Medical Overview

As this is primarily a site for information on birth litigation, the medical aspect is only added because you will receive your hospital notes, expert witness reports and the Letter of Response which will have medical terms relating to the birth and the birth injury.  In many cases there is some negligence around the pregnancy and post delivery, as well as or instead of, the birth.  Therefore, I have added this section to try to clarify some of the terms you will see.  However, a lot of the issues you will read will be unique to your case, and will often be complex to understand.  Sadly, the difference between the delivery of a healthy baby and an injured one, can often be counted in minutes. 

Newborn babies can be remarkably resilient, but the brain is particularly vulnerable to a significant or prolonged lack of oxygen. The severity and duration of the oxygen deprivation, together with other factors, influence whether brain injury occurs and how severe it may be. In birth injury litigation, very small differences in timing can sometimes be extremely important, which is why the medical records and expert evidence examine events so closely.

If the baby is subjected to an acute loss of oxygen, especially just before delivery (emergency or otherwise) the pattern of brain injury is quite distinctive and the area most often damaged is the basal ganglia.  This is the deep grey matter of the brain controlling smooth movement, amongst other things.  This will show on a contemporaneous MRI scan and a neuroradiologist will be able to pinpoint when the damage occurred in relation to the birth. 

A prolonged or repeated reduction in oxygen and blood flow can produce different patterns of injury, often involving the white matter, although the patterns can overlap and are not always specific to one type of event.  Again, it can be picked up on MRI.  You can have an acute loss on top of a chronic lack of oxygen.  The patterns point to timings, and these timings can tie in with the care given to the mother as noted in the medical notes and the mother’s statement.  

Another factor looked at by the medical experts is the blood gas readings. Blood gases provide information about the baby’s acid-base balance, including the pH. Blood is normally slightly alkaline, with a pH around 7.35–7.45. If a baby experiences significant oxygen deprivation, the blood can become more acidic (acidaemia). The degree of acidaemia, together with other blood-gas measurements and the circumstances around birth, can form part of the evidence considered when assessing whether significant oxygen deprivation occurred. You may see blood-gas results recorded in the baby’s obstetric or neonatal notes.  

In proving negligence its important to put several pieces of a puzzle together to form a coherent picture.  This is where the medical experts employed by your solicitor come in.  They must form links to negligent behaviour by the healthcare professionals, to the physical damage caused to the baby.

When babies sustain a brain injury, particularly a sudden injury, the injured cells in the brain set up a reaction which sees further cells injured and dying, which proceeds to cascade down, causing further injury even after the baby is born and receiving supplemental oxygen.  This is why cooling babies is often successful in reducing the continuation of this process as it reduces the oxygen requirement of the brain.  

The reason I have gone into this aspect of Birth Injury is that the reports and responses you receive will be looking very closely at timings, and the opinions of the experts on them.   The case often rests on detailed findings by the experts, so it might help you to know what they will be looking at.