The first priority with a potential birth injury is to manage the infant’s medical
condition. Under no circumstances should concerns about possible litigation be
allowed to interfere with the infant’s medical care. The second priority is to
make a definitive diagnosis. Determining what caused the problem may guide
the treatment of the child and may help avoid similar problems in future
children. It is also critical to the defense of any subsequent litigation.
The careless use of diagnoses such as cerebral palsy or anoxic birth injury has
exacerbated the problem of obstetric malpractice litigation. [ACOG Technical
Bulletin 163. Fetal and Neonatal Neurologic Injury. January 1992.] The
pediatrician and the obstetrician should work together to obtain a good
etiologic diagnosis for the child. There is a general assumption among
laypersons and plaintiffs’ attorneys that all nonspecific central nervous system
damage is due to birth hypoxia and is therefore the physician’s fault.
Obstetricians have fostered this belief by failing to investigate the underlying
causes of seeming birth injuries.
One example has been the development of placental analysis. Historically
physicians have either discarded placentas or sold them to drug companies.
Only recently have obstetricians realized that the placenta is an invaluable
research tool and forensic pathology specimen. Placental research is
documenting chronic placental insufficiency diseases that may account for 50%
of what have traditionally been termed birth injuries. Placental pathology
studies showing placental insufficiency have been used to defend physicians
from charges of negligently injuring a child at birth.
In cases of suspected birth injury, the entire placenta and umbilical cord should
be weighed and appropriately preserved. The placenta may be stored until it is
determined that the baby does not have any residual damage. If the baby is
injured, the placenta should be examined by a pathologist who is skilled in
placental pathology. This is not a routine skill and must be specifically sought
out. If an unskilled pathologist records that the placenta looks normal, this
opinion will only bolster the plaintiff’s case. Since these examinations are
expensive and usually cannot be billed to the patient, physicians and their
malpractice insurance companies must cooperate to pay for the pathologist’s