Birth injury series - caesarean section

If fetal distress is identified during labour or some other obstetric emergency occurs then an emergency caesarean section may need to be performed. This involves making a cut in the front wall of a woman’s abdomen (tummy) through to her uterus (womb) from which the baby is carefully removed.

Delays in making the right decision about how a baby should be delivered and whether a caesarean section should be performed can result in the baby suffering irreversible brain damage.

There are three stages of labour and each stage must be managed with care by the maternity staff, to ensure that mother and baby remain safe and healthy. Labours can become prolonged (longer than expected) and progress can be slow for a variety of reasons. The ability of the unborn baby to withstand the rigours of labour will lessen over time and it is vital that the unborn baby’s condition is carefully monitored, particularly where the labour has been induced (artificially started with drugs).

Staff should be alert and quick to recognise any abnormalities in the labour, as it can sometimes be in the interests of both the mother and baby for the baby to be delivered by an emergency caesarean section.

Emergency situations which may require delivery by a C-section include some of the following situations:

• Pelvic disproportion (the mother’s pelvis is not wide enough to permit the baby to be delivered safely)
• Abruption of the placenta (where the placenta detaches from the wall of the uterus before the baby is born)
• Placenta praevia (where the placenta is situated very low on the uterine wall, either completely or partially obstructing the cervix (the opening of the womb)
• Cord prolapse (where the umbilical cord slips or falls out of place and becomes squashed)
• The position of the baby in the uterus is not ideal, such as in the breech position (bottom first)
• Fetal distress in labour is identified (the babies heart rate is identified as being low or slow to recover following contractions),
• or very slow progress occurs in labour
• When there has been a failed attempt at a forceps or ventouse delivery (instruments used to assist the delivery of the baby)
• Uterine rupture (where the uterus opens, usually at the site of a previous c-section scar)

Delay in performing an emergency caesarean section when one is required can lead to the unborn baby being deprived of oxygen for too long. Brain damage can occur when the baby has been repeatedly, but not always continuously, deprived of oxygen over a period of time (sometimes referred to as chronic or partial hypoxia), or when an acute event happens such as a cord prolapse resulting in sudden and near total acute hypoxia (lack of oxygen). Injuries resulting from lack of oxygen of this kind can result in a clinical diagnosis of cerebral palsy as the child develops.

It is not always immediately apparent that a baby has been damaged however as the brain injury may only become clear as the baby’s tiny brain further develops after birth. Signs that all may not be well at the time of birth include poor Apgar scores (The Apgar score is a simple check used by midwives and doctors to assess a newborn baby’s health. The results of the check are given as a score out of ten – the lower the score the poorer the outcome is likely to be), or the baby suffers from fits shortly after birth, or requires ventilation (artificial help breathing).

If any of these events occur and your baby develops cerebral palsy this may be as a result of a mistake being made by the doctors/midwives at the time of birth, but this is not always the case. Cerebral palsy can occur for a variety of reasons and in some cases the cause is never established and no one is to blame. If however you think that your baby has suffered an injury because the birth was not managed well then you may wish to seek legal advice.

This blog first appeared in At Home Magazine.

Further information

For more information, please visit our page on Cerebral Palsy and Birth Injury. You may also be interested in reading some of our other blogs on this topic, including; 

• Birth injury series - Cerebral palsy and brain damage
• Birth injury series - Fetal distress
• Birth injury series - Erb’s palsy or brachial plexus injuries
• Birth injury series - assisted or instrumental delivery
• Birth injury series - jaundice and kernicterus
• Home birth v hospital birth – which is safer? The debate continues

Kingsley Napley is experienced in acting in clinical negligence claims relating birth injuries. If you would like advice, please contact the Clinical Negligence and Personal Injury team on 020 7814 1200 or by emailing us at clinnegenquiries@kingsleynapley.co.uk.