Inside the Delivery Room: A Nurse’s Perspective on Hypoxic-Ischemic Encephalopathy

The delivery room can be a beautiful place. It’s where the countdown ends and a mother gets to finally meet her baby for the first time. Where nine months of dreaming of what they will look like and what it will feel like to hold them for the first time actually becomes a reality.

For many mothers, the greatest stress after childbirth is learning how to feed their child and wondering if their newborn will sleep long enough so they can get some rest. For others, their dream of caring for a healthy baby was taken from them as they worry about how their baby is doing in the NICU, if they are breathing okay, and if they will even be in the same room as their child during the night.

In labor and delivery, things can change at a moment’s notice. As a nurse, I know how important it is to stay vigilant, monitor your patient, and recognize the warning signs that something is wrong.

Quick and safe actions can often prevent birth injuries from occurring. However, the wrong actions during labor, birth, or shortly after can cause serious harm, including hypoxic-ischemic encephalopathy (HIE).

What Is HIE?

HIE is a condition that occurs when the brain is deprived of oxygen (hypoxia) and blood (ischemia). It can cause brain injury that ranges from mild HIE to severe hypoxic-ischemic encephalopathy.

There are many circumstances that can cause the brain to lose adequate oxygen and blood supply.

Hypoxic-ischemic encephalopathy causes​ often involve:

• Birth asphyxia, or a lack of oxygen around the time of birth
• Complications with the umbilical cord, like compression
• Emergencies with the uterus, such as a rupture

While the labor complications may not have been able to be prevented, quick action by the medical team can prevent prolonged distress to the baby.

How Medical Teams Monitor and Respond During Delivery

Nurses in labor and delivery are trained to notice when a baby is in distress or when something is wrong. In most circumstances, a baby’s heart rate and the mother’s contractions are monitored continuously when she is admitted to the labor and delivery unit.

The nurses and physicians should monitor the infant closely for any signs of distress, such as a prolonged drop in the infant’s heart rate. Heart rate patterns can give the medical team a picture of the baby’s health and indicate if something is wrong during labor.

Events like a shoulder dystocia, where the baby’s head is delivered, but the shoulder is stuck behind the mother’s pelvic bone, can cause the baby to be compressed and block oxygen from getting to the brain.

If this occurs, the medical team must perform the right actions to help release the shoulder, such as applying pressure to the suprapubic area, internal rotations, or quickly changing the mother’s position.

I have been in many of these situations where my team had to jump into action. When delivery emergencies occur, the medical team must notice signs and act quickly to help the baby.

Emergencies That Can Put a Baby at Risk

There are many emergencies that can occur in labor and delivery that can place a baby at risk for HIE. When distress is observed, the risk of injury can be reduced by performing quick, safe medical actions.

Failing to perform these necessary actions when there are signs of a lack of blood or oxygen to the baby can be considered medical negligence.

Signs a Baby May Have HIE

If trauma during labor or birth causes hypoxic-ischemic encephalopathy, early signs of HIE can be noticed in the infant after birth. Nurses and doctors should be trained to recognize signs of injury and know the appropriate actions to take when they are observed.

As a nurse who has attended many deliveries over my 10-year career, I have seen many infants born in distress. I know how crucial it is to perform the right actions to prevent damage to the brain.

Initial signs of distress that I look for after delivery that point to HIE are:

• Decreased or absent breathing at birth
• Floppy muscle tone
• Low heart rate
• Pale or blue skin tone
• Weak or absent cry
• Weak or absent reflexes

Infants born displaying these signs in the delivery room need to be attended to quickly. Breathing support should be initiated with a mask that can provide oxygen, pressure to the lungs, and breaths if the baby cannot take them on their own.

Sometimes chest compressions and medications are needed to help the heart. Prolonged distress might require placing a breathing tube through a process called intubation. After the artificial airway is placed, the baby can be transferred to the NICU and placed on a machine called a ventilator that gives controlled breaths, oxygen, and pressure.

One of the best treatments that can be performed on a baby suspected of having HIE is therapeutic hypothermia. For ultimate effectiveness, this treatment should be started within 6 hours of birth. Therapeutic hypothermia is when the core body temperature is lowered for 72 hours to prevent brain damage.

Effects of Hypoxic-Ischemic Encephalopathy

The complications of HIE don’t just end in the delivery room or the NICU, but the effects can follow a child for the rest of their lives. Initially, babies with HIE can experience a range of symptoms in the following days to weeks.

While mild HIE may be treated without lasting harm, moderate to severe HIE can lead to conditions like cerebral palsy or other movement disorders, epilepsy (seizure disorder), hearing or vision loss, and learning disabilities.

Parents can see developmental delays in the first few years of life that point to brain injury conditions like cerebral palsy, where a child can have difficulty controlling their movements due to problems with muscle tone or balance.

Get Legal Help for HIE

It is heartbreaking when things go wrong in the delivery room. When a baby is in distress, the birth team must act quickly and safely. As a nurse, I know how important it is to watch closely, alert the doctor, and respond right away.

When a medical team does not respond this way, a baby can suffer a serious birth injury like hypoxic-ischemic encephalopathy. If you believe your child’s HIE could have been prevented, reach out to our team.

An experienced hypoxic-ischemic encephalopathy lawyer may be able to help you seek justice and financial support for your child.

If your child was harmed, the Birth Injury Justice Center team is here to help. Call us at (800) 914-1562 or fill out our form to see if you can work with our experienced HIE attorneys today.