Prenatal/ Perinatal/ Neonatal Malpractice

We trust doctors, nurses and other health care providers who offer care to pregnant women, developing fetuses and newborn children will engage in the best practices to ensure optimal outcomes.

Unfortunately, that sometimes does not happen. In some cases, this may be the result of overstaffing at a certain hospital or facility. It could be a lack of proper training. Sometimes, it involves failure to follow important safety guidelines and care standards.

At Jeffrey Glassman Injury Lawyers, our Boston birth injury attorneys recognize that while not all infant injuries or deaths are cause for legal action, about11 percent are attributed to maternal complications of pregnancy and unintentional injuries. That’s according to the U.S. Department of Health and Human Services, which reports the overall infant mortality rate in the U.S. is 6.68 infant deaths per 1,000 live births.

Generally, in order to hold a medical professional legally at-fault for an infant injury, medical condition or death, one needs to first identify the accepted standard of medical care for that profession and that region. That standard will differ depending on the stage at which the injury occurred, and whether it was:

• Prenatal
• Perinatal
• Neonatal

Preventable medical error is a serious national health problem that affects people of all ages, ethnicities and socioeconomic backgrounds. In fact, medical errors have been identified as the third-leading cause of death by the Journal of Patient Safety, accounting for as many as 440,000 patient deaths a year. Many more suffer severe and lasting injuries.

Nowhere is it more tragic than when it affects the life of a newborn infant. Those who survive often face a lifetime of physical, developmental, cognitive and social challenges.

The test of whether a patient has a valid medical malpractice claim is not necessarily the severity of injury or condition, but whether the physician or other health care provider abided the accepted standard of care.

The Standard of Care refers to those practices and procedures that are generally accepted by a certain class of medical professionals in a certain geographic region when treating patients suffering from a particular disorder or disease. The standard of care can vary depending on a broad range of factors, including one’s age and medical history.

So for example, a nurse would not be judged to have the same standard of care as a physician, even in the same location and under the same circumstances. Similarly, an OBGYN doctor treating a patient in need of an emergency Cesarean section would not be held to the same accepted standard as one who was treating a patient undergoing a routine vaginal delivery. And doctors who perform their work in fewer areas with less access to top quality resources and technology aren’t going to be judged by the same standards as physicians in more metropolitan areas.

Expert medical testimony will be required by plaintiff to prove the health care provider breached their duty to offer the accepted level of care.

Prenatal malpractice refers to negligence that occurs in the course of care received throughout pregnancy and prior to birth.

Numerous studies reveal that quality prenatal care can greatly increase the odds a child will be born healthy. For example, the U.S. Department of Health & Human Services reports babies born to mothers who receive no prenatal care, compared to those who do, are:

• Three times more likely to be born at low birth weight.
• Five times more likely to die.

The National Collaborating Centre for Women’s and Children’s Health reports it is ideal for women to begin receiving prenatal care in the first trimester, and continue with greater frequency as the pregnancy progresses. In this way, doctors can assess any potential risk factors and timely address then in order to avoid adverse outcomes.

Physicians providing prenatal care generally should offer:

• Weight and blood pressure measurements
• Uterus measurements (ultrasounds) to ensure proper fetal growth
• Physical exam to identify problems or discomforts
• Urine test to measure protein levels and sugar, which can indicate diabetes or preeclampsia
• Fetal heart rate measurement
• Education on proper nutrition and lifestyle
• Prenatal screenings to check for conditions like anemia
• Adequate warnings of specific risks and complications
• Treatment and supervision of any complications that do arise

The Massachusetts Executive Office of Health and Human Services reported approximately 15.4 percent of pregnant women in the Commonwealth do not receive adequate prenatal care.

Some potential complications of which health care providers should be aware and on the lookout for:

• Fetal distress
• Preeclampsia
• Breech birth
• Rh factor incompatibility
• Gestational diabetes
• Atypical fetal growth
• Fetal growth restriction
• Ectopic pregnancy
• Uterine rupture
• Umbilical cord compression
• Pregnancy-induced hypertension

If a doctor fails to identify or address a problem he or she should have that failure results in injury or illness to the baby, this may be grounds to assert prenatal malpractice.

Perinatal refers to the time immediately before or after birth.

While a doctor of Obstetrics and Gynecology (OBGYN) may provide care for a patient through pregnancy and delivery, the nurses who provide care during labor and delivery are referred to as “perinatal nurses.”

During labor and delivery, these nurses are generally expected to:

• Assess a patient and ascertain whether there are any potential complications upon intake. Potential complications that should be spotted ahead of time include eclampsia, diabetes, prolapsed cord and ruptured uterus.
• Be prepared to handle the delivery is imminent and occurs before the doctor or midwife arrives.
• Clean the patient to prevent infection.
• Monitor fetal heart rate and identify signs of fetal distress.

Doctors during labor and delivery are generally expected to:

• Assess the patient to ascertain any potential complications.
• Monitor baby’s heart rate and other vitals for signs of fetal distress.
• Choose the appropriate instruments and tools – if any – with which to deliver the child.
• Prescribe appropriate medications, including pain relievers and drugs that may help induce labor.
• Timely decide whether a Cesarean section is appropriate.
• Use appropriate care in performing either a C-section or assisting in vaginal birth.

Anesthesiologists during labor and delivery are generally expected to:

• Conduct a thorough preoperative evaluation, assessing patient’s focused history and physical examination, reviewing available lab history and special test results and assessing the need for additional testing prior to proceeding.
• Provide proper medication to the patient.
• Provide continual medical assessment of patient.
• Monitor and control patient’s vital life functions, including breathing, heart rate and rhythm, body temperature and balance of bodily fluids.
• Control patient’s pain.
• Provide post-anesthesia care in recovery.

Failure by these professionals to perform these duties could be grounds for a medical malpractice action.

After birth, newborn babies are extremely vulnerable to a number of medical issues and conditions that could put them at high risk for profound, permanent disability or death.

Some of these potential complications include:

• Jaundice;
• Oxygen deficiency (resulting in brain dysfunction);
• Circulatory problems;
• Infections acquired from the mother;
• Breathing problems or respiratory distress.
• Health care providers have a duty to properly monitor newborns and ensure any problems are quickly identified and addressed.