Articles Posted in Birth Injuries

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The American Congress of Obstetricians and Gynecologsts, lead by Syracuse OBGYN RIchard A. Waldman, M.D., recently released a position statement on New York State bill S5007/A8117 which, once signed into law, will repeal a state requirement that certified nurse midwives execute “written practice agreements” with hospitals and doctors. In sum, the new law will permit midwives to manage low-risk deliveries, which account for 60-80% of all births, completely independent from a medical doctor or hospital facility. ACOG insists that the “written practice agreements” remain in place to ensure the safety of pregnant women by requiring that a doctor or hospital be available in the event of an obstetrical emergency.

According to Syracuse birth injury lawyer Michael A. Bottar, the passage of the Midwife Modernization Act may contribute to a rise in preventable birth injuries, such as cerebral palsy and Erb’s palsy, from at-home births that appear “low-risk” but evolve into complicated deliveries due to, e.g., umbilical cord compression, shoulder dystocia, fetal distress and/or maternal hemorrhaging. Simply stated, a “low-risk” birth can become a “high-risk” birth in a matter of seconds and, where a laboring mother and fetus attended to by a midwife (who is not qualified to perform a cesarean section), a mother and baby may suffer harm before there is time to relocate to a hospital for surgical or therapeutic intervention. This is why, according to American Medical Association Resolution 205 (2008), “the safest setting for labor, delivery and the immediate post-partum period is in a hospital or birthing center within a hospital.”

At the present time, there are approximately 1,000 licensed midwives practicing in the State of New York, with more than one-half practicing in and around New York City. The balance are spread around the State, with roughly 50 practicing in and around Syracuse, Binghamton, Utica, Herkimer, Oneida, Oswego and Watertown.
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Syracuse medical malpractice lawyer Anthony S. Bottar, managing partner of Bottar Law, PLLC, one of Upstate New York’s oldest law firms with a practice limited to medical malpractice, wrongful death, birth injuries, work injuries, brain injuries, and product/premises liability, was elected president of the New York State Academy of Trial Lawyers, an organization dedicated to protecting, preserving and enhancing the civil justice system.

The New York State Academy of Trial Lawyers boasts a membership of more than 1400 judges, law clerks, law firms, lawyers, paralegals and law students, including: Syracuse medical malpractice lawyers handling cases concerning stroke misdiagnosis, failure to diagnose cancer and failure to prevent a heart attack; Syracuse work injury lawyers handling cases concerning construction site accidents, scaffolding accidents and injuries caused by a fall from a height; Syracuse birth injury lawyers handling cases concerning fetal hypoxia and ischemia, cerebral palsy and Erb’s palsy; Utica brain injury lawyers handling cases concerning concussions, post-concussion symdrome and TBI; Watertown medical malpractice lawyers handling cases concerning Samaritan Medical Center negligence and Fort Drum physician mistakes; and Watertown injury lawyers handling New York State Thruway accidents.

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Persistent pulmonary hypertension of the newborn is a very serious condition where a baby’s circulatory system does not adapt properly to life outside of the womb. While in utero, a fetus obtains oxygen from the placenta through the umbilical cord. Because there is no real need for the lungs before a baby is born, a fetus maintains high lung pressure which causes blood to steer away from the lungs and toward other developing organs via a “switch” known as the ductus arteriosis.

After birth, a baby needs to breathe. In babies with PPHN, the ductus arteriosis does not close on day one of life, leaving blood directed away from the lungs and low blood oxygen levels. While many babies suffer from PPHN due to a birth injury, according to Binghamton New York birth injury lawyers Bottar Law, PLLC, a recent study also links PPHN to maternal consumption of selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Zoloft, Paxil, Symbyaxm Celexa, Cymbalta, Effexor and Lexapro.

The study reported a shocking statistic. That is, that women who took SSRIs during their third trimester were six times more like to deliver a baby diagnosed with PPHN after birth (usually within 12 hours, if not sooner). A failure to diagnose persistent pulmonary hypertension of the newborn can result in damage to a baby’s brain, kidneys and liver. Many babies with PPHN are diagnosed with cerebral palsy secondary to PPHN oxygen deprivation.
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Gestational diabetes is a condition where a pregnant woman develops high blood sugar levels, or diabetes, during pregnancy. As many as 1 in 25 women experience some degree of gestational diabetes as pregnancy hormones block the action of naturally produced insulin. Insulin is the chemical the body uses to break down sugar in the blood.

According to Syracuse New York gestational diabetes lawyers Bottar Law, PLLC, well-known blood sugar level benchmarks may soon be revised in order to better diagnose and treat women diagnosed with diabetes during pregnancy. Soon to be released revised guidelines will result in more women carrying the diagnosis of gestational diabetes, as well as better care for blood glucose levels which may pose a threat the health and safety of a mother and her unborn fetus.

Historically, a fasting blood sugar level of 92 mg/dL was considered “safe,” as was a one-hour level of 180 mg/dL and a two-hour level of 153 mg/dL. New standards will set the bar much lower. Medical intervention at lower maternal blood glucose levels should reduce the number of premature deliveries, shoulder dystocias due to big babies, and a high blood pressure condition called preeclampsia. A failure to diagnose preeclampsia can cause maternal heart failure, and death.

The failure to diagnose gestational diabetes can have serious consequences, including maternal or fetal death, maternal or fetal heart damage, Erb’s palsy, cerebral palsy, polycythemia, jaundice and hypocalcemia.
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Normal pregnancy lasts 40 weeks. A baby born before 37 weeks is considered a preterm delivery. A baby born before 32 weeks is considered very premature. According to Syracuse New York premature birth injury lawyers Bottar Law, PLLC, preterm deliveries are on the rise for women who conceive through in-vitro fertilization (IVF) or intracytoplsmic sperm injection (ICSI).

Danish researchers recently published the results of a study of births from 1989 through 2006. Of the 730 babies born to women who underwent IVF or ICSI, 8% were born premature and 1.5% were born very premature, compared to 5% and 0.06%, respectively, for women who conceived “naturally.”

There are many health risks for premature babies. Some premies are born with respiratory distress syndrome (RDS) and need to be on a mechanical ventilator for the first few weeks of life. Other premature baby diagnoses include intraventricular hemorrhaging (bleeding in a baby’s brain following birth), periventricular leukolamacia (baby brain damage), cerebral palsy, bronchopulmonary dysplasia (when a baby needs oxygen after 36 weeks), or retinopathy of prematurity (due to abnormal blood vessels in the eyes). In addition to any of the above problems, premature babies are also predisposed to learning disabilities, problems with their hearing and vision, blindness, deafness, and mental retardation. More often than not, however, premature babies grow up with no problems whatsoever.
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All too often, cerebral palsy caused by medical malpractice occurs in Syracuse, Utica, Oswego, Watertown and Binghamton, New York. As many as one-third of cerebral palsy cases are associated with an early labor and delivery resulting in a premature baby.

When OBGYNs or labor and delivery nurses correctly diagnose an impending preterm birth, a recent study suggests that magnesium sulfate should be prescribed to protect against cerebral palsy. According to Syracuse birth injury lawyers Bottar Law, PLLC, magnesium sulfate may strengthen fetal blood vessels and, in turn, increase oxygen transport despite swelling and inflammation associated with an early delivery.

While scientists have not identified exactly how magnesium sulfate may aid in protecting a premature baby from brain injury, and despite the fact that the therapy has not been approved by the FDA, many OBGYNS are recommending the chemical compound (which also goes by the name Epson salt) to pregnant mothers.

According to John Thorpe, co-author of one of the largest studies of cerebral palsy and magnesium sulfate, “[v]irtually every delivery room in the United States is already stocked with magnesium sulfate solutions that are given to pregnant women during childbirth for other reasons. [W]hat we have learned from this study is that we have a cheap, widely available treatment already in hand that cuts in half the risk of babies being born with an extremely disabling disorder. That is a tremendously exciting development.”
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According to New York medical malpractice lawyers Bottar Law, PLLC, with offices in Syracuse, Utica and Watertown, magnetic resonance imaging (MRI) may reduce a potentially lethal labor and delivery complication known as placenta acrete.

Placenta accrete is a condition occurring in 1 out of every 2,500 births. It involves the placenta attaching too deeply to the uterine wall – through the endometrium and into the myometrium. If undetected until the time of labor and delivery, either because an OBGYN failed to order an MRI to diagnose the complication, because and MRI was misread by a radiologist, or because the condition was occult, post-partum hemorrhaging may occur as the placenta is delivered during the third stage of labor.

A recent study suggests that an MRI may be more than 90% effective in diagnosing placenta accrete. Risk factors for placenta accrete include: a prior uterine surgery, prior cesarean section, myomectomy, advanced maternal age (over 35), D&C and, according to some literature, a female fetus.
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According to Syracuse New York birth injury lawyers Bottar Law, PLLC, children diagnosed with cerebral palsy are on the rise in the United States, especially in cases involving prematurity.

In a recent study of 222 preterm births, research reported that connective tissue may be the link between cerebral palsy and prematurity. More specifically, inflammation in the connective tissue in the umbilical cord may lead to cerebral palsy. There are many potential causes for inflammation in the connective tissue in the umbilical cord, including: premature birth from preterm labor, premature rupture of the amniotic sac, and infection.

The umbilical cord is the pathway for oxygen and nutrients to a fetus, and waste from a fetus. Where there is umbilical cord inflammation, the ability of the cord to pass oxygen to a fetus may be impaired. Likewise, the ability of the cord to pass waste from the fetus (contributing to acidosis) may be impaired. During labor and delivery, an OBGYN should monitor a pregnant mother and unborn fetus for problems with umbilical cord function. Often times, fetal distress visible on tracings created by an external fetal heart rate monitor (EFM) may suggest that an unborn baby’s lifeline is failing or is compromised and, in turn, the baby should be delivered by cesarean section as soon as possible.
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According to the American Academy of Neurology and the Child Neurology Society, botulinum toxin type A (also known as Botox) may be an effective treatment for Central New York children diagnosed with cerebral palsy including, specifically, symptoms of cerebral palsy like muscle tightness and spasticity.

The intended effect of a Botox injection is to paralyze a spastic muscle. However, the benefits are not without risk. According to the FDA, there have been reports of “isolated cases of generalized weakness following use of botulinum toxin type A for spasticity.” These reports are under investigation. In addition to Botox, recent guidelines also propose the use of diazepam or tizanidine for suppression of spasticity. Each are associated with side effects, including liver toxicity.

Cerebral palsy is a condition, often caused by hypoxia in the womb or ischemia during child birth, affecting the brain and nervous system functions such as movement, hearing, vision, cognition and thought. While spastic quadriplegic cerebral palsy is the form most often associated with a birth injury or birth trauma, there are other forms, e.g., dyskinetic, ataxic, hypotonic and mixed.
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Testing of a new therapy is underway at Nationwide Children’s Hospital in Columbus, Ohio, which may revolutionize the way that Syracuse babies diagnosed with cerebral palsy exercise to strengthen their muscles.

The system incorporates a harness into the use of a treadmill. The harness supports the child’s weight while he or she walks, which should make it easier for cerebral palsy patients to walk without the risk of falling. As children using the system learn how to walk and grow stronger, the amount of weight carried by the harness can be decreased — essentially returning the child’s body weight to their legs.

Previously, children with cerebral palsy received physical therapy only once a week. With the treadmill program, they can receive therapy several times a week. More therapy means more practice walking, and shorter periods of complete disability. More than 90% of recent participants showed improvement in walking over the course of eight weeks. Two children made remarkable advances, with one moving completely out of braces and the other moving to less supportive bracing.

Every day, at least one child in the United States is diagnosed with cerebral palsy. All too often, cerebral palsy is the result of a doctor’s mistake, such as when an OBGYN fails to perform a cesarean section despite fetal distress, when a medical resident ignores ominous fetal heart rate monitor tracings, or when a labor and delivery nurse negligently increases Pitocin despite pregnancy complications.
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