Vaginal births comprise almost 70% of the births in the United States annually. Although most vaginal childbirth occurs without incident, at times, vaginal delivery becomes an operative procedure with the use of a vacuum extractor or forceps. Forceps deliveries have declined over the past few years, but a significant percentage of vaginal births are still accomplished with the use of either forceps or a vacuum extractor.
If your baby was delivered using either of these methods, a Washington, D.C. forceps injury attorney can help. LawMD has represented numerous clients who have been injured or whose children were injured by the negligent use of forceps and/or vacuum extractors.
Forceps are utilized in obstetrics to attempt to maneuver a child through the birth process if they are experiencing one of many potential problems of movement or position. Breech presentations, shoulder dystocia, and situations in which the child’s head will not pass easily through the birth canal may all prompt the use of forceps. Typically, they are used because the benefits exceed the risks in the attending physician’s estimation.
In many cases today, physicians will preempt a difficult delivery (if it can be foreseen) by scheduling a caesarean section. However, although we would all wish that childbirth was predictable and routinely ended with a joyful celebration of new life, the fact remains that difficulties in delivery cannot always be predicted, and forceps are sometimes used to deliver a healthy baby while avoiding any maternal injury.
Unfortunately, some physicians do not use forceps properly, whether because of a lack of ability or knowledge, or perhaps because of negligence. The results can be devastating to either mother or child.
Maternal injuries after childbirth may occur due simply to the significant stress of childbirth on the mother. However, if the physician miscalculates his/her use of forceps, it may result in long-term health problems for the mother. These problems include an entire spectrum of injuries, ranging from the grave condition of uterine rupture, which is life-threatening, to perineal injuries. Prolapse of the pelvic organs may occur as a result of damage to ligaments or muscles. There may be injuries to the urethra or bladder, causing infection or incontinence. Fecal incontinence in the mother may sometimes occur if the forceps are inappropriately placed. Blood loss and infection may be transient or can result in a series of unfortunate events that could even end in death.
Injuries to the infant from use of forceps often have tragic results. There are head injuries that have left infants functionally disabled for life as the result of poorly applied forceps used to aid in delivery of the head. These injuries may range from skull fractures to permanent brain damage to disfigurement and damage to the facial nerve. Years of medical treatment will follow in these cases.
Shoulder dystocia has been treated with forceps delivery and in more than a few cases, there has been damage, including avulsion injuries, which leave the infant with a paralysis of the extremity.
Conditions that may necessitate the use of forceps include macrosomia (a large fetus), malpresentation, or failure to progress in labor. Some of these conditions can be anticipated with good prenatal care.
A vacuum extraction procedure is often indicated when the infant fails to progress through the birth canal during the second stage of labor, which begins when the cervix thins and dilates to four centimeters. The vacuum pump is also indicated when delivery is underway and the fetus is in distress.
If the mother is unable to make an adequate effort at expulsion, is exhausted, or failing to cooperate, these are relative indications. However, the technique is not always successful, and a caesarean section is sometimes required to deliver the child.
The delivering physician applies a soft or a rigid cup with a handle and a vacuum pump, which is then used to assist delivery of the infant’s head through the birth canal as the mother is having a contraction.
There are definite risks both to the mother and child as a result of using a vacuum extractor. Poor outcomes or injury may occur if the cup is not correctly placed on the infant’s head. Permanent scarring may result from bleeding or swelling on the face, as a result. Because the skull is not fused, there is more risk of injury to the brain. A physician may use excessive force on the head of the infant, causing injury to the brachial plexus, which is an important nerve bundle that enervates the arm. Inappropriate maneuvers, such as twisting the infant’s head or neck, may result in Erb’s palsy, a disorder of the upper trunk of the brachial plexus.
Should the vacuum extractor fail to work, the physician must perform a caesarean section or the infant will be deprived of oxygen, and this can cause devastating injuries, both neurological and cognitive. Death may occur for this reason, or because of faulty equipment. An excess of suction may result in either skull fracture or intracranial hemorrhage. Normally, the physician will attempt other manual maneuvers first.
Contraindications to use of vacuum extraction include pre-term infants (generally accepted as less than 34 weeks gestation) or neonates with prenatal defects of injury to the skull revealed by ultrasound. Delivery by vacuum extraction has no place when labor is progressing normally.
Vacuum extraction is also not appropriate when the infant is high in the pelvis. The mother should be pushing. Relative contraindications include active bleeding, an incompletely dilated cervix, malpresentation, a large infant (macrosomia), or cephalopelvic proportions. In these cases, the risks and benefits must be carefully weighed.
Because there are risks and benefits under any circumstance when assisted delivery is required, including forceps delivery, caesarean section, and vacuum extraction, the mother must be given the opportunity to weigh the risks and benefits and give informed consent.
If you or your child has experienced an injury from improper use of forceps or a vacuum extractor during delivery, you may be entitled to assistance for the ensuing years of medical treatment that may be required. If the midwife or physician is responsible, you may be entitled to compensation. You may simply want to discuss the events of the delivery with a trained and objective professional.
With medical doctors on staff, LawMD may be able to assist you in obtaining an understanding of a tragic event and potentially enable you to receive compensation for any negligence if present. If your child has suffered an injury that may be due to negligence, the legal and medical professionals at LawMD may be able to assist you.