Maternal Birth Injuries

In a delivery there are two patients. When something goes wrong, attention goes almost entirely to one of them, and the reasons are obvious and humane.

The consequence is that maternal injuries are systematically under-pursued. A mother who spent a week in intensive care after a hemorrhage, or who was left with a fistula, or whose fertility ended in an emergency hysterectomy, will frequently describe those events as background to her child's story rather than as her own injury.

They are her own injury. She was a patient. The care she received is measured against a standard in exactly the way her child's was, and her damages — medical, occupational, and personal — are hers.

Where the child also has a claim, the two run together and share most of the evidence. Where the child is uninjured, the mother's claim stands entirely alone, and there is no reason for it to be treated as lesser.

Postpartum hemorrhage is among the leading causes of severe maternal morbidity, and much of it is regarded as preventable — which is precisely why it is the subject of organized quality improvement work rather than treated as an unavoidable risk.

Obstetric units run written hemorrhage protocols: risk assessment on admission, quantified rather than estimated blood loss, staged responses with defined triggers, and a massive transfusion pathway. Quantified blood loss is worth understanding, because visual estimation is known to be substantially inaccurate and the shift to weighing and measuring exists for that reason. A record showing estimated loss where the protocol calls for quantified loss is a departure from the unit's own document.

The examinable questions are the familiar ones: was risk assessed on admission, was loss quantified, were the staged triggers acted on at the point they were reached, how long between recognition and transfusion, and how long between deterioration and escalation to an attending physician or to the operating room.

What a delay costs is real — intensive care, hysterectomy and the end of fertility, and in the worst cases hypoxic injury from prolonged hypotension.

Preeclampsia is a hypertensive disorder of pregnancy that can progress to eclampsia, stroke, HELLP syndrome, liver rupture, renal failure and pulmonary edema. It is screened for at every prenatal visit — blood pressure and urine protein — for exactly that reason.

Failures here divide into recognition and response. Recognition failures are documentary: readings recorded and not acted on, a rising trend across visits treated as a series of isolated numbers, proteinuria not followed up. Response failures concern treatment of severe hypertension, magnesium sulfate for seizure prophylaxis, and the timing of delivery, which is the definitive treatment.

A recurring pattern deserves specific mention because it is common and avoidable: symptoms after discharge. Headache, visual disturbance, epigastric pain and swelling in the days following delivery are the recognized warning signs, and postpartum preeclampsia can present in a woman who had no hypertension at all during pregnancy. A telephone triage record describing those symptoms alongside reassurance is a document that speaks for itself.

A cesarean is major abdominal surgery performed close to the bladder, the bowel and the ureters, sometimes in a hurry.

Injury to any of those can occur without negligence. What is examinable is recognition: an injury identified during the operation and repaired is a complication, while one identified three weeks later because a fistula developed is a different matter. The operative note, the postoperative observations and the response to reported symptoms are the record.

Retained surgical items sit in a category of their own. A sponge or instrument left in the abdomen is prevented by counting protocols that every operating room operates, and a count discrepancy is required to be resolved before closure. Because the prevention is procedural rather than judgmental, these cases are unusually straightforward compared with the rest of this page.

Retained placental tissue presents afterwards as bleeding, pain and infection. The questions are whether the placenta was examined for completeness at delivery, and how promptly the later symptoms were investigated.

Severe perineal tears involving the anal sphincter are recognized complications of vaginal delivery and are not, in themselves, evidence of poor care.

What is examinable is whether the tear was identified and correctly graded, whether the repair was performed by someone appropriately trained and in an appropriate setting, and whether the follow-up that should follow such a repair actually happened.

A tear that is under-graded is under-repaired, and the consequence is faecal incontinence — an injury with a disproportionate effect on a person's working life, relationships and dignity that is frequently minimized in the record as a minor complication.

This is also the injury women are least likely to raise, and one that a lawyer who does not ask about it will never hear about.

Illinois treats a minor's own claim more generously than an adult's, in recognition of the fact that a child cannot bring a claim and their injuries may not be apparent for years.

A mother's claim for her own injuries is not a minor's claim. It runs on the adult timetable, which is materially shorter, and it is not extended by the fact that her child's claim remains available.

That asymmetry causes real losses. A family that spends two years focused on their child's diagnosis, and then consults a lawyer, may find the child's claim entirely intact and the mother's already gone.

There are further complications that change the analysis again — a claim against a public hospital is governed by different provisions, and a claim arising from care at a federally funded health center may be against the United States rather than the clinic, on a different track altogether. Which of these applies depends on facts about the provider that are frequently not obvious to a patient.

No page can give a reliable answer to how long do I have, and this one deliberately does not try. What it can say is that the mother's question is a different question from the child's, that it is usually the more urgent of the two, and that it is worth asking early.