Maternal obesity is defined as a Body Mass Index of over 40. This translates into the expectant mother being more than 100 pounds over her ideal body weight. Maternal obesity increases the risk of gestational diabetes and a higher need to use instrumentation (i.e., forceps or vacuum extraction) during delivery, all of which have been proven to lead to a higher rate of birth injury.
Rh factor is a protein that is found in certain red blood cells. Approximately 8 percent of the population carries this protein and these people are identified as Rh-positive. Conversely, those people who do not carry this protein are identified as Rh-negative. When an expectant mother and the baby’s father are not both Rh-positive or Rh-negative, they are called Rh-incompatible.
Importantly, Rh-Incompatibility does not pose a problem during the mother’s first pregnancy. However, in subsequent pregnancies, Rh-Incompatibility can pose serious health risks to the baby. If an Rh-negative mother is pregnant with a baby after her initial pregnancy that is Rh-positive (inherited from the baby’s father), the mother’s Rh-negative antibodies will identify the Rh proteins on the surface of her baby’s red blood cells as foreign and the mother’s antibodies potentially can cross the placenta and attack the baby’s red blood cells.
This can cause the baby to become severely anemic. When this occurs, the baby’s red blood cells, which deliver oxygen to the baby, are destroyed faster than the baby’s body can re-produce them and ultimately result in the baby experiencing life-threatening multi-system organ failure.
Fortunately, Rh-Incompatibility is easily diagnosed by way of a simple blood test. If diagnosed during the mother’s first pregnancy, the mother will receive an Rh-immune globulin injection (Rhogam) around week 28 of her pregnancy and a second shot within 3 days of giving birth. These shots act similar to a vaccine and prevent the mother’s body from making Rh antibodies that could potentially impact her future pregnancies.
Those mothers who are 19 years or younger or 40 years and older have a statistically higher risk of pre-term labor, which increases the risk of a birth injury.
Each labor is different and can pose risk to both the infant and mother. When labor exceeds 18 hours, compression on the baby’s brain can prove to be too difficult for the baby to withstand. During labor, the mother’s contractions and the baby’s heart rate are continuously monitored by Electronic Fetal Monitoring. This enables obstetricians and obstetrical nurses to monitor and assess the baby’s physiologic response to the forces of labor. If the forces of labor begin to deprive the baby’s brain of oxygen, signs of fetal distress will become evident on electronic fetal monitoring strips to the trained obstetrician or obstetrical nurse.
Often the most severe birth injuries are due to oxygen (anoxic brain injury or hypoxic ischemic encephalopathy) the baby experiences deprivation during the birthing process. It is for this reason that accurate interpretation of Electronic Fetal Monitoring is essential. The proper interpretation of the baby’s response to the stress of labor will guide the type and timing of interventions that range from change of maternal position to the administration of fluid to delivery by Cesarean Section.
The primary medical equipment used to perform instrumented deliveries are forceps and vacuum extractors. Forceps are placed on the baby’s head to enable the obstetrician to guide the baby through the birth canal. A vacuum extractor is a suction device that attached to the baby’s head and pulls the baby through the birth canal. Both forceps and vacuum extraction deliveries pose the risk of injury to the baby’s head and the possibility of brain damage.
Mothers who have certain types of infections before or at the time of delivery experience a higher birth injury rate. If not diagnosed and treated properly, maternal infections can spread to the placental and fetal membranes where it poses potential significant risk to the baby. While there are numerous infectious organisms that can cause injury to a baby during the birthing process, Group B Streptococcus, commonly referred to as GBS, is the number one risk of infection to newborns.
While GBS is present in many healthy women, if the baby comes into contact with this organism as he or she passes through the birth canal, the baby can suffer a serious and life-threatening infection. The potential risk factors for GBS are premature labor, a past history of GBS, and premature rupture of maternal membranes. Expectant mothers should be screened for GBS and, if present, be treated with antibiotics.
This is a condition that typically occurs toward the end of pregnancy (however, it can also occur during the post-partum period which extends until 6 weeks after delivery). It is believed to be triggered by abnormalities in the placenta and is reported to occur, in varying degrees, in upwards of 9 percent of all pregnancies. If not properly diagnosed and treated, it can cause significant risk to mother and baby. If untreated, Pre-Eclampsia can evolve into Eclampsia which poses the immediate risk of maternal and fetal death, thereby mandating emergent delivery regardless of fetal age. The risk factors for Pre-Eclampsia include a personal or family history, pregnancy with twins or triplets and maternal age younger than 18 or older than 40.
Meconium is a tick or thin greenish colored fecal material that builds in a baby’s intestines while still in the womb and is often found in amniotic fluid. In essence, meconium found in the amniotic fluid represents the baby’s first bowel movement. Although babies receive their nutrients in utero through their umbilical cord, they still can and do swallow in the womb. Since Meconium is produced as the baby’s GI tract matures, it only impacts the baby close to term as Meconium is not produced prior to the timeframe. In most instances, Meconium stays in the baby’s intestine until birth. However, if the baby experiences stress in utero prior to birth, the baby can pass Meconium filled stools that mixes with the amniotic fluid surrounding the baby.
Risk Factors associated with Meconium passage in utero include late for date pregnancies, placental abnormalities, oligohydramnios, Pre-Eclampsia, and fetal distress.
If Meconium is passed in utero, the baby likely will breathe in the Meconium. Unlike stool which is filled with bacteria, Meconium is sterile. While typically not life-threatening, Meconium aspiration can lead to respiratory distress. Upon delivery, a baby who is in respiratory distress from Meconium aspiration can appear cyanotic (bluish skin coloring), experience difficulty breathing and have low Apgar scores. Typically, successful treatment will only require the immediate suctioning of the baby’s mouth and airway. However, in severe cases, intubation may be required to assist the baby to breathe. In either case, the prognosis for Meconium aspiration is typically very favorable.