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Jonathan Rosenfeld

March 2, 2023

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A baby is born in the breech position when its head does not come out first during vaginal delivery. The head down position is the safest during a vaginal birth. When the baby has a breech presentation, it comes out with its feet first.

Fetus Breech Position

While a breech birth is not a guarantee of injuries, it can lead to serious long-term consequences. In some cases, doctors can be legally responsible for injuries caused by a vaginal breech delivery.

The attorneys at Rosenfeld Injury Lawyers can help you if your baby suffered a birth injury due to medical negligence. We can work for you to receive financial compensation for a vaginal breech birth that caused an injury.

The Baby’s Head Down Position During Pregnancy

At some point before the mother goes into labor, the baby’s head should move into the down position. This happens naturally towards the end of pregnancy. It is also known as vertex presentation.

Usually, the baby will move into the head down position between weeks 32-36 of the pregnancy. The doctor should regularly be examining the mother to determine the baby’s position. A breech baby is an issue that the doctor and mother will usually learn about during the last weeks of pregnancy, and it is one that must be addressed.

The doctor should be able to see what position the baby is in just by putting their hand on the mother’s stomach. In some cases, the doctor would perform an ultrasound to check the baby’s position. They may perform electronic fetal monitoring, both during pregnancy and in the delivery room.

Statistics About Breech Babies

The baby is breech in roughly 3-4% of full-term pregnancies. Just because the baby is breech does not mean that they will automatically be injured. Most babies can be born safely when the doctor exercises a reasonable level of care.

Breech positions are far more common in premature babies than in normal pregnancies. In a premature birth, the baby may not have yet been able to move into the appropriate position before the mother goes into labor.

Risk Factors for a Breech Birth

Here are some things that may elevate the risk of the baby not being in the downward position before birth:

  • It is not the mother’s first pregnancy
  • The mother’s uterus has more than one fetus
  • There is too much amniotic fluid or not enough fluid
  • There is an abnormally shaped uterus
  • There are abnormal growths in the uterus, such as fibroids
  • The mother has placenta previa, where the placenta covers all or part of the uterus

The reasonable medical professional, exercising a normal level of care, would know of these health risks and would act accordingly as the due date approaches. They may mean that the mother should not plan on having the baby born vaginally. It may be a judgment call for the doctor when there is a slightly elevated risk of a breech baby.

Examples of a Breech Position

There are four different types of a breech position that can present risks to the delivery. They are:

  • Frank breech– the baby’s buttocks are pointed towards the birth canal with their legs sticking straight from the body and the feet near the head.
  • Complete breech– the baby’s knees are bent, and their feet and bottom are above the birth canal
  • Footling breech – one or both of the feet are presenting forward
  • Incomplete breech– the bottom and foot are closest to the birth canal, but only one of the knees is bent

What Doctors Do When the Baby Is Breech

The doctor will rarely allow for the mother to have a vaginal delivery when the baby remains in the breech position. If the mother has a planned vaginal birth, the doctor would often decide to do a cesarean delivery to lower the risks to the baby.

A doctor who exercises a reasonable amount of care would know that the baby is not in the head first position before a planned vaginal delivery. They may decide to schedule a c-section delivery to reduce the risk to the mother and baby.

Risks When the Baby Is Breech

The cervix must be stretched enough for the baby to come out properly. The head down position is the one that most effectively stretches the cervix. The baby’s feet, or the baby’s legs, cannot stretch the cervix to the same extent.

When the baby is breech, the mother’s cervix will not be stretched enough to allow the head to properly leave the body. The baby’s head or shoulder may become wedged in the mother’s pelvis.

Any delays or trauma in delivery raises the risk that the baby can suffer a birth injury. The baby may be deprived of oxygen or nutrients in an extended delivery. In addition, trauma to the head can raise the risk that the child is born with cerebral palsy.

Injuries That Babies Suffer When Born in the Breech Position

Most breech babies are born healthy and are safely delivered. However, some with breech presentations may have an elevated risk of certain birth defects or other lasting birth injuries. One study [1] showed that a breech baby has a 33% higher chance of injury or death than a baby who is born from the head down position.

In addition, the baby can suffer injuries that are associated with either trauma or oxygen deprivation. These injuries can include:

  • Prolapsed umbilical cord
  • Fetal stroke from oxygen deprivation
  • Brachial plexus, which is an injury that hurts the baby’s shoulders or her hands
  • Nerve damage
  • Seizures
  • Developmental delays

All of these injuries can cause permanent damage. For example, cerebral palsy is a brain injury that affects the baby’s movement. Depending on which part of the brain was injured, the baby may have either very stiff or floppy muscle tone.

Cerebral palsy can also impact gross motor skills and language abilities. Cerebral palsy will cost more than $1 million over the course of the child’s lifetime to treat, along with other damages that the child will suffer.

Any type of birth injury can have considerable associated costs in the form of treatment, pain and suffering and other care that is necessary for a child with a disability.

The Role of External Cephalic Version (ECV)

When doctors learn that a baby is breech from prenatal care, there is a measure that they can try to turn the baby into the proper birth position. An ECV is a manual procedure where the doctor tries to change how your baby is positioned.

In an ECV, the doctor will place firm pressure on the mother’s stomach in an attempt to maneuver the baby into the right position. Essentially, the doctor is using their hands to try to turn the baby inside the mother.

There are some risks to an ECV, so the doctor may not want to try it, depending on the circumstances. The mother may experience vaginal bleeding, or her water can break from the procedure.

The ECV procedure will be successful about 40-60% of the time. Once the mother has gone into labor, it is too late to try to move the baby. Most often, this means that the mother will need to have a c-section delivery.

In some cases, the doctor is able to successfully turn the baby. A pelvic exam may reveal whether the procedure was successful. If the ECV was unsuccessful in changing the child’s pose, the doctor may consult with the mother about a c-section to reduce the risks to the baby and the mother.

Other Risks From a Breech Birth

Besides the risks to the baby from a breech birth, the mother could also suffer an injury. The trauma to the reproductive system from delivering a breech baby could affect the mother’s ability to deliver a baby in the future.

In addition, the trauma from a breech baby could cause the mother to bleed heavily, or it will delay her recovery from childbirth.

Many women still want to try a vaginal delivery, even after learning that the baby is breech. The doctor would need to get involved and insist on a c-section if their professional judgment tells them that a surgical procedure is necessary to protect the baby’s health.

How Doctors Can Be Negligent in a Breach Birth

94% of babies who are born breech are delivered by a c-section. The question is when the doctor decides to do the procedure. Doctors should be prepared ahead of time because they are familiar with the health risks and have examined the mother.

Even if the mother wants to continue to try a vaginal delivery because they want that experience and do not want a c-section, the doctor must stand firm if they believe that a caesarian section is the safest form of delivery, as it usually is.

Even if the doctor is willing to allow the mother to try to have a natural childbirth, they should be prepared for an immediate c-section if it looks like there is any danger.

Doctors may try to deliver the breech baby vaginally (6% of breech babies are delivered vaginally) or they may decide to deliver the baby by c-section after the baby has already suffered complications. If the doctor waits too long to deliver, the baby’s oxygen supply could be interrupted. Even a minor cutoff of oxygen could cause a fetal stroke or permanent brain damage.

While it is often easy after the fact to say what a doctor should have done (and it seems clear that doctors should perform surgery when the baby is breech), a medical malpractice case looks at what the doctor did at the time based on what they knew.

A birth injury lawsuit compares what the doctor did to what a reasonable doctor would have done under the circumstances. In other words, the legal inquiry would be whether the doctor made a reasonable decision knowing what they knew at the time.

Birth Injury Attorneys Helping Families

If the mother or child has been injured during childbirth, the family may be entitled to significant financial compensation when the injuries were caused by medical malpractice. The attorneys at Rosenfeld Injury Lawyers have a track record of delivering results for our clients in personal injury and medical malpractice cases.

You should retain a birth injury attorney immediately to determine whether you may have a right to be paid for the injuries. The costs to treat your child over the course of their lifetime can be considerable when they have suffered a birth injury.

To schedule your free initial consultation, you can fill out an online contact form or call us at (888) 424-5757. We work for you on a contingency basis, meaning you do not need to pay us unless you win your case.

Resources: [1] Reuters

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