue that pressures healthy nerves. These nerves will never totally heal.

Rupture: A rupture occurs when the nerve is ripped apart, torn at the nerve root beyond the spinal cord. This injury will never heal on it’s own, and requires surgery that grafts a spliced nerve from another part of a baby’s body to injured area.

Cause of Erb’s Palsy

Erb’s palsy is caused by prolonged, difficult and abnormal deliveries, namely when a baby is stuck in the birth canal. The baby may be too large, their shoulder may become wedged in the pelvis, their head is too big, the mother’s pelvis is too small, or the baby is in breech position; all of these situations put dangerous pressure on the baby. A wedged shoulder, known as shoulder dystocia, pushes the baby’s head out but keeps the neck vulnerable to the mother’s contractions, which may cut off oxygen to the baby. The delivery team must act quickly to save the infant, and in order to do so, they will perform a variety of maneuvers, many of which exert force on the infant. If these normally life-saving procedures are performed incorrectly and too much force is put on the baby, Erb’s palsy may occur.


Symptoms of Erb’s Palsy

Symptoms of Erb’s Palsy may be immediately clear at birth, or take time to develop. Symptoms differ based on the severity of the infant’s injury, and where the injury occurred. Symptoms include:

• Arm or shoulder paralysis

• Arm awkwardly bent toward body

• Weakness in arm, or impaired reflexes.

• Decreased grip

• Loss of feeling in fingers, hand, and arm.

• Intense/abnormal pain in the arm, shoulder, or neck

• Waiter’s tip deformity; the arm hangs down, the hand is

turned backwards in a ‘waiter’s tip’ formation. This is one

of the most common physical symptoms.

DiagnosisAn early diagnosis is important to effective treatment. Parents who notice potential symptoms of Erb’s Palsy should notify their physician immediately. A doctor may diagnose from observing the child, and follow up with tests, such as:

Computerized Tomography (CT) scans create a precise picture of a child’s spinal cord and nerve roots.

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Electromyography (EMG) will record electrical activity of an infant’s muscles as they move.

Magnetic Resonance Imaging (MRI) will show if a nerve has been ripped from the spinal cord, and can show extended internal damages.

Nerve Conduction Study (NCS) will examine the function and electrical conduction capability of sensory and motor nerves.

Treatment of Erb’s Palsy

Infants may recover from minor injuries over time, under their pediatrician’s watchful care. Other children aren’t so lucky, and their treatment will fall into two categories: surgery, or physical therapy.

In some severe cases of Erb’s Palsy, surgery is the only option. Your physician may recommend nerve graft repairs or nerve decompression. A nerve graft repair splices a healthy nerve from another part of the child with the damaged nerve. Nerve decompression eases the pressure on injured nerves by placing a special surgical instrument at the site of the injury. While surgery is a life-changing option, not all children positively respond to surgery, and may continue to experience life-long issues. Daily, comprehensive physical therapy is the most common treatment for Erb’s palsy. Physical therapy can be demanding for both parents and the infant. Physicians recommend consistent, daily range-of-motion exercises beginning when the baby is three weeks old. A physical therapist will create goals and exercises specific to your baby’s needs.


Legal Concerns

Erb’s Palsy is preventable through your doctor’s fastidious planning and precautionary measures. How can you know if your doctor was medically negligent during your delivery, causing your child’s Erb’s Palsy? An experienced attorney can determine if medical malpractice injured your child, and can walk you through potential financial compensation that can cover costly surgeries and therapies.

Support

Non-profit organizations like United Brachial Plexus Network and Brachial Plexus Palsy Foundation are support networks for parents and children dealing with Erb’s Palsy and other brachial plexus injuries.

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Infant brain damage can occur from a number of medical errors resulting in a child experiencing long-term, or even life-long, neurological and physical problems. Brain injuries are the leading cause of death and disability for American children, especially infants. Infant brain damage may happen during pregnancy, delivery, or after birth.

Causes of Infant Brain Damage

Infant brain damage has a myriad of causes, including but not limited to:

Birth Asphyxia (Oxygen Deprivation)

Also called “hypoxic-ischemic encephalopathy” or “intrapartum asphyxia”, oxygen deprivation happens to 2-10 out of every 1,000 infants. Birth asphyxia is divided into two categories: anoxia and hypoxia. Apoxia happens when a baby has absolutely no oxygen, and hypoxia occurs when a baby lacks an adequate amount of oxygen. The most common causes of birth asphyxia are:

Birth canal problems: a difficult labor may leave a baby lodged in the birth canal. Medical intervention must be immediate, or the baby may suffocate

Blocked airway: when mucous constricts an infant’s airway.

INFANT BRAIN DAMAGE


Placental eruptions: when the uterus and placenta separate too quickly, the infant may suffer from reduced oxygen supply.

Umbilical cord issues: tangled, twisted, or prolapsed umbilical cords can cut off an infant’s oxygen supply. Occasionally, doctors will cut the cord too soon, before a child can breathe on their own.

Jaundice

Infant jaundice is a yellow or greenish skin pigmentation and yellowing of the eyes that occurs when the baby’s blood has too much bilirubin, the yellow-colored pigment of red blood cells. It is a fairly common condition, and treatment isn’t often required. However, bilirubin is toxic to brain cells, and if a baby has severe jaundice, bilirubin might pass into the brain. This is called acute bilirubin encephalopathy. If this condition causes permanent brain damage, kernicterus may occur, resulting in impaired movement, seizures, loss of upward gaze, hearing loss, and in some cases, death.

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Physical Trauma

Unusual use of medical devices such as forceps or vacuums, excessive and forceful pulling, and extended labor may lead to brain damage.

Maternal Infections

Maternal infections are common during pregnancy and birth and are a major cause of infant brain damage, which can occur during both pregnancy and the delivery process. The most prevalent types of brain damaging maternal infections are intrauterine infections and preeclampsia. Intrauterine infections occur within the womb and include infections like cytomegalovirus, herpes, and rubella. Preeclampsia is a pregnancy disorder characterized by high blood pressure and high amounts of urine protein, which leads to restricted blood flow. Reduced blood flow puts babies at a high risk for brain damage.

Symptoms of Infant Brain Damage

Each case of infant brain damage will vary in type and severity, and symptoms may present immediately or become noticeable at developmental milestones. Symptoms may be physical or temperamental. Symptoms include but are not limited to:

• Excessive crying or wailing

• Struggling to sleep while lying down

• Abnormal feeding issues

• Extreme and unwarranted fussiness (continued next page)


Diagnosis and Treatment of Infant Brain Damage

Your doctor will perform a variety of tests to determine how severe your child’s brain damage is. Testing may include an MRI, CT scan, or the Glasgow Coma Scale, which analyzes the conscious state of your baby.

Treatments for infant brain damage might include medication, physical therapy, cognitive rehabilitation, and surgery.

Anti-seizure medications may be prescribed to help control irregular movement and seizures, behavioral medications may help manage aggression, ADD or ADHD, and diuretics may reduce fluid built up in tissue.

• Unusually small head

• Struggle focusing eyes

• Distorted facial features

• Seizures

• Oddly shaped spine

• Neck stiffness

• Delays in crawling, walking, smiling, learning, etc

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Physical and occupational therapy are common treatments for infants who have suffered brain injuries. Physical therapy improves mobility, strength, coordination, and balance. Occupation therapy helps children and adults perform daily tasks, like managing emotional outbursts, and eating, dressing, and grooming themselves independently.



INFANT WRONGFUL DEATH

What is infant wrongful death?

Infant wrongful death is a legal term used for the death of a baby before, during, or after birth caused by medical malpractice. Many cases are preventable and are often caused by negligent healthcare providers and poorly managed hospitals.

What Causes Infant Wrongful Death?

There are major risk factors and potential injuries to consider during your pregnancy and delivery, and the most fatal birth injuries are:

• Antepartum Hemorrhage

• Hypoxia (oxygen deprivation)

• Delivery trauma

• Kernicterus

• Placenta previa

• Placental abruption

• Reduced blood flow

• Spinal cord damage

• Uterine rupture

• Medical tools, such as forceps


Legal Considerations

Examinations

A key question in wrongful death lawsuits asks if death could be avoided by competent medical care for both the infant and mother. Did staff fulfill their responsibilities? Did their actions lead to birth injuries which caused the infant’s death? These are questions of duty of care, meaning that the delivery team was both responsible for your baby’s care and that their actions breached duty of care, resulting in the wrongful death of your infant.

Stillbirths

Stillborn birth is not always considered wrongful death, as physicians and other medical staff are not always to blame. In some cases, the mother has experienced a traumatic event, such as a car accident, that leads to the child’s death.

Typically, an infant must be viable at the time of death for the case to be considered wrongful death. Viability means that the child would be able to survive outside the womb, on their own, but malpractice leads to a stillborn birth.

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Lawsuits and Damages

A wrongful death lawsuit offers support to families overwhelmed by grief and the unforeseen expenses of a baby’s death. Hospital bills, funeral costs, grief counseling, and other unpredictable expenditures add up quickly and can financially devastate an already distressed family. Damages awarded in a wrongful death case can cover both economic and emotional damages, such as hospital bills, medications, loss of income, emotional trauma, loss of potential love and companionship, and the pain your infant suffered during delivery and death. Calculating these losses, and thus your compensation, is complicated, so it’s difficult to estimate exactly how much you will receive beforehand.

A lawsuit also gives grieving families real justice by holding the responsible parties accountable, and in some cases, forces hospitals to make life-saving procedural changes, so other families will not have to suffer as you have.

Choosing to file a wrongful death lawsuit is an important decision, and it may take time to determine if it’s the right choice for your family. As you explore your options, be sure to check on the statute of limitations in your state. Some states, like Maryland, offer up to three years for a family to file a wrongful death lawsuit, while others, like the District of Columbia, only allow a year.


Support

Support groups are critical for families struggling to deal with the death of their infant. It takes incredible strength to attend a support group, but you are not expected to discuss your grief or any legal processes openly. Sometimes, it’s soothing just to listen and empathize with another’s story. A support group may help guide you through the grieving process and reassure you that you are not alone in your experience. Hospital staff, a therapist, or your attorney can help you find a support group right for you.

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INFANT INJURIES CAUSED BY DEFECTIVE

MEDICAL PRODUCTSOccasionally, life-saving medical devices can cause unintended harm to your child. Medical devices that could save or improve your child’s life may have defects that prevent safe and proper utilization, leading to infant injury or even death. Infants who are injured by medical devices may need corrective surgeries, continuous medical care, and potentially therapy. Some serious injuries caused by defective products are:

• Asphyxiation

• Burns

• Choking

• Cuts

• Death

• Loss of limbs

• Strangulation

• Suffocation

These injuries may be caused by defective products such as:

• Medical devices

• Continuous positive airway pressure (CPAP) systems, meant to help infants breathe

• Tracheostomy tubes

• Infant medications

• Medications that lead to birth defects


All medical devices must be approved by the U.S. Food and Drug Administration (FDA) before they are sold in the United States. Unfortunately, this doesn’t guarantee that these devices are foolproof; they suffer manufacturer defects just like all other products. Product issues and side effects may be discovered after the product has been on the market.

Manufacturers are required to report medical device defects and potential dangers to the FDA and consumers, and may even pull defective products from the market. A manufacturer who fails to warn both the public and FDA can be considered negligent, and the company may be liable for any damages, illness, or even deaths that result from the product defect.

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We hope that you’ve found this information

helpful and informative. If you have any

questions or concerns, please do not

hesitate to contact us- we’re always here to

help. As you embark on this new chapter

in your lives, we wish you a happy, healthy,

and successful pregnancy.

Call us now for a free consultation:

Toll-free 1-855-LAW-4-YOU

Learn more at:

www.ihlaw.com

A Guide to a Healthy Pregnancy & Understanding Birth Injuries is a resource for families who are afraid, confused, and worried about the health of their infant, and wonder if their child has suffered a birth injury.

At Ingerman and Horwitz, we believe that education is key to helping parents understand birth injuries. We’ve put this book together as a guide for families to learn about injuries and how to seek help for their children. You’ll learn what birth injuries are; the most common causes such as brain damage and defective products; resulting in disorders such as Cerebral Palsy and Erb’s Palsy, and how to cope with infant wrongful death. We also walk you through legal concerns; how medical negligance may have led to your child’s injury, how to file a birth injury lawsuit, costs, and compensation. If you have any questions, or wish to explore legal options, please contact us today.


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