Many people believe that they know things about their babies before they’re even born. Based on their baby’s movements in the womb, some pregnant people can sense that their baby reacts to certain types of music, is very active at specific times of day, or has other reactions to external stimuli.
But the doctor doesn’t care about any of that. The doctor’s 1st evaluation of your baby after they’re born is their Apgar score.
When a baby is born, regardless of whether the delivery is vaginal or by a Cesarean section (c-section), an Apgar test is administered at 1 minute and then again at 5 minutes after birth. If the 2nd score is low, a 3rd test could be performed 10 minutes after birth.
The 1st test, done 1 minute after birth, is intended to assess how well the baby tolerated the birth process. The 2nd test, done 5 minutes after birth, assesses how the baby is faring outside the womb.
APGAR stands for “Appearance, Pulse, Grimace, Activity and Respiration.” Each criterion is assigned a point value; most babies don’t score a perfect 10, which is the highest score. Most get an initial score of 7 or higher.
|Test||0 points||1 point||2 points|
|Appearance (color)||Blue or pale||Body pink, hands and feet blue||Completely pink|
|Pulse (heart rate)||Absent||Fewer than 100 beats per minute||More than 100 beats per minute|
|Grimace (reflexes, or catheter or bulb syringe placed in the baby’s nose to gauge reaction)||Absent||Grimace||Grimace and cough or sneeze|
|Activity (muscle tone)||Limp||Some flexing of arms and legs||Active motion|
|Respiration||Absent||Slow, irregular, weak cry||Good, strong cry|
Once you know what the doctor or midwife looks for when they check your baby after birth, you’ll also want to understand why.
What do these scores mean, and what would cause your baby to have a low Apgar score? These questions are important because your baby’s Apgar score can inform the type of treatment they need (and when they need it), as well as their prognosis.
What causes a low Apgar score?
Often, a baby who has a low Apgar score was deprived of oxygen at some point. It’s important to note that a high Apgar score doesn’t mean that your baby wasn’t deprived of oxygen, though.
But my baby was just born a few minutes ago. How could they already have been deprived of oxygen?
In the womb, your baby doesn’t “breathe” as we do. An unborn baby receives oxygen from its mother’s placenta through the umbilical cord. A baby’s lungs are filled with fluid at birth, and they take their 1st breath of air within about 10 seconds after delivery.
That 1st breath is crucial. Increased oxygen in the lungs (from breathing) causes a decrease in blood flow resistance to the lungs, and the blood flow resistance of the baby’s blood vessels also increases. Fluid either drains or is absorbed from the respiratory system, and the lungs inflate and begin to work on their own. At that point, the baby’s own breathing moves oxygen into the bloodstream (as they breathe in) and removes carbon dioxide (as they breathe out)—just like adults.
If your baby is oxygen-deprived, it could be because of a condition of the baby or parent before birth, or it could be the result of a mistake made during the labor and delivery process.
These are some of the ways your baby could be deprived of oxygen either before, during or shortly after birth:
- Uterine rupture
- Fetal monitoring errors
- Placental abruption
- Preterm birth
- Prolonged or arrested labor
- Umbilical cord problems
- Uterine hyperstimulation and tachysystole (sometimes caused by drugs used to induce labor, like Pitocin)
- C-section delays or mistakes
- Uterine rupture
- Medical conditions of the parent during pregnancy
Some of these conditions are the result of a birth injury, which could be due to medical malpractice. However, even if the condition wasn’t caused by negligence or malpractice, it could become negligence or malpractice if the doctor failed to diagnose or treat the condition in a timely manner.
In other words, if the parent or the baby had a condition while the baby was in utero that would cause problems if left untreated, and if checking for that particular problem would be detectable through routine prenatal care and testing, then the doctor might have been negligent if they didn’t observe and treat the problem.
A physician’s failure to act on a low Apgar score and provide treatment could be negligent and might be medical malpractice.
For example, when a person is admitted to a hospital to have a baby, they are generally hooked up to a fetal monitor. These machines monitor the baby’s heart rate and other vital signs before birth while labor is in progress. The doctors and nurses are responsible for paying attention to the monitor and reacting if there’s any abnormality or problem. If the fetal monitor detects an abnormality or shows that the baby is in distress, it’s the doctor’s responsibility to determine whether the situation requires the baby to be delivered immediately via an emergency C-section.
An abnormal fetal heart rate could indicate that something is wrong, like the umbilical cord is wrapped around the baby’s neck, for example. These warning signs should change how the doctor approaches the delivery process and how quickly they get the baby out.
Failing to perform a c-section and continuing with vaginal delivery in this type of circumstance could be considered malpractice.
The standard for medical malpractice is whether the doctor acted in a way that was consistent with the generally accepted standard within that community. In other words, would another doctor with the same training, in the same location and under the same circumstances have acted the same way? If not, the doctor could be negligent.
Certainly, there are instances when a baby could suffer a birth defect that could result in a low Apgar score, and there is nothing that the doctor or parent could have done to prevent it. In general, a birth defect is a problem arising from your child’s DNA (or their genetic makeup). You can’t usually prevent defects that stem from DNA, but sometimes they can be diagnosed and treated before birth or at the time of delivery.
A birth injury is a preventable condition that results from something that happened in the process of delivering the baby.
Birth injuries can happen because of reasons that include:
- Pulling or twisting the infant during delivery
- Miscalculating the size of the fetus
- Premature or post-mature delivery because of improper pregnancy dating
- Rh incompatibility
- Failure to provide oxygen to a newborn if needed
- Deliveries using forceps or vacuum extraction
- Failure to perform an emergency c-section
- Failure to detect or monitor distress or fetal heartbeat
- Incorrect medications or dosagages to the mother during pregnancy or labor
Is your baby the victim of medical malpractice or a birth injury?
A low Apgar score (or other symptoms) could suggest that your baby suffered a birth injury, or it could indicate a birth defect. It could also simply mean that your baby is having trouble adjusting to being outside the womb, in which case the baby typically rebounds and is completely fine—That happens, too.
If you believe that your baby has suffered from birth injury-related malpractice, there are a few things you can do. Your priorities should be to have your baby’s condition properly diagnosed, seek treatment if necessary and establish a plan for long-term care if the condition will result in ongoing problems or delays.
In order to make a claim for malpractice (or any personal injury), there must be financial damages. In other words, the injury has to have cost you money. Obviously, seeing your baby in pain or knowing that they might experience lasting effects from an injury is about the worst thing in the world for a new parent. But the courts can’t bring a baby back to health, unfortunately. The law is intended to compensate for financial losses related to the injury and restore the injured person to the financial condition they would be in if the accident hadn’t happened.
If your baby has suffered as a result of malpractice, you might be able to claim damages that include:
- Medical care, present and future, which includes hospital stays, surgery, diagnostics, prescription medication and other treatment related to the injury
- Assistive devices, such as prosthetics or a wheelchair, etc.
- Educational expenses, if the child is left with developmental or intellectual disabilities that would require specialized schooling
- Home modifications, like a wheelchair ramp if your child’s injury results in a condition that might lead to their being unable to walk
- Wrongful death and funeral or burial costs, if the injury resulted in the baby’s death (or the death of the birthing parent)
- Pain and suffering or emotional distress
As you might imagine, some of these costs—particularly when you could be looking at a lifetime of expenses—are hard to quantify when the child is still an infant. There are going to be 3 major components to a successful medical malpractice lawsuit:
- First, proving that the doctor or hospital was negligent.
- Second, proving that the negligence caused your baby’s injury or condition.
- Third, determining the full value of your claim (or how much you’re owed in compensation).
An experienced birth injury lawyer will be able to assess each of these components and will work with medical and financial experts and actuaries to make your case and ensure that you can recover the full amount to which you’re entitled.
If your child has experienced a birth injury that could leave them with life-long effects, you might be surprised at how quickly the costs add up. And, if your child will never be able to work or earn their own income, you want to know that they can be financially secure when you’re no longer around. It’s a lot to digest, and the financial strain combined with your emotional trauma, exhaustion and stress can be almost too much to bear.
That’s why I’ve devoted my career to helping families like yours through unimaginably difficult times. I have worked with families of babies who’ve suffered birth injuries to make sure that they’re compensated for their losses. While financial loss doesn’t compare to the devastation of adjusting your hopes and dreams for your precious baby, we want to help ease the struggle so you don’t face even more trauma.
The 1st step is to have your baby evaluated by a different provider. In other words, get a 2nd opinion about your baby’s diagnosis and prognosis. If the 2nd physician suspects that there could have been malpractice, contact me right away. We will work through your options and determine where to go and what to do to help you receive compensation.