When we write about birth injuries, our focus is typically on the newborn. Injuries such as cerebral palsy or brachial plexus injury, such as Erb’s palsy, are common sources of medical negligence litigation in Ohio. But we also know that preventable injuries can happen to a mom as well. Today, I would like to discuss one complication of child birth: excessive maternal bleeding after delivery (aka postpartum hemorrhage). This is the leading cause of maternal death and it can happen to anyone.
The American College of Obstetrics and Gynecology (ACOG) publishes a variety of materials that address birth injuries. In 2006, ACOG published a bulletin on postpartum bleeding. Because it can occur without warning, ACOG recommends that: “All obstetric units and practitioners must have the facilities, personnel, and equipment in place to manage this emergency properly.” The bulletin even recommends that hospitals undergo drills to prepare personnel for this complication and post protocols for managing bleeds in L&D units.
Common causes of postpartum bleeding include uterine anomalies, lacerations, retained placental and coagulopathies. Diagnosis of a bleed requires careful monitoring by nursing staff, careful assessment by a physician and, often, diagnostic tests such as lab work and imaging. Treatment depends upon the cause and severity of the bleed, but may include administration of medications to improve uterine tone, fluids, blood products and, occasionally, emergency surgery.
Typically, a medical malpractice case arises out of a postpartum bleed only if an avoidable delay in diagnosis or treatment results in the wrongful death of the mom or other severe consequences, such as brain injury or consequences of hypovolemic shock.