Delayed Emergency C-Section When a Baby is in Distress

The birth of a child is a thrilling experience. Most of the time, babies are born healthy and have no major problems. Sometimes, however, the baby is in distress and the obstetrician and healthcare team fail to promptly act to relieve the baby of the distressing condition(s). Often, relief from distress means that the baby must be quickly delivered via emergency C-section. Failure to timely deliver a baby who is in distress can result in the baby being deprived of oxygen for too long, which can cause brain injury and conditions such as hypoxic ischemic encephalopathy (HIE) and periventricular leukomalacia (PVL), which can result in the baby being diagnosed with seizures, cerebral palsy, motor disorders, developmental delays, intellectual disabilities and other lifelong conditions.

What Causes Oxygen Deprivation & Distress in a Fetus?

Oxygenated blood from the mother travels to the placenta, where the oxygen diffuses through the placenta into the baby’s blood. This oxygen-rich blood is carried to the baby via the umbilical cord (umbilical vein). Problems with the mother’s circulation, the uterus, the umbilical cord or the placenta can cause the baby to be deprived of oxygen, which causes distress and a non-reassuring status. The healthcare team says a baby has a non-reassuring status when there are non-reassuring heart tracings on the fetal heart rate (FHR) monitor. These tracings are also called non reassuring FHR patterns. Babies sometimes experience a non-reassuring status during the latter part of pregnancy or during labor and delivery. A non-reassuring status indicates that the baby may not be getting enough oxygen. An ominous status is even worse than a non-reassuring status, and it requires that delivery occur right away.

Medical Malpractice Cases Involving Delayed Emergency C-Section

We have reviewed many different cases in which a baby should have been quickly delivered, but the staff failed to do so. Some cases involve the baby exhibiting non reassuring FHR patterns and the staff failing to recognize the severity of these FHR patterns. Or, the staff recognizes the patterns, but spends too much time trying to pinpoint the causes of the non-reassuring patterns and trying to relieve them, all the while delaying C-section preparation. In other instances, the healthcare team recognizes that the baby needs to be delivered right away, but they have to wait for the doctor to arrive. We have also seen cases whereby the baby was in distress and needed emergent delivery, but there was no C-section suite available – or no anesthesiologist available – so the delivery was significantly delayed. In one case, the obstetrical team wanted to perform an emergency C-section, and the team repeatedly paged the on-call anesthesiologist and got no response for almost an hour. Thus, this C-section was not emergently performed, and the baby suffered devastating consequences.

Over the years, obstetricians who were sued for failing to quickly perform an emergency C-section when needed would argue that as long as they performed the C-section within “30 minutes from decision to incision,” they did nothing wrong. This “decision to incision” principle is outdated and originated many years ago when deliveries were performed in hospitals that did not have the capacity to quickly mobilize and perform an emergency C-section. For example, an anesthesiologist may not have been in-hospital around the clock. However, in the present medical climate, anesthesiologists and other staff needed for emergency C-sections are present in the hospital 24 hours a day. In fact, it is a violation of the standard of care for a hospital to hold itself out as having a labor and delivery unit, and then not having the appropriate staff to perform emergency C-section deliveries.

In many of our cases, we find that the decision for C-section is hugely delayed. Once the decision for C-section is made, however, the obstetrical team must move as quickly as possible to get the baby delivered. In many instances, 30 minutes from decision to incision is be far too long for the baby to be in distress.

Indeed, when a baby is in distress and an emergency C-section is indicated, the obstetrician’s obligation is to rescue the baby as soon as possible. If a C-section can be performed in 10 minutes, as is often the case, then that is the obligation of the obstetrician. In fact, FHR patterns that are ominous require delivery to occur immediately. Conditions that can produce ominous FHR patterns include prolonged umbilical cord compression, tetanic uterine contractions (which can be caused by Pitocin), and epidural and spinal anesthesia. Indeed, umbilical cord problems such as cord compression (which can occur when there is cord prolapse, a nuchal cord (cord wrapped around baby’s neck), and a true knot in the cord), placental abruption (especially when there is a complete abruption) and uterine rupture are conditions that can cause the baby to be completely cut off from the mother’s oxygen supply, thereby requiring immediate delivery.

Of course, if a condition can be relieved, such as when a physician can manually move and hold the umbilical cord to relieve cord compression, the team should try and relieve the condition. But while relief is attempted, the staff must be quickly preparing for C-section delivery. Attempts to relieve fetal distress should not delay preparation for an emergency C-section.


If you think your baby experienced oxygen deprivation, a traumatic birth, a brain bleed, delayed delivery, or delayed emergency C-section, or if your baby’s care was mismanaged after birth in the NICU, please contact our team of experienced birth injury attorneys. The medical malpractice team at Grewal Law is comprised of attorneys and healthcare professionals, including an on-site physician, registered nurse, pharmacist, paramedic, and respiratory therapist. We also work with the best consultants and experts from around the country. Our attorneys are licensed in Michigan, Florida and Arizona and we help victims of medical malpractice and birth trauma throughout the country.

If your baby was diagnosed with HIE, seizures, cerebral palsy, motor disorders, periventricular leukomalacia (PVL), hydrocephalus, intellectual disabilities, or developmental delays, or if you experienced problems during delivery or shortly before or after birth, please call us. Our medical malpractice attorneys and medical staff are available to speak with you 24/7.

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