A vacuum extractor is a medical device used during vaginal delivery to assist in pulling the baby through the birth canal when labor is not progressing adequately or when rapid delivery is medically indicated. It consists of a soft or rigid cup that is applied to the baby’s head, creating suction to allow the delivering physician to apply traction during contractions.
There are certain safety guidelines and procedures physicians should follow, especially when using an extractor to prevent injury to both the mother and baby. The vacuum extractor should generally be discontinued and converted to a Cesarean delivery if the vacuum cup detaches more than 2 to 3 times, if there is no downward progress after 3 sets of pulls, or if the total application time exceeds 20 to 30 minutes.
Fetal monitoring is an essential safeguard that allows the delivering physician to know whether the procedure is tolerable for the baby, whether fetal distress is developing, and when it becomes necessary to abandon the vacuum and proceed to an emergency cesarean section. The hospital nursing staff and the physician are equally responsible to make sure that laboring patients are properly monitored. Hospitals are required to have safety policies and procedures in place that govern the monitoring of patients in labor.
If these procedures and guidelines are ignored, major complications can occur. In this case, our client’s physician did not adhere to the standard of care, resulting in severe injuries to our client. The Townsley Law Firm fought and secured over $10,500,00 in a settlement to help provide for our client’s family and the lifetime care our client now requires.
What Happened: A Delivery Room Failure That Changed Everything
The Use of a Vacuum Extractor and the Absence of Proper Monitoring
Our client’s doctor repeatedly used a vacuum extractor during our client’s delivery without proper fetal monitoring, for over an hour. Due to the lack of monitoring, the physician did not recognize the signs of her distress in time to intervene and was making critical decisions about an instrumental delivery without the clinical data that those decisions require.
Fetal monitoring during an assisted delivery is not a secondary consideration. It is the mechanism through which a physician knows whether to continue, modify, or abandon the procedure. Without it, the physician is proceeding blind to the baby’s condition.
The result of that failure was severe oxygen deprivation to her developing brain during the most critical minutes of her life.
Our client was diagnosed with spastic quadriplegic cerebral palsy. She is nonverbal, and she cannot control her head, walk, or sit independently. She requires lifelong, around-the-clock care because of her physician’s negligence.
Oxygen Deprivation and Brain Injury
During the prolonged vacuum-assisted delivery without adequate monitoring, our client experienced severe oxygen deprivation. Oxygen deprivation during birth, called perinatal hypoxia, occurs when the baby does not receive adequate oxygen during the labor and delivery process. The developing brain is very sensitive to oxygen deprivation. Even relatively brief periods of inadequate oxygen supply can cause permanent damage to brain cells that will never regenerate.
The longer oxygen deprivation continues without recognition and intervention, the more extensive and irreversible the brain injury becomes. Proper fetal monitoring exists specifically to allow delivering physicians to detect the signs of fetal oxygen deprivation, including characteristic changes in the baby’s heart rate pattern, and to respond before the deprivation reaches a level that causes permanent damage.
Monitoring was not properly conducted, distress was not recognized in time, and intervention did not come when it needed to.
By the time the extent of the crisis was understood, the damage had been done.
The Diagnosis and the Life She Now Lives
Our client was diagnosed with Hypoxic Ischemic Encephalopathy (HIE) and spastic quadriplegic cerebral palsy. The type of cerebral palsy she was diagnosed with is the most severe form of cerebral palsy, involving significant motor impairment affecting all four limbs as well as the muscles of the trunk and neck.
She requires continuous, comprehensive care for every aspect of her daily life, including feeding, bathing, positioning, mobility, communication, and medical management. That will be required for the remainder of her life.
The toll this places on her family extends beyond the profound grief of watching a child live with severe disability. It encompasses the financial reality of lifelong care costs, the physical and emotional demands on her caregivers, and the complete restructuring of a family’s life around the needs of someone who wouldn’t have required this care if not for a physician’s negligence.
What Is the Standard of Care for Fetal Monitoring During an Instrumental Delivery?
The standard of care in obstetric medicine requires continuous electronic fetal monitoring during labor in high-risk situations and during any instrumental delivery. Continuous fetal monitoring allows the delivering physician and nursing team to observe the baby’s heart rate in real time and identify patterns that indicate developing distress.
During a vacuum-assisted delivery specifically, the standard of care requires that the physician assess fetal wellbeing before initiating vacuum use, conduct continuous monitoring throughout the procedure, evaluate fetal response between applications, and recognize and respond to any signs of fetal distress including abnormal heart rate patterns. If monitoring reveals signs of distress at any point during the procedure, the physician is required to respond promptly, which may include abandoning the vacuum and proceeding to emergency cesarean section.
The standard also addresses the duration and number of pulls. Most clinical guidelines specify that vacuum-assisted delivery should be abandoned if delivery is not accomplished within a defined number of attempts or if total procedure time exceeds accepted parameters. These limitations exist because of the well-documented relationship between prolonged vacuum use and fetal injury.
Using a vacuum extractor for more than an hour without proper fetal monitoring violates multiple components of the standard of care simultaneously. It fails the requirement for continuous monitoring. It exceeds accepted duration parameters. And it deprives the physician of the information needed to make safe clinical decisions throughout the procedure.
The Lifelong Cost of a Birth Injury Caused by Medical Negligence
Securing just compensation in a birth injury case involving lifelong disability is not simply about calculating past medical bills. It requires projecting the full scope of what this child will need for the entirety of her life, in a world where medical costs continue to rise and her needs will not diminish.
For a child with spastic quadriplegic cerebral palsy, a comprehensive life care plan must account for all of the following across a projected lifetime:
- Skilled nursing and personal care assistance, which for a child with this level of disability is typically required around the clock
- Physical therapy, occupational therapy, and speech therapy to optimize function and prevent complications such as contractures and respiratory problems
- Augmentative and alternative communication devices and programs to support her ability to interact with the world despite being nonverbal
- Adaptive equipment including specialized wheelchairs, seating systems, positioning aids, and home modifications
- Medical management including neurology, orthopedic surgery, pulmonology, gastroenterology, and other specialties commonly required in spastic quadriplegic cerebral palsy
- Medications including antispasticity agents, antiepileptic drugs if seizures are present, and other therapeutic medications
- Residential and day program costs as she ages beyond the years when her family can fully manage her care alone
- The loss of earning capacity she would have had over a full working lifetime
The settlement secured by the Townsley Law Firm was built around a thorough accounting of a lifetime of need. It represents not just what her care has already cost but also, all future costs.
What Is Spastic Quadriplegic Cerebral Palsy?
Cerebral palsy is a group of permanent movement disorders caused by damage to the developing brain, most commonly occurring before, during, or shortly after birth. It is the most common cause of physical disability in children. The term “cerebral” refers to the brain, and “palsy” refers to the resulting impairment of movement and motor control.
Spastic cerebral palsy is the most common type and is characterized by increased muscle tone, causing stiffness and difficulty with movement. In spastic quadriplegic cerebral palsy, all four limbs are affected along with the muscles of the trunk, neck, and often the face and mouth. This is the most severe subtype of cerebral palsy and is the form most commonly associated with perinatal brain injury from oxygen deprivation.
Children with spastic quadriplegic cerebral palsy typically experience a combination of motor impairments including inability to walk or sit independently, difficulty controlling head and neck position, limited or absent hand function, and in many cases the inability to communicate verbally. They often also experience associated conditions including epilepsy, intellectual disability, vision and hearing impairments, and feeding difficulties requiring nutritional support.
The brain injury that causes spastic quadriplegic cerebral palsy is permanent. The brain cells damaged by oxygen deprivation during birth do not regenerate. While therapy, medical management, and supportive care can help optimize function and quality of life, they cannot reverse the underlying neurological injury.
What Is Perinatal Hypoxia and Why Does It Cause Brain Damage?
Perinatal hypoxia refers to insufficient oxygen supply to the baby’s brain during the period surrounding birth, including during labor and delivery. The fetal brain is metabolically active and highly dependent on a continuous supply of oxygenated blood. When that supply is disrupted or inadequate, brain cells begin to sustain injury within minutes.
The process of brain injury from oxygen deprivation is progressive. In the initial phase, cells deprived of oxygen switch to less efficient metabolic pathways to maintain function. If oxygen supply is restored quickly, many cells can recover. If deprivation continues, cells begin to die.
In the hours following the initial injury, a secondary wave of cell death can occur as inflammatory processes and other cascades initiated by the initial deprivation cause additional damage. This secondary injury phase is one of the reasons that rapid recognition and intervention are so critical: the goal is not only to restore oxygen as quickly as possible but to limit the secondary injury that follows.
The pattern of heart rate changes that indicates developing fetal hypoxia during labor is one of the most well-studied areas of obstetric medicine. Characteristic decelerations and other abnormalities visible on electronic fetal monitoring tracings alert delivering physicians to the possibility of oxygen deprivation. These patterns are taught to every obstetrician and labor and delivery nurse as part of their training. They exist so that no baby should suffer prolonged unrecognized oxygen deprivation in a monitored delivery setting.
When monitoring is not conducted, those patterns cannot be seen. When those patterns cannot be seen, the distress cannot be recognized. When the distress cannot be recognized, the intervention that could prevent or limit brain injury cannot happen.
That is the chain of causation that destroyed our client’s future in a delivery room in Mississippi.
