Birth injuries are not always immediately apparent. A consult with pediatric neurologist could indicate something went wrong. A review of electronic fetal monitoring strips can find a mistake during labor and delivery.

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PRESENTEDBY
WHENTO
WORRY
From Difficult Labor
To Birth Injuries

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When a baby fails to thrive or a
toddler falls behind on developmental
milestones, there are questions. One
that might not immediately come to
mind, but should, is this: Did my child
suffer a birth injury?
Crandall & Pera Law, LLC has been
fighting for injured patients in Ohio
and Kentucky for almost two decades
and has medical professionals on
staff. In this white paper, we address
some of the concerns that parents
have come to us with over the years.

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This presentation is for those coping
with a diagnosis of hypoxic-ischemic
encephalopathy and related brain
injuries, cerebral palsy, Erb’s palsy or
Klumpke’s palsy. We cover:
• When symptoms of birth injuries
appear – sometimes it is not until a
well child appointment and pediatric
neurologist referral
• How fetal monitoring can indicate
something went wrong during
delivery
• When to seek legal counsel and
what questions to ask

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Medical terms used during delivery can be hard to understand (non-
reassuring fetal heart rate) and may not alert you that something is
wrong. Once a baby arrives, there are more tests and jargon – APGAR
test (Appearance, Pulse, Grimace, Activity and Respiration) and blood
gas.
Birth injuries are not always immediately apparent. In serious injury
cases, lifetime care can be required. Few medical providers admit to
making an error.

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Birth injury often involve damage to the brain and nerves. It may be
hard to know what a diagnosis means, here are some of the more
common ones:
• HYPOXIC-ISCHEMIC ENCEPHALOPATHY(HIE) where decreased oxygen
and blood flow can cause brain damage, seizures and
multi-system organ failure.
• CEREBRAL PALSY(CP)which can affect an arm or leg (spastic) or the
ability to control movement in limbs, face or tongue (dyskinetic).
• SHOULDERDYSTOCIAdamaging nerves in their shoulder and arm.
• ASKULLFRACTURE during vacuum extraction or other intervention
In many cases, it can take six months to several years before the true
severity of the injury becomes apparent.
DIAGNOSIS

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Pediatric neurologists treat children who are having problems
with their nervous system. Referral to this type of specialist
can be necessary to figure out what is causing muscle
problems, seizures or developmental delays. Several tests
that they use, include:
ELECTROENCEPHALOGRAM (EEG)to look at electrical
activity in the brain.
MAGNETICRESONANCEIMAGING(MRI)and CT scans to
image the brain and spine.
In brain injury and CP cases, child neurologists can be an
important part of a care team. They often work closely with
occupational and speech therapists as well as physical
therapists.
NERVOUSSYSTEMTESTING

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When issues arise looking back at Electronic Fetal
Monitoring, or “EFM,” strips from delivery can offer clues.
This machine analyzes how your baby responds to
contractions during the labor process.
THEMONITORINGLOOKSATFOURTYPESOFDECELERATIONS:
• Spontaneous
• Early decelerations
• Variable deceleration
• Late deceleration
The first two are generally normal, but the second two do
not follow typical patterns and can be cause for concern.
Interventions like changing a position or providing an
oxygen mask or fluids through an IV can help.
ELECTRONICFETALMONITORING

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Fetal heart rate ties in with the decelerations
and falls into one of three categories:
• CATEGORY I– Baseline heart rate of 110 to 160 beats
per minute.
• CATEGORY II– Some variable or late decelerations, but the
baby’s heart rate remains normal. Heart rate that is too high.
Deceleration lasts more than 10 minutes.
• CATEGORY III– Frequent variable or late deceleration. Little
variability. Slow baseline heart rate
Monitoring tests work together, yet they are only as good as the
subjective interpretation of a physician or midwife.
HEARTRATECLASSIFICATIONS

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The law holds medical professionals
responsible for negligence – this
standard considers what other
reasonable physicians in Ohio and the
region would have done in similar
circumstances. A malpractice
lawsuit may ensure your family has the
financial protections in place to cover
lifelong care.
An attorney can spot red flags that this
standard of care may have been breached.
In our experience, further investigation can sometimes uncover altered
records, staffing shortages that caused delays or other types of
negligence.

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When you make the decision to seek legal advice, ask whether a law firm
has registered nurses on staff or attorneys with medical backgrounds. Find
out what past results they have obtained in similar cases as well.
At Crandall & Pera Law, our attorneys
have been fighting for injury victims
and their families for nearly two
decades and have 40 years of
combined legal experience. We also
keep registered nurses on staff and
carefully identify the best experts in
each case. Our trial lawyers go into
courtroom when necessary and have
obtained sizeable verdicts.

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CONTACTUS
© 2019 Crandall & Pera Law, LLC.
All rights reserved. Design and editorial
services by Super Lawyers, part of
Thomson Reuters.
Share the white paper
The decisions of an ob-gyn or midwife
can make the difference between a
healthy baby and a serious birth injury.
When you have concerns that a mistake
occurred, seek experienced legal
counsel and advice as soon as possible.
Review our white paper for help
deciphering the jargon that didn’t make
much sense during delivery. Uncovering
that a mistake occurred is only part of
the process. Justice begins with learning
your legal rights.