Anesthesia Errors In Birth And Delivery

You don’t need to tell any mother: childbirth is an incredibly painful process. Medical professionals use anesthesia to assist mothers with stress on their bodies during the labor and delivery process. When administered correctly, anesthesia can allow a mother to comfortably deliver her baby. However, when anesthesia errors occur during labor and delivery, severe harm may come to the mother and child.

The two main types of pain-relieving drugs during childbirth are analgesics and anesthetics, which are given to the mother through either an epidural injection or spinal block. Though the two terms for medication types are often used interchangeably, it is important to know the differences. Analgesics refer to drugs that numb pain without a total loss of feeling. Anesthetics are drugs that dull or remove all sensation and feeling from an indicated area of the body.

Errors During Epidural Administration

The most common mistakes with epidural administration involve insertion technique and dosage.

• Injection – if an anesthetic is not inserted properly, it can cause serious problems, including nerve damage. Mothers who are given an improper epidural injection may suffer low blood pressure, cardiac arrest, seizures, or other medical emergencies that can cause injuries to themselves and their child.
• Dosage – it is imperative that medical providers administer the right dose of an anesthetic. Providing too little anesthesia can cause the mother to suffer needlessly throughout delivery. On the other hand, giving too much can cause the mother to experience issues such as headaches, respiratory issues, or paralysis. In the worst cases, over-sedation can lead to death. Too much anesthesia can lead to brain damage and paralysis for the baby, too.

Risk Factors With Anesthesia/Analgesia

During childbirth, pain-relieving drugs may be administered via an epidural, a spinal block, or a combination of both routes. An epidural is a method of administering anesthesia that numbs the lower half of the mother’s body to block pain. It is injected directly into the space around the spinal cord. A single injection of anesthetics into the epidural space is not sufficient to last for the entire labor and delivery. To prevent the medication from wearing off, the anesthesiologist inserts a special type of needle that stays in the mother’s back and is attached to a catheter or drip device in order to provide additional doses of medication as needed. This method of pain control has risks to both mom and baby.

Risks to Mother

• Low Blood Pressure: Approximately 14% of women who get an epidural experience a sudden drop in blood pressure. Lower blood pressure may increase the risk of certain complications and cause nausea and discomfort.
• Abnormal Uterine Contractions: Uterine contractions can become weaker and less frequent during anesthesia/analgesia epidural use. Doctors may then prescribe a drug called Pitocin to increase contractions. This is a risky drug that can cause too strong, frequent, or long contractions. This can result in fetal distress due to a lack of oxygen. If the contractions get too strong, it can cause the uterus to rupture. Uterine rupture is very dangerous for babies and sometimes results in hypoxic-ischemic encephalopathy (HIE) or death. It can also cause serious symptoms in the mother, such as postpartum hemorrhage.
• Heart Problems: Mothers may experience bradycardia (an abnormally slow heart rate), heart block in which the electrical activity of the heart chambers become dissociated, and sometimes even cardiac arrest.
• Breathing Problems: Mothers may go into respiratory arrest (stop breathing) or experience other breathing difficulties when anesthesia/analgesia is used during childbirth.
• Fever: Epidurals trigger a fever in around 23% of women who get them. A sudden spike in maternal fever may create serious risks for the baby. A recent study has shown that epidural induced fevers increase the chances of a baby being born with poor muscle tone, breathing issues, and lower Apgar scores.
• Nerve Damage:Minor nerve damage can occur following childbirth. Nerve damage can cause loss of feeling or movement in parts of your lower body.
• Seizures: In rare cases, an epidural can trigger a seizure if the pain medication gets into your vein. A seizure is shaking or convulsions due to abnormal electrical activity in your brain.
• Headaches & Dizziness: When an anesthesiologist inserts the needle for an epidural, they risk inserting it too far. This occurs in about 1% of all epidural placements. When the needle goes too far, it is known as a dural puncture. A dural puncture can cause spinal fluid to leak, which can trigger a post-epidural headache within 1–7 days. Also, the epidural may affect the nerves that go to your blood vessels, leading to the fall in blood pressure, causing dizziness.

Risks To Baby

• Forceps & Vacuum Extractors: These tools put a baby at risk for head trauma and brain bleeds, which can cause permanent brain damage. With large doses of anesthesia/analgesia, the mother may lose the ability and instinct to bear down and push. This may interfere with the second stage of labor, increasing the likelihood that physicians will use forceps and vacuum extractors.
• Hypoxic Ischemic Encephalopathy (HIE): HIE is a type of brain damage caused by insufficient oxygenated blood flow during or near the time of birth.
• Fetal Oxygen Deprivation: If your unborn baby experiences an oxygen deficiency during labor, then serious cognitive issues could result, such as Cerebral Palsy.
• Cerebral Palsy (CP): CP is a disability in which the brain is damaged and not able to properly control body and muscle movement. The particular type of brain damage that causes cerebral palsy typically occurs during childbirth when the supply of oxygen to the baby’s brain is temporarily interrupted.
• Low Heart Rate: The most common side effect of an epidural is a reduction in the mother’s blood pressure. When the mother’s blood pressure goes down, it can cause changes in the baby’s heart rate. 
• Umbilical Cord Prolapse: When the cord drops through the open cervix into the vagina before your baby moves into the birth canal, the cord is squeezed between your baby’s body and your pelvic bones. This reduces your baby’s blood supply, leading to loss of oxygen to your baby.
• Placenta Previa: A condition in which the placenta lies very low in the uterus and covers all or part of the cervix. During labor, your baby passes through the cervix into the birth canal. If you have placenta previa, when the cervix begins to thin out (efface) and open up (dilate), blood vessels connecting the placenta to the uterus may tear. This can cause severe bleeding during labor and birth, putting you and your baby in danger.

Pre-Existing Conditions

Your medical history should be discussed with your anesthesiologist to understand what drugs should be administered during childbirth. Pre-existing conditions may cause adverse outcomes of epidural anesthesia. Certain medical conditions or allergies can increase your risk of complications, such as:

• Allergies to a specific drug
• Spinal abnormalities, such as spina bifida or scoliosis
• Previous spinal cord injury, which may have created scar tissue
• Low circulating blood volume
• Bleeding disorders
• Bloodstream infections
• Infection near intended catheter site
• Central nervous system disorders, such as syringomyelia or multiple sclerosis
• Heart valve issues, such as aortic stenosis

If you or your baby have suffered injuries related to anesthesia errors during childbirth, please contact the experienced medical malpractice attorneys at The Eisen Law Firm. We will work tirelessly and attentively to help you understand your rights when anesthesia errors occur during birth and delivery. Call The Eisen Law Firm today at (216) 687-0900 or contact us online to learn more.