It is very rare for babies to suffer a serious brain injury at birth. However, the effects can be absolutely devastating and lifelong for babies and their families.
Some signs and symptoms of brain damage can be detected shortly after birth. However, this is not always so and some symptoms may not be apparent until several years later.
Medical negligence claims – baby brain injury due to midwife or doctor negligence
Sometimes, basic errors in care during an otherwise routine pregnancy and labour can, unfortunately, cause or contribute to a devastating birth injury. If the way your baby’s birth was managed caused a brain injury, you may be able to make a claim on behalf of your child to secure financial compensation for their future needs. Research carried out by the Royal College of Obstetricians and Gynaecologists (RCOG) shows that 854 babies suffered a severe brain injury in 2015. Of these babies, 76% might have had a different outcome with better care.
The 2021/22 HSIB Maternity Investigation Report highlighted problems with the inconsistency in guidance across the NHS, and in some areas, a complete lack of any guidance at all. This has led to inconsistency in maternity care across England. Guidelines should protect the health of the mother and baby, and ensure that any problems are detected at an early stage. They cover, for example:
- what an initial assessment of the woman should include
- the frequency of maternal observations (blood, temperature and pulse)
- how the baby’s heart rate should be monitored and how to interpret the results
- how frequently vaginal examinations should be performed
- the use of pain relief
- what should be done if things are not progressing as they might
- interventions that may be taken to help deliver the baby.
Doctors and midwives are only human, but unfortunately, when they make mistakes there can be devastating consequences for babies and their families. Sometimes, medical professionals fail to follow the right procedures during labour. For example, any untoward changes in the baby’s heart rate, could suggest that the baby is in distress and, depending on the level of concern, may mandate an expedited delivery. If a caregiver fails to correctly interpret the baby’s heart rate and delivery is delayed, this may mean that the baby has been starved of oxygen for longer than should have been the case and that this has caused brain damage.
Examples of mismanagement after birth may include:
- poor management of resuscitation shortly after birth
- a failure to treat jaundice
- a failure to treat low blood sugar levels promptly.
The most common mistakes tend to occur because of lack of experience, lack of training, poor communication between staff (for example, during a shift change), insufficient staffing levels and fatigue and stress (for example, if the delivery ward is particularly busy midwives might need to look after multiple labouring women at the same time).
If your baby has a brain injury and you are worried about the care you or your baby received, a birth injury claims solicitor can help you find a way forward. Brain-injured babies may have long-term and complex needs, and it is important that any solicitor has the necessary expertise in these cases to help you get the best for your child. Many children with brain injuries go on to lead full and independent lives, but some children may require lifelong care and specialist support (such as adapted housing, equipment and therapy) to help them live their lives to the fullest. At Tees we are committed to helping families get the support and security they need. Our birth injury claims specialists understand what you’re going through, and we can help you get answers about your care. We’ll listen to your experiences, and help you find out what happened.
Caring for women in labour
There are protocols and guidelines that caregivers should follow when caring for women in labour. These are in place to protect the health of the mother and baby and ensure that any problems are detected at an early stage. They cover, for example:
- what an initial assessment of the woman should include
- the frequency maternal observations (blood, temperature and pulse)
- how the baby’s heart rate should be monitored and how to interpret the results
- how frequently vaginal examinations should be performed
- the use of pain relief
- what should be done if things are not progressing as they might
- interventions that may be taken to help deliver the baby
Common causes of brain injury at birth
If the brain does not develop properly or if there is damage to the developing brain, this may cause a wide range of physical problems, in addition to behavioural and learning difficulties.
The most common brain injury related to birth trauma is Cerebral Palsy. Cerebral Palsy can occur before birth, during birth or soon after birth.
Problems before birth
Sometimes cerebral palsy can occur before labour and birth. Some things increase the risk of a baby having a brain injury, for example:
- problems with the mother’s blood pressure (‘pre-eclampsia’), thyroid, or maternal seizures
- maternal infections during pregnancy
- multiple births
- premature births
Problems during labour
Sometimes cerebral palsy occurs because a baby is starved of oxygen during labour. This is called birth asphyxia. It means that the baby’s oxygen supply or blood flow to the brain was interrupted during birth. Serious complications (acute events) during the early stages of labour or during established labour can interrupt the baby’s oxygen supply. For example:
- the placenta separating too early from the uterus (‘placental abruption’)
- problems with the umbilical cord
- the baby getting stuck in the birth canal and shoulder dystocia (where the baby’s head is born but the shoulder gets stuck).
Serious physical injuries can cause brain injury. If the baby suffers a skull, neck or spinal injury (such as a fracture) this can be very serious. Physical injuries can be caused by physical injury to the mother during pregnancy or by instrumental deliveries such as forceps deliveries.
Doctors might recommend an instrumental delivery if the baby needs help to be born. In very rare situations an instrumental delivery can cause brain injury if the instruments injure the baby’s skull (which is very soft), neck or spine. Such injuries are rare, and may be associated with improper or negligent use.
Problems after birth
Sometimes a baby is born in poor condition and it is important that they receive prompt and appropriate resuscitation. If this does not happen, unfortunately, the baby may be starved of oxygen for too long and may have permanent brain damage.
Other complications after birth include jaundice and low blood sugar levels (‘hypoglycaemia’). Jaundice is relatively common in babies, especially premature babies. It is the yellow colour seen in the skin of many newborns. Jaundice happens when too much bilirubin (a chemical naturally produced by the body) builds up (‘hyperbilirubinemia’). If infant jaundice is treated immediately, there usually isn’t a reason for concern. However, if left untreated, high levels of bilirubin in a baby’s brain can cause a serious condition called acute bilirubin encephalopathy. A very low blood sugar level, if untreated, can also cause cerebral palsy.
For many parents, understanding what happened during their child’s birth – and why – can be extremely important. Whatever caused the baby to be born with a brain injury, it’s an incredibly difficult situation for any parent to go through.
Signs and symptoms of brain injury in babies
The signs and symptoms of brain injury vary and depend on the severity of the injury. Generally speaking, the more serious the injury, the more obvious the symptoms.
Doctors use a grading scale to classify the severity of brain injuries at birth. There are 3 grades: mild (Grade 1), moderate (Grade 2) and severe (Grade 3). More severe injury normally means the initial symptoms and long-term effects will be more serious.
A mild injury (Grade 1 hypoxic ischaemic encephalopathy (‘HIE’)) may not be obvious immediately after a baby’s birth. Parents of babies with mild brain injuries may notice their baby is irritable and has problems sleeping or feeding. Other signs include hyper-alertness or if the baby’s eyes are wide open. Normally, the symptoms of a Grade 1 injury last for the first 24 hours after baby’s birth. If your baby’s birth was particularly difficult, or you suffered complications during delivery, your caregivers may ask you to look out for these symptoms.
Severe brain injuries can cause serious symptoms immediately after birth. These may be immediately noticeable. For example, babies who are born very poorly may be pale and floppy when they’re born.
Symptoms of a moderate (Grade 2 HIE) injury include:
- lethargy (low energy, lack of movement)
- reduced muscle tone
- decreased or absent reflexes (for example, the sucking or gag reflex)
- clinical seizures
- pale in colour
Babies who suffer a severe (Grade 3 HIE) injury may exhibit the following symptoms:
- lack of response to stimulation
- unable to breathe independently
- low or no heartbeat
- lack of muscle tone
- pale in colour
- clinical seizures.
In very sad cases, a hypoxic brain injury can even lead to a baby’s death.
Treatment for brain-injured babies at birth
When caregivers suspect a baby may be born in a poor condition, a paediatrician should be called. If an emergency situation arises, help should be summoned quickly. However, this often means that midwives, obstetric doctors and paediatric doctors rush to the mother’s bedside. It can be a very frightening experience for the mother, and those supporting her during labour. Ideally, mothers should be told about the potential for such a situation during their pregnancy (however unlikely it may be).
Resuscitation
A paediatrician will be present for the birth in order to resuscitate the baby (if necessary).
Depending on the seriousness of the baby’s condition, they will usually be admitted to a Special Care or a Neonatal Intensive Care Unit. Although this can be frightening for parents, it means that poorly babies get the care and support that they need to help their recovery.
Neonatal Therapeutic Hypothermia (infant cooling)
Neonatal Therapeutic Hypothermia (infant cooling) is a relatively new way of treating brain-injured babies at birth. It involves lowering the baby’s body temperature. Research suggests that this can improve the chances of babies starved of oxygen at birth from developing serious brain injuries, such as cerebral palsy.
Oxygen deprivation to the brain can cause a ‘cascade’ of neurological injuries. It causes gradual death of brain cells which in turn can cause brain injury and, in very sad circumstances, it can cause the baby’s death. Cooling therapy works by slowing down your baby’s metabolism, which slows and prevents the death of brain cells following oxygen deprivation. Cooling cannot, however, reverse the brain injury that has already occurred.
If your baby suffered a serious case of oxygen deprivation, they may be ‘actively cooled’. Your baby may be placed on a special cooling mat, or have cooled packs placed around them, to reduce their body temperature. The baby will be looked after in the neonatal care unit and cooled to 33C for 3 days after birth. Alternatively, your baby may be ‘passively cooled’, a process which involves taking early steps not to warm the baby up. Doctors may recommend removing the baby’s bonnet or turning off the heater to keep her/him cooler.
Both treatments are time-sensitive, and guidelines recommend cooling to start within 6 hours of birth. Although infant cooling is relatively new, early research suggests it is effective in improving the chances of brain-injured babies.
Unfortunately, not all brain-injured babies are candidates for infant cooling. Doctors might not recommend it if the baby is premature, has a very low birth weight or has a serious problem with their heart or lungs.
Imaging
If your baby suffered a brain-injury at birth, your doctors should offer an MRI scan or CT scan of the head. These tests examine the baby’s brain and can show signs of injury to the brain. Scans provide doctors with a detailed image of your baby’s brain and skull, and can show if there is bleeding or swelling, ischaemic brain tissue or fractures to the skull.
Prognosis for babies with a brain injury
Every baby is different and their prognosis will depend on the extent of the damage, where the damage occurred and what treatment they received.
It is usually hard to say what the likely course of any future disability may be until the child is older and how, and to what extent they have responded to therapies and support. However, in many cases there are long-term physical, in addition to learning and/or behavioural difficulties. In some cases, the child may also suffer epilepsy.
Children with cerebral palsy usually need life-long support from a multi-disciplinary team, which may include a Paediatrician, a Neurologist, a Neuropsychologist, an Orthopaedic Surgeon, Physiotherapists, Occupational Therapists, Speech and Language Therapists, social workers, educational psychologist, a mental health specialist. It can be very difficult to access but such therapies and support are known to significantly improve outcomes.
Some children will grow up to be capable of independent living and meaningful employment. Others, sadly, will not.
Life expectancy also varies enormously. Many children with a mild brain injury will have a normal life expectancy. Those at the more severe end of the spectrum will, sadly, have a considerably shorter life expectancy. If you have any questions or concerns about your child’s prognosis you should talk with your caregiver.
If your child has a brain injury and you are concerned about the care you or your baby received talk to our birth injury claims specialists. We’ll listen to your experience and help you find out what happened.
Brain injury at birth terminology
Below is a useful glossary of terms which you might hear in connection with brain injuries at birth.
Where appropriate, these terms are explained specifically in the context of brain injuries at birth.
- Hyperbilirubinemia: a condition whereby there is too much bilirubin in the blood
- Hypoglycaemia: low blood sugar levels
- Hypoxia: where part of the body (in this case, the baby’s brain) does not receive enough oxygen
- Hypoxic ischemic encephalopathy (HIE): where the baby’s brain does not receive enough oxygen or blood and it causes a problem with the baby’s health
- Hypothermia: a very low body temperature
- Neonatal encephalopathy (NE): abnormal signs of brain injury shortly after the baby’s birth
- Neurological: relating to the nervous system (the brain, spinal cord and nerves).
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