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Guide to birth injuries and claims

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Posted by Jeanette Whyman on 18 July 2016

Jeanette Whyman - Medical Negligence Solicitor
Jeanette Whyman Partner - Head of Medical Neglience

Being pregnant and looking forward to the birth of your baby is a unique experience. Becoming a parent is one of the precious moments in a person’s life and most of us will anticipate the event with an equal mixture of trepidation and excitement.

Although in the past giving birth was a dangerous time in a woman’s life, the enormous advances in obstetric care mean that the vast majority of babies born in the developed world are delivered safely with no lasting physical harm to mother or baby. Nonetheless, complications can, and do, arise which have lasting effects and this guide is here to help you if you or your baby has suffered from a birth-related injury or medical negligence.

 

Caput succedaneum

Definition

“A diffuse swelling of the scalp in a newborn, usually caused by the trauma of the scalp pushing through a narrowed cervix during birth. The swelling may extend across the midline of the scalp and may exhibit discoloration or bruising”

(source: Family Practice Notebook)

This condition is usually harmless. It is where the scalp of the infant swells and a bump or lump can appear on the infants head shortly after being delivered. It is not present in all births and more common after the membranes have broken because the amniotic sac is no longer there to support and cushion the baby’s head. It commonly occurs in deliveries that are difficult or long.

Treatment is not usually needed for the condition as it resolves itself in a matter of days. A doctor or midwife may perform an initial examination to check for jaundice which can be associated with Caput succedaneum. If quickly and correctly treated jaundice poses no harm to your baby but can lead to serious complications if left untreated.

Information and support

Symptoms

  • The baby’s head may appear swollen, soft and puffy and may appear bruised or discoloured.
  • The section of the head presented first is usually most affected.

Sources - 

http://dxline.info/diseases/caput-succedaneum/

http://www.fpnotebook.com/nicu/neuro/CptScdnm.htm

Jaundice

Jaundice is very common in new borns and it is recognised by the yellowing of the skin caused by the baby producing too much bilirubin. It is easily spotted by the medical team and can be quickly and simply treated using phototherapy. In more stubborn cases a blood transfusion may be necessary although this is rare.

Kernicterus is an incredibly rare form of damage to the brain which is caused by excessively high levels of bilirubin. If jaundice is not recognised or treated appropriately and in a timely manner then it can progress to kernicterus.

Information and support

Symptoms

The symptoms of jaundice are usually the colouring of the baby’s skin and whites of the baby’s eye which will appear yellowish.

For the kernicterus the symptoms can be more difficult to identify but may include:

  • A high degree of jaundice.
  • The startle reflex is missing.
  • The baby suckles poorly
  • The baby seems overly sleepy and has low muscle tone. 

Support

Stories and case studies

Sources - 

https://www.nlm.nih.gov/medlineplus/ency/article/007309.htm

Obstetric fistula

Definition

“An obstetric fistula is a hole between the vagina and rectum or bladder that is caused by prolonged obstructed labour”

(source: Fistula Foundation)

Obstetric fistula (or vaginal fistula) is almost entirely preventable. It is a condition that occurs after a traumatic and prolonged childbirth where a hole (fistula) develops between with the vagina and bladder or the rectum and vagina. It tends to occur during a Caesarean section, particularly if performed in an emergency. The injury can be treated with surgery in some instances. However, it can leave women with urinary and rectal incontinence as well as difficulty and pain during sex.

Although the injury is very rare in Europe and America, there are a handful of instances each year By contrast, in the developing world an estimated 2 million women in sub-Saharan Africa, Asia, the Arab region, Latin America and the Caribbean are living with this injury, and some 50,000 to 100,000 new cases develop each year.

Information and support

Symptoms

  • Ongoing flatulence
  • Odorous vaginal discharge
  • Recurring urinary or vaginal infections
  • Vaginal pain or irritation, including during sex 

Support

 

Case studies and stories

Sources - 

https://en.wikipedia.org/wiki/Obstetric_fistula

https://www.fistulafoundation.org/what-is-fistula/

Broken bones and fractures

Broken bones and fractures tend to occur when the baby is under severe distress but, in most cases, proper medical care and appropriate intervention will prevent fractures from occurring.  A doctor or midwife will monitor the baby for signs of distress and if necessary perform a emergency caesarean.

Reasons why fractures occur can include a large baby who struggles to pass through its mother’s cervix (cephalopelvic disorder (CPD) or a midwife or doctor may apply too much force, or the wrong technique, when trying to deliver the baby , particularly if using forceps which can increase the risk of injury to the mother and baby.

Furthermore a mis-managed delivery can result in a baby developing nerve injuries such as brachial plexus injuries. This type of injury can be avoided by performing an emergency caesarean. 

Information and support

Symptoms

  • The area may be swollen and painful
  • There may be signs of bruising,  redness and / or inflammation
  • The baby may not be able to move the fractured.
  • The affected limb may seem deformed 

Support

Sources - 

http://www.birthinjuryguide.org/birth-injury/types/infant-broken-bones/

Skull fractures

When a baby is born the skull isn’t fully formed. The plates that make up the skull are yet to fuse together and become a single piece of bone which makes them vulnerable to injury. There are four types of skull fracture that can happen during the birth of ar baby: linear fractures, diastatic skull fractures, depressed skull fractures and basilar skull fractures. In most instances the fractures are recognised and resolved by the attendant medical team. If a fracture has been missed it can cause brain bleeds which can be fatal. 

Linear fractures

A linear fracture occurs where one of the bones breaks but doesn’t move, it causes minimal harm to the baby and usually resolves itself without any medical intervention.

Diastatic skull fractures

A diastatic skull fracture occurs along the suture lines of the skull which is where the bones will eventually fuse together as the baby grows. If a baby has a diastatic skull fracture the suture lines will be widened until they heal and fuse together.

Depressed skull fractures

A more serious fracture to the skull is a depressed fracture, which can appear with or without a cut on the scalp; these are caused by the sinking of the skull due to trauma. If any area of the skull is pushing into the brain then medical intervention and surgery will be needed to resolve the issue.

Basilar skull fractures

A basilar fracture occurs when a bone at the base of the skull breaks. The first symptom of this in children is usually bruising around the eyes and ears. There may also be a clear fluid discharging from the nose or ears if the fracture has damaged the covering of the brain.

Some skull fractures happen naturally during the process of labour and birth. During the delivery there is a significant amount of pressure on the baby from either side of the birth canal. Skull fractures can also occur from the incorrect use of forceps and the ventouse cap.

Information and support

Symptoms

The symptoms of skull fractures vary greatly depending on the type of fracture. They can include:

  • Bruising to the face
  • Pain and sensitivity to the fractured area
  • Bleeding from the nose and/or ears

 

Stories and case studies

Sources - 

http://www.cerebralpalsysymptoms.com/birth-injury/skull-fracture/symptoms /

Subconjunctival haemorrhage 

Definition

“Subconjunctival haemorrhage is bleeding underneath the conjunctiva”

(source: Wikipedia)

Subconjunctival haemorrhage is caused by burst blood vessels leaving the whites of the baby’s eyes bleeding. In the case of childbirth the injury usually occurs during a difficult labour and delivery.It usually resolves itself in a few weeks without any medical intervention. However, it is important that a doctor or midwife checks the baby for any other signs of trauma. 

Information and support

Symptoms

Usually the only symptom of subconjunctival haemorrhage is the physical appearance of blood and redness in the whites of the eyes. 

Sources - 

http://www.allaboutvision.com/conditions/hemorrhage.htm

https://en.wikipedia.org/wiki/Subconjunctival_hemorrhage

Retained Placenta

Definition

“A retained placenta is where the placenta or part of the placenta remains in your womb for over an hour after the birth of your baby”

If left untreated, a retained placenta can cause postpartum haemorrhage, a life threatening condition and the third leading cause of maternal mortality in the UK. A retained placenta can cause excessive blood loss which is dangerous if left undiagnosed and untreated. 

There are three types of retained placenta: 

Placenta adherens

Placenta adherens, the most common type of retained placenta,  occurs when the placenta remains attached to the uterine wall rather than being expelled as afterbirth. 

Trapped placenta

A placenta which detaches from the uterine wall but is not expelled is known as a trapped placenta. This tends to happen if the cervix starts to close before the placenta can be expelled.

Placenta accreta

Placenta accreta occurs when the placenta attaches to the muscular layer of the uterine wall rather than the lining. Delivery is much more difficult and excessive bleeding can occur, which may necessitate a blood transfusion or, in the worse cases, a hysterectomy. 

Information and support

Symptoms

  • Severe blood loss
  • Stomach cramps
  • Foul smelling vaginal discharge
  • Fever
  • Absence of breastmilk

 

Stories and case studies

Sources - 

http://www.babycentre.co.uk/a562148/retained-placenta
http://patient.info/doctor/retained-placenta
http://www.healthline.com/health/pregnancy/complications-retained-placenta#Types2

Pre-eclampsia

Definition

“Pre-eclampsia causes the blood flow from the placenta to be reduced which can mean a lack of oxygen to the baby”

One in every 200 pregnant women will develop pre-eclampsia.

Pre-eclampsia or preeclampsia (PE) is a condition that occurs during pregnancy; the symptoms include high blood pressure and greatly increased levels of protein in the urine. If pre-eclampsia is left untreated it can be dangerous for  both the mother and baby. Pre-eclampsia reduces the blood flow from the placenta which can prevent oxygen reaching the baby. Pre-eclampsia is defined on a scale on one to three from mild to severe; the treatment depends on the severity.

Women suffering from  mild pre-eclampsia are likely to be treated in outpatients with rest and regular blood and blood pressure tests. Moderate to severe pre-eclampsia will need regular monitoring, medication and possible ultrasounds to monitor mother  and your baby probably requiring a  hospital stay until the  condition stabilises.

Complications from pre-eclampsia are rare but can include kidney and liver failure, stroke, fluid in the lungs and, in extremely rare cases, HELLP syndrome, a blood clotting and liver disorder. 

Information and support

Symptoms

  • Swollen face, hands, ankles and feet
  • Fluid retention
  • Intense headache
  • Problems with vision
  • Discomfort or soreness below the ribs 

Support

Stories and case studies

Sources - 

http://www.babycentre.co.uk/a257/pre-eclampsia
http://www.pre-eclampsia.co.uk/

Placental Abruption

Definition

“Placental abruption is where the placenta or part of it starts to detach from the womb during pregnancy”

Placental abruption impacts approximately one in 100 pregnancies but in the vast majority of cases, it is treated successfully without any harm to either the mother or baby.

Placental abruption is where the placenta, or part of, starts to detach from the womb during pregnancy. This can result in  the baby notreceiving enough oxygen or nutrients. Placental abruption often increases the risk of the baby being born early and can lead to severe blood loss, endangering the lives of both mother and baby. Diagnosis usually involves an ultrasound, blood tests and monitoring of the baby.

Information and support

Symptoms

The symptoms of placental are quite vague but it you experience any of the things below it is important you seek medical advice.

  • Bleeding or spotting from the vagina
  • Blood in the fluid when your  waters break
  • Soreness  or pain in your stomach
  • Pain or discomfort in your back
  • Recurrent contractions, or a continuous contraction
  • The baby moves less 

Support

Stories and case studies

Sources - 

http://www.babycentre.co.uk/a1024974/placental-abruption/

Placenta previa (placenta praevia)

Definition

“Placenta previa is a condition where the placenta grows in the lowest part of the womb, the uterus, it partially or completely covers the opening to the cervix and therefore can cause complications during birth”

(source: Medline Plus)

It’s not uncommon for the placenta to start off in the lower part of the womb but as the pregnancy develops it moves up to allow a clear pathway to the cervix and the safe delivery of the baby.

The bleeding caused by placenta previa can be life threatening to both the mother and baby if not identified and treated correctly. The majority of babies are delivered by caesarean because a vaginal delivery runs the risk of excessive blood loss, potentially endangering the life of the mother.  In some extreme cases the baby may need to be delivered early, although only as a last resort in case the baby’s organs are not fully developed. 

Information and support

Symptoms

  • Sudden vaginal bleeding
  • Stomach cramps

Support

Stories and case studies

Sources - 

https://www.nlm.nih.gov/medlineplus/ency/article/000900.htm

Prolapsed Umbilical Cords

Definition

“A prolapsed umbilical cord is where the umbilical cord comes out of the uterus before the presenting part of the baby”

(source: Wikipedia)

A prolapsed umbilical cord is very rare only affecting approximately 1% of pregnancies, in less than 10% of cases it results in the death of the baby. It can become an issue when the umbilical cord becomes squashed or compressed because it stops the blood flow to the baby which can be life threatening if it is not addressed quickly.

A prolapsed umbilical cord is a medical emergency where in most instances an emergency caesarean is necessary. If not treated quickly, the compression of the cord between the baby and the mother’s pelvis can lead to fetal hypoxia.

There are two types of umbilical prolapse that can occur:

  • overt umbilical cord prolapse: this is the commonest form of cord prolapse where the umbilical cord protrudes beyond the baby, through the cervix, into the vagina and sometimes beyond. Membranes are usually ruptured. 

  • occult umbilical prolapse: this occurs when the cord has slipped alongside the  baby but has not gone beyond the presenting part. Again, membranes are usually ruptured.

Information and support

Symptoms

  • The heartrate of the baby will suddenly drop and does not quickly improve.
  • The umbilical cord is visible or can be  felt on vaginal examination

Stories and case studies

Sources - 

https://en.wikipedia.org/wiki/Umbilical_cord_prolapse

PROM (Premature Rupture of Membranes) or PPROM (preterm) or SPROM (spontaneous)

Definition

“PPROM is the premature rupture of waters (amniotic sac) during pregnancy”

There are three causes of neonatal death that have been associated with premature rupture, including umbilical cord prolapse, placental abruption and oligohydramnios (where there is not enough amniotic fluid) which can affect the growth of the baby or even lead to perinatal death. The earlier in the pregnancy these events occur the poorer the prognosis is for the baby.

One serious risk of PPROM (preterm premature rupture of membranes) is chorioamnionitis, an infection of the placenta that can be extremely dangerous to both mother and baby.

The seriousness of PPROM depends on how far advanced the pregnancy is. In the early stages of pregnancy it can result in the death of the baby. Once past 37 weeks it is usually considered fairly minor and shouldn’t pose any problems for either the mother or baby.

It is hard to pinpoint the exact cause of PPROM; there are some known causes which include:

  • Infection within the womb
  • Distension or a ballooning effect of the uterus and amniotic sac.
  • External trauma

Information and support

Symptoms

  • Amniotic fluid leaking from the vagina

Support

Stories and case studies

Sources - 

http://www.pregnancycorner.com/giving-birth/complications/pprom.html
http://www.webmd.com/baby/tc/preterm-premature-rupture-of-membranes-pprom-topic-overview

Chorioamnionitis (intra-amniotic infection)

Definition

“Chorioamnionitis is a bacterial infection that can occur during pregnancy, it specifically affects the outer membrane that protects the foetus”

(source: Healthline)

The condition if not closely monitored can result in a premature birth and serious complications for both the mother and baby. In most instances antibiotics will successfully treat the condition however, the more premature the baby, the greater the risks. Chorioamnionitis can lead to serious complications for the baby, including meningitis, and an infection of the lining of the brain and spinal cord. Fewer than 1% of babies delivered full term will be affected.

Information and support

Symptoms

  • A high or elevated temperature
  • A high or rapid heartbeat
  • Tenderness of the uterus
  • A discharge from the vagina which may be odorous or discoloured

Stories and case studies

Sources - 

http://www.healthline.com/health/pregnancy/infections-chorioamnionitis#Causes2

Meconium aspiration syndrome

Definition

“Meconium aspiration syndrome is a condition that occurs during birth where the baby’s lungs fill up with meconium (the dark green substance forming the first faeces of a newborn) and amniotic fluid that they breathe in before or during the delivery”

It can be a life threatening condition because it can block the baby’s airways, although in most cases it is not this serious if treated promptly by doctors and midwives.

If the baby’s meconium is thick or lumpy, their airways will be checked by the midwife and, if necessary, cleared using suction by the medical team. They will be monitored for up to 24 hours after the delivery. In some cases the baby may need to be put on a ventilator. If the meconium is discoloured but not thick or the baby shows any of the symptoms below they will be monitored every two hours for up to twelve hours after the birth.

Information and support

Symptoms

  • The amniotic fluid may be dark green 
  • Staining of the baby’s skin at birth.
  • The baby may appear limp
  • Laboured, rapid or abnormal breathing

Stories and case studies

Sources - 

http://patient.info/doctor/meconium-aspiration

Group B strep infection (GBS or group B streptococcus)

Definition

“Group B strep are bacteria found normally in the intestine, vagina, and rectal area in about 25% of all healthy women. Group B strep infections can affect newborn babies”

(source: MedicineNet)

Group B strep is a common bacteria which rarely causes any problems. It is estimated about one pregnant woman in five in the UK carries GBS in their digestive system or vagina.

During pregnancy, particularly during labour and birth, many babies come into contact with GBS bacteria. The vast majority are not affected, but a small amount become infected. 

Although GBS infection in newborn babies can cause serious complications which can be life threatening, this is not common as the majority of babies are successfully treated. Nonetheless, approximately one in 10 babies born with GBS will die, and one in five babies with GBS infection will survive but be permanently affected.

In extremely rare cases, during pregnancy GBS infection can cause a miscarriage, premature labour, or a stillbirth.

Although routine testing is carried out between 35 and 38 weeks in a number of countries including Australia, Canada, France, Germany and the USA, it is not routine in the UK for two main reasons: first, as testing is typically carried out three to five weeks before the due date, it cannot predict whether or not the woman will still be carrying GBS by the time she goes into labour; and second, the unreliability of the test results would mean many women being given antibiotics unnecessarily, contributing to the current overuse of antibiotics and fears of antibiotic resistance. Campaigners are trying to raise awareness of the condition and are pressing the UK authorities to change their stance on testing.

Information and support

Symptoms

  • The baby may appear limp, unresponsive, and struggles to feed properly   
  • The baby seems irritable, grunts and is prone to seizures
  • The baby’s temperature is either too high or too low and their breathing and heart rate are too fast or too slow. 

Support

Sources - 

http://www.nhs.uk/chq/pages/2037.aspx?categoryid=54
http://www.medicinenet.com/group_b_strep/article.htm

Epidural birth injuries

Epidural anaesthesia is the injection of an anaesthetic into the epidural space of the spinal cord to lessen the pain of child birth whilst maintaining the natural process and experience for the mother. It works by numbing the pain nerves in the spinal cord to reduce the feelings in the chest and lower body, the pain levels are determined by the amount of anaesthetic given.

An epidural is a frequently used procedure and is a successful in most cases. However issues can arise including nerve damage which can be temporary or permanent. In rare cases (around 1 in 100) the dura, which is the outer layer of the spinal cord, is punctured.

Other more common issues arise when the mother doesn’t give consent for the procedure, the anaesthetic is not correctly monitored or the wrong type of anaesthetic is used by the medical team which can cause a sudden drop in blood pressure, seizures, fever, severe changes in the baby’s heart rhythm, and respiratory issues for the baby. There is also an increased risk of vacuum extraction or forceps being used in the delivery which can lead to further problems. 

Information and support

Support

Stories and case studies

Forceps delivery and vacuum-extraction injuries

Forceps have been used to deliver babies for many years, in most instances, without causing damage or long term injuries to either the mother or baby. The medical team use forceps to hold the baby’s head  to help it gently slide from the birth canal. Before using forceps, a doctor needs to ensure that the  baby is engaged in the correct position in the pelvis and that the mother is fully dilated or serious complications can arise. 

In many cases light bruising or cuts to the baby can be seen where the pressure has been placed but these will normally  disappear within a few days and are generally not a cause for concern.

Over the last twenty years vacuum delivery has been used by midwives and doctors to help deliver babies.  The ventouse cap is placed on the baby’s head and suction is used to extract the baby from the womb. It is widely considered to be safer than using forceps, although severe and even fatal injuries have occurred during the use of the ventouse cap. 

Brain bleeds

Cephalohaematoma

Cephalohaematoma is an injury that can be occur when using forceps; it is bleeding under the skin between the baby’s skull and periosteum (vascular connective tissue) due to the pressure placed on the skull during the birth. Although not common, there may also be an underlying skull fracture. Generally speaking,  a cephalohaematoma rarely s causs the baby any long term problems.  

Subgaleal haematoma

Subgaleal haematoma is bleeding on the brain. It can be caused in the same way as cephalohaematoma following pressure is applied by the forceps. In extremely rare cases of birth complications subgaleal hemorrhage can be fatal. The symptoms of subgaleal haemorrhage can take several days to appear. 

Information and support

Symptoms

Cephalohaematoma Symptoms

  • The only real symptom is an unnatural bulge on the baby’s head.

Subgaleal haematoma

Support

Stories and case studies

Sources - 

http://www.seattlechildrens.org/healthcare-professionals/education/neonatal-nursing-education-briefs/subgaleal-hemorrhage/

Bells’ palsy

Definition

“Bell's palsy is a condition that causes weakness or paralysis of the muscles in one side of the face”

(source: NHS)

Bell’s palsy is a facial nerve palsy named after the doctor who discovered the link between facial paralysis and the seventh cranial nerve. In cases of birth trauma it is caused when a certain facial nerve (seventh cranial nerve) is put under pressure just before or during delivery, causing the loss of facial movement on the baby’s face. In many instances the cause is unknown but there is evidence that the use of forceps increases the risk of nerve damage. The nerve tends to affect the lower part of the face and mouth and becomes apparent  when the baby tries to cry.

The outlook for babies with the condition is good, in most cases the symptoms and facial paralysis disappear of their own accord within a few months of birth. In cases where there is permanent damage and paralysis ongoing therapy may be needed. 

Information and support

Symptoms

  • The eyelid on the affected side of the face may not close
  • The lower part of the face may appear uneven or nonsymmetrical , particularly when crying
  • he mouth doesn’t move the same way on both sides.
  • There may be no movement and complete paralysis on the side of the face affected. 

Support

Sources - 

https://www.nlm.nih.gov/medlineplus/ency/article/001425.htm/
http://www.nhs.uk/conditions/bells-palsy/Pages/Introduction.aspx

Brachial plexus injury

Definition

“The brachial plexus an injury to the network of intertwined nerves that control movement and sensation in the arm and hand”

(source: OrthoInfo)

The brachial plexus is a series of nerves running from the spine near the neck and shoulders which sends signals to your shoulders, arms, hands and fingers. In simple terms a brachial plexus injury (also known as Erb's Palsy) is an injury to those nerves. Brachial plexus injuries during birth can be caused by many factors including trauma as the baby moves through the birth canal, excessive force on the baby’s shoulders when being delivered or in the instance of a breached birth the arms being under pressure as they are often raised above the baby’s head.

In most cases babies affected by brachial plexus injury will recover in 3 – 6 months. If the damage is more severe and there is no sign of improvement after six months, surgery is an option, although the outlook is variable. 

Information and support

Symptoms

Support

Stories and case studies

Sources - 

https://www.nlm.nih.gov/medlineplus/ency/article/001395.htm

ERB’s palsy (Erb–Duchenne palsy)

Please see brachial plexus injuries above. Erb’s palsy affects the upper groups of the arms main nerves (C5 – C6).

Klumpke’s Palsy (Klumpke's paralysis  or Dejerine-Klumpke palsy) 

(please see Erb’s palsy above) affects the lower part of the arms nerves (C8 – T1) 

Cerebral palsy

Definition

“Cerebral palsy is a term used to describe a number of neurological conditions”

(source: NHS)

Cerebral palsy is caused when  either the part of the brain or nervous system, responsible for muscle control, is damaged. This affects a person’s co-ordination and movement.

The condition can be caused by either damage to the brain while in utero or an injury caused at birth. The symptoms vary from mild to severe. 

There are three types of cerebral palsy called spastic, athetoid and ataxic.

The most common type of cerebral palsy is spastic cerebral palsy. . In cases of children with spastic cerebral palsy, their muscles are sniff which can cause their movements to look awkward, inflexible, forced and lurching. Spasticity is caused by damage to the motor cortex of the brain which can happen before, during or after birth. Sufferers of spastic cerebral palsy have muscles which are tight, this may worsen over their lifetime. This can make movement painful and awkward. There are varying degrees of the condition ranging from spastic hemiplegia which affects one side of the body through to spastic diplegia which impacts walking because it is related to use of the legs and, in the worst case, spastic quadriplegia which affects all four limbs.

Dyskinetic forms (or athetoid) of cerebral palsy cause involuntary movement which is particularly obvious when the child tries to move. The condition can also affect speech because of the impact on vocal chords. In some cases eye contact and issues with eating can occur.

Ataxic cerebral palsy is the least common form of the illness and affects around 5% of suffers. In some cases children may exhibit very few symptoms although, like all forms of cerebral palsy, it affects the movement of limbs and co-ordination. The main symptoms include trembling and shaking, difficulty with balance, and weaker muscles.

There is currently no cure for cerebral palsy but treatments are available to improve the quality of life of those affected. 

Information and support

Symptoms

  • Stiffness or limpness of the muscles.
  • Weakness of the muscles
  • Uncontrolled and random body movements
  • Problems with co-ordination and balance  

Support

Stories and case studies

Sources - 

https://www.cerebralpalsy.org.au/what-is-cerebral-palsy/types-of-cerebral-palsy
http://www.cerebralpalsy.org.uk/athetoid-cerebral-palsy.html

Horner’s syndrome

Horner’s syndrome is a very rare condition occurring in approximately one in every 100,000 people. It is even rarer for it to occur as the result of a birth injury. Horner’s syndrome affects the nerves that lead from the brain to the eye, usually just on one side of the face. Horner’s syndrome can be caused by the incorrect use of forceps, pulling too hard on the baby during the delivery or the incorrect procedures being used in a breached birth. 

Information and support

Symptoms

  • The pupils may seem to be different sizes and the one in the affected eye might appear constricted
  • The pupil takes time to dilate. 
  • The affected eyelid may appear to droop and the eye appear sunken 

Support

Sources - 

http://www.birthinjuryguide.org/birth-injury/types/horners-syndrome/

Infant brain damage 

Of all birth-related injuries, injuries to the brain are the most common reasons for lifelong disability. (source: The Brain Injury Association of America (BIA) and the Centers for Disease Control and Prevention (CDC)).. There are a number of reasons why damage occurs: a difficult, prolonged labour in which the baby’s  head is constricted in the birth canal for too long; a forceps delivery; or, more commonly, oxygen deprivation during labour.

Although symptoms of brain damage can be spotted up soon after birth, most tend to be recognised as the baby develops. Missing developmental milestones is one of the commonest signs that a baby might have suffered brain damage at birth. The extent of the damage depends on the extent of the trauma experienced: some babies exhibit mild symptoms, others suffer life-changing injuries. 

Information and support

Symptoms

Symptoms (from birth)

  • The forehead may appear abnormally large 
  • Facial features may be distorted 
  • The head may appear small, this is more evident in younger children. 
  • Neck stiffness
  • Difficulties in focusing 
  • Seizures
  • The spine may appear to have an irregular shape

As a child grows and develops other symptoms may appear that indicate damage to the brain.  These may not be immediately obvious but will be picked up my parents or medical professions at key developmental times in a child’s life. These may include cognitive, perceptual and physical symptoms

Cognitive symptoms

As the child grows the cognitive symptoms are usually identified because they may miss development milestones such as:

  • Concentrating
  • The processing and recalling of information
  • Processing language
  • Controlling impulses
  • Speech

 

In some cases, the damage to the brain isn’t evident until the child is much older and attending school. In these instances it is usually a learning disability that is highlighted and diagnosed such as . attention deficit hyper disorder (ADHD) or attention deficit disorder (ADD).  Asperger’s Syndrome, Autism or other learning difficulties are also indications of possible brain damage 

Perceptual symptoms

Perceptual symptoms can be more difficult to diagnose, but symptoms include:

  • Spatial unawareness
  • Hearing or vision changes
  • Increased pain sensitivity

Physical symptoms

As the child gets older, there may be further symptoms that appear. Some of these symptoms are less obvious, like headaches, other symptoms may be more self evident.

  • Severe tiredness
  • Disruptions in sleep
  • Sensitivity to light
  • Paralysis
  • Tremors

Support

Stories and case studies

Sources - 

http://www.birthinjuryguide.org/brain-damage/symptoms/

Oxygen deprivation (or asphyxia)

Definition

“Oxygen deprivation or asphyxia is exactly as it sounds; it is a condition where the body and importantly the brain are starved of oxygen during birth or birth complications”

(source: CerebralPalsy.org)

Historically it was believed that asphyxia during birth was a cause of cerebral palsy, however research suggests that oxygen deprivation accounts for 6-8% of cerebral palsy cases.

In many cases, asphyxia can be picked up by midwives and doctors monitoring a baby’s heartbeat to check oxygen levels and to ascertain if the baby is coping or in distress.  A lack of oxygen to the brain can result in mild to severe brain damage.

Aphyxia can be very serious if midwives and doctors are not quick enough to  recognise it and do not intervene. It is estimated that 80% of surviving babies with severe birth asphyxia will develop serious long-term complications.

“Worldwide, nearly one quarter of babies who die within a month of birth lose their lives to a problem called birth asphyxia or perinatal asphyxia”

(source: Action Media Research for Children)

Information and support

Symptoms

  • The baby’s breathing is very weak or they are not breathing at all
  • The colour of the skin is pale or bluish.
  • Low heart rate
  • Weak reflexes and poor muscle tone 
  • The blood is too acidic and there is meconium staining (first stool) in the  amniotic fluid 

Support

Stories and case studies

Sources - 

https://www.action.org.uk/our-research/oxygen-deprivation-birth-protecting-vulnerable-newborns-brain-damage
https://www.action.org.uk/birth-asphyxia
http://www.seattlechildrens.org/medical-conditions/airway/birth-asphyxia-symptoms/

Dystonia (spasmodic torticollis)

Dystonia is a general term used to describe muscle spasms that are uncontrollable and often painful for the person affected. The condition is a neurological movement disorder where the brain sends incorrect signals to the body resulting in spasms, uncontrollable movements, twisting and abnormal posture. There are nine types of dystonia which affect different parts of the body including the eyes, neck, mouth and voice, arms and hands and abdomen, there is also generalised dystonia which can affect any part of the body.

Dystonia can be caused by a birth trauma, usually because a prolonged labour and difficulty during the birth resulting in a lack of oxygen to the baby. When dystonia is evident in babies and children it is usually secondary to a primary condition which, in over 80% of cases, is cerebral palsy. 

Information and support

Symptoms

  • involuntary muscle movements
  • dragging a limb
  • cramping in the foot
  • uncontrollable blinking

Support

Stories and case studies

Sources - 

http://www.dystonia.org.uk/index.php/about-dystonia
http://www.birthinjuryguide.org/birth-injury/types/infant-dystonia-disorder/

Necrotising enterocolitis (NEC)

Definition

“Necrotising enterocolitis (NEC) is an inflammation of the bowel”

(source: Great Ormond Street)

This can be a serious illness; it only tends to affects babies between a few days and a few weeks old. It is an inflammation of the bowel which can cause intolerance to milk. In its severe form, the illness causes the tissue to die and creates a hole in the bowel where the contents of the intestines leak into the abdomen which can cause a dangerous infection.   

Necrotising enterocolitis is rare, affecting approximately one in every 10,000 births.

In most cases the condition is treated by resting the bowel, feeding intravenously and giving antibiotics if there is a high of infection. In the most extreme cases surgery may be needed to repair the hole in the tissue.  

Information and support

Symptoms

  • Unstable body temperature
  • Abdominal bloating
  • Feeding problems and vomiting
  • Lack of energy
  • Unstable breathing, heart rate, or blood pressure
  • Diarrhoea and blood in the stool

Support

Stories and case studies

Sources - 

http://www.uhs.nhs.uk/OurServices/Childhealth/Neonatalsurgery/Conditionswetreat/NecrotisingEnterocolitis.aspx
http://www.gosh.nhs.uk/medical-information-0/search-medical-conditions/necrotising-enterocolitis https://www.nlm.nih.gov/medlineplus/ency/article/001148.htm

Hirschsprung's disease (Aganglionosis)

Definition

“Hirschsprung's disease is a disorder of the bowel where part of the bowel is permanently compressed causing a blockage”

(source: NHS)

Each year one in 5,000 babies is affected by a rare but treatable condition called Hirschsprung's disease. Usually it is the last section of the large bowel which is affected. It the majority of cases the condition is identified at birth and corrected with surgery. 

Constipation is the main symptom of Hirschsprung's disease, ranging from mild to severe, meaning stools move through the intestines more slowly than usual. Some babies and children with Hirschsprung’s disease are not able to pass stools at all; this is usually identified very quickly by the medical team and can be rectified with surgery. Babies born with less severe symptoms may have difficulty passing stools and the condition may not be diagnosed until later in their childhood. 

Information and support

Symptoms

  • The first symptom is usually that the baby cannot pass meconium (their first stool)
  • swollen belly and constipation
  • vomiting a green fluid (bile)

Support

Stories and case studies

Sources - 

http://www.nhs.uk/conditions/hirschsprungs-disease/Pages/Introduction.aspx
http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/hirschsprung-disease/Pages/ez.aspx

Screening during pregnancy

All pregnant women are offered a screening test for Down’s, Edwards’ and Patau’s syndromes, between 10 and 14 weeks of pregnancy. The mother can choose not to have the test, or opt to test for one or more of the syndromes. The test is a combination of a scan and a blood test and indicates the likelihood or not of the baby carrying one of these conditions. If there is a high risk, the mother will be offered a diagnostic test (chorionic villus sampling or amniocentesis) which will confirm whether or not the baby has Down’s, Edwards’ or Patau’s syndrome.

Down’s syndrome (trisomy 21)

Definition

“Down’s syndrome is a genetic condition which usually means the person has some learning disabilities”

(source: NHS)

Although not specifically a ‘birth injury’ Down’s syndrome is a condition that can be identified during pregnancy. 

Down’s syndrome is a genetic condition which usually means the person has some learning disabilities, although this varies greatly from person to person. They will also have certain physical characteristics, again these are different for each individual but include low muscle tone, eyes that slant upwards and outwards and a small mouth with a protruding tongue. It is caused by the presence of an extra copy of chromosome 21 in a baby's cells.

Screening

As part of your routine appointments during pregnancy you have the option to be screened to see the likelihood that your baby has Down’s syndrome.  If the initial screening indicates your baby may have the condition further tests can be carried out to confirm the diagnosis.

Information and support

Support

Stories and case studies

Sources - 

http://www.nhs.uk/conditions/Downs-syndrome/Pages/Introduction.aspx /

Edward’s syndrome (trisomy 18)

Definition

“Edwards' syndrome  is a serious genetic condition caused by an additional copy of a chromosome 18 in some or all of the cells in the body”

(source: NHS)

Most babies with  Edwards’ syndrome are either miscarried or stillborn. If they do survive then the chances of them living beyond their first birthday is remote. However, there have been some very rare incidences of  people living into their 20’s.

Pregnant women can be screened for Edwards’ syndrome between 10 and 14 weeks of pregnancy.  Further diagnostic tests are offered if the screening indicates a high risk of the foetus having the condition.

Information and support

Symptoms

  • a small, abnormally shaped head
  • a small jaw and mouth
  • long fingers that overlap, with underdeveloped thumbs and clenched fists
  • low-set ears
  • smooth "rocker bottom" feet (with a rounded base) 
  • a cleft lip and palate (a gap or split in the upper lip and/or the roof of the mouth)
  • an exomphalos (where the intestines are held in a sac outside the tummy)

Support

Stories and case studies

Sources - 

http://www.nhs.uk/conditions/edwards-syndrome/Pages/Introduction.aspx

Turner’s syndrome

Definition

“Turner’s syndrome is a genetic condition that only affects females”.

(source: NHS)

Turner’s syndrome only affects girls (and is  present in one in every 2,000 baby girls) and is caused by a missing chromosome. A girl born with Turner’s syndrome only has one x chromosome rather than the usual two. The majority of girls diagnosed with Turner’s syndrome lead relatively normal lives and although  there is no cure,  the symptoms can be managed. 

Information and support

Symptoms

  • Swollen and puffy hands and feet
  • Infertile (the ovaries do not function)
  • Short stature
  • Some women may also have an usual amount of  skin on the neck
  • Skeletal abnormalities
  • Heart defects
  • High blood pressure
  • Kidney problems

Support

Stories and case studies

Sources - 

http://tss.org.uk/

About the author

Jeanette Whyman

Partner - Head of Medical Neglience

Jeanette is head of the medical compensation team, specialising in medical negligence and personal injury claims.

Jeanette Whyman

Jeanette is head of the medical compensation team, specialising in medical negligence and personal injury claims.

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