What medical errors can cause HIE during labor and delivery?

Medical errors during labor and delivery that can cause HIE

Several medical errors can occur during labor and delivery that deprive a newborn of oxygen, ultimately leading to HIE. The most common include:

Missing or misreading fetal distress on the monitor

Electronic fetal monitoring tracks your baby’s heart rate alongside contractions. It’s the main tool doctors and nurses use to spot oxygen deprivation during labor.

Clinicians sort tracings into three categories:

• Category I: Normal, with no specific action needed
• Category II: Indeterminate, requiring closer evaluation and ongoing reassessment
• Category III: Abnormal, linked to acid buildup in the baby’s blood and requiring prompt action

When a tracing shifts from Category I to Category II or III, prompt recognition and response are critical. Unfortunately, monitoring errors are more common than many realize and can have serious consequences. Common errors include:

• Missing worsening patterns, such as recurring late decelerations or lost variability
• Recognizing a problem but not calling the physician
• “Watching and waiting” on a Category III tracing instead of preparing to deliver
• Mistaking the mother’s heart rate for the baby’s
• Not switching to an internal scalp electrode when the external signal is poor

Waiting too long to perform an emergency C-section

When a baby shows serious distress and vaginal birth isn’t close, an emergency C-section may be the only way to stop the oxygen loss. A commonly miscited “benchmark” for the time from decision to incision is 30 minutes, and some emergencies demand far faster action.

Delays can come from a late decision, an unavailable surgeon or anesthesiologist, an occupied operating room, or poor communication. Our C-section injury lawyers regularly see these breakdowns in HIE cases.

Overusing Pitocin during labor

Pitocin (oxytocin) is used to start or strengthen labor. Too much can cause uterine tachysystole, defined as more than five contractions in 10 minutes, averaged over 30 minutes. That leaves your baby too little recovery time between contractions.

Errors include raising the dose despite excessive contractions, not reducing or stopping Pitocin when the heart rate worsens, and not monitoring closely enough during the infusion.

Mishandling obstetric emergencies

Some events can cut off a baby’s oxygen suddenly, such as:

• Umbilical cord prolapse or compression, when the cord slips ahead of the baby or is squeezed
• Placental abruption, when the placenta separates from the uterine wall
• Uterine rupture, especially during labor after a prior C-section
• Shoulder dystocia, when the baby’s shoulder gets stuck after the head is delivered

These emergencies aren’t always preventable, but the response to them is judged against clear standards. Did the team recognize the event quickly, have the right staff available, and deliver fast enough? Families affected by umbilical cord strangulation or shoulder dystocia often have HIE claims for this reason.

Prolonged or improper vacuum and forceps delivery

Assisted delivery with a vacuum or forceps can be appropriate. But repeated or drawn-out attempts can delay the delivery of a baby already in distress, and too much force can cause bleeding in the brain.

A failed attempt that should have been abandoned sooner in favor of a C-section is a recurring issue in HIE cases. Learn more about vacuum birth injuries.

Failing to manage a high-risk pregnancy

Conditions such as preeclampsia, growth restriction, gestational diabetes, overdue pregnancy, reduced fetal movement, and maternal infection raise the risk of oxygen deprivation. They often call for closer monitoring, earlier delivery, or delivery at a hospital with a higher-level NICU.

Missing these risks, or failing to adjust the labor plan for them, can set the stage for HIE. Proper care for high-risk pregnancies starts long before labor begins.

Newborn resuscitation and cooling delays

The care your baby receives in the first minutes and hours after birth can change the outcome. Errors include delayed or improper resuscitation, problems placing a breathing tube, and failing to recognize that a baby qualifies for cooling.

A Cochrane review of 11 randomized trials involving 1,505 infants found that cooling reduces deaths without increasing major disability in survivors. It also found cooling should begin within six hours of birth for eligible babies with moderate-to-severe HIE.

Missing that window through late recognition or a slow transfer to a cooling center can be a separate basis for a claim. Unrecognized seizures and untreated low blood sugar can also worsen the injury. These are among the most serious NICU injuries we see.

When the hospital system itself fails

Many HIE cases involve no single catastrophic mistake. Instead, the system breaks down.

A nurse calls a physician who doesn’t come. Concerns aren’t passed along at shift change. The hospital doesn’t have enough staff to perform an emergency C-section quickly. Hospitals can be held responsible for these institutional failures.