The moment of birth is one of the most critical times in a young child's life. It is absolutely essential that they are provided with safe and appropriate care during this period, as a failure to do so can have lifelong consequences for the child and their family.

One of the most important aspects is ensuring that the child receives an adequate supply of oxygen. In some cases, however, complications can lead to a baby being starved of oxygen at birth (birth asphyxia), which can have a significant impact on their long-term health.

In this guide, we will walk you through the causes, symptoms and treatments associated with birth asphyxia, as well as provide information on what you should do if you believe that medical negligence played a role in your baby being starved of oxygen.

What are the potential causes of oxygen deprivation at birth?

When a baby is cut off from oxygen during the birthing process, this is known as birth asphyxia or perinatal asphyxia. It constitutes a medical emergency, as the baby's brain cannot go for long without oxygen before starting to sustain serious damage.

Several factors can contribute to birth asphyxia, with some of the most common causes including:

• Umbilical cord problems - the umbilical cord can become compressed or twisted, restricting the flow of oxygen-rich blood and nutrients from the mother to the baby
• Placental abruption - this occurs when the placenta partially or completely separates from the uterus before birth, which also stops oxygen from the mother's blood from reaching the baby
• Prolonged labour - a long and difficult labour can cause distress to the baby, resulting in an insufficient blood flow and oxygen supply
• Trauma in utero - if the mother experiences physical trauma while pregnant, this can interrupt the blood flow to the baby
• Infections - certain maternal infections during pregnancy can lead to inflammation of the placenta or amniotic fluid, which can impact the baby's oxygen supply
• Preeclampsia and eclampsia - high blood pressure or seizures suffered by the mother during pregnancy or birth can lead to a lack of oxygen for the baby
• Shoulder dystocia - the baby's shoulders become stuck on the mother’s public bone during the birth process, trapping them in the birth canal. In this position their oxygen supply can be severely restricted, due to the umbilical cord being compressed and the fact that the baby is still unable to breathe air.  

Sometimes, these circumstances will be unavoidable, but in other circumstances, they may occur as a result of mistakes made by healthcare providers, or because the correct action was not taken quickly enough.

How long can a baby go without oxygen before brain damage occurs?

The exact length of time that a baby can go without oxygen before brain damage occurs may vary depending on various factors, such as the baby's overall health and whether or not the disruption to the baby's oxygen supply is total or partial. A reasonable estimate is that the baby will start to sustain brain damage after around five to 10 minutes without enough oxygen, and that death is likely if this persists for much longer.

This underlines the importance of ensuring signs that birth asphyxia is occurring are detected and treated as a medical emergency. It is important to note that even mild oxygen deprivation can have serious long-term consequences for the baby, and that the longer the period of oxygen deprivation, the greater the risk of severe and irreversible brain damage.

What are the most common birth asphyxia symptoms?

Symptoms of birth asphyxia will vary from case to case, but some of the most common signs that a baby may have been starved of oxygen at birth include:

• Low Apgar scores - Apgar scores are used to assess a newborn's physical condition at one, five and ten minutes after birth. A low score may be a sign that the baby has not received enough oxygen
• Bluish or pale skin - a lack of oxygen can cause a baby's skin to appear blue or pale, particularly around the lips and nail beds
• Weak muscle tone - poor oxygen supply can lead to poor muscle tone and a floppy or limp appearance
• Laboured and weak breathing - a baby who has been starved of oxygen may struggle to breathe, or may not breathe at all immediately after birth
• Seizures - oxygen deprivation can cause seizures in newborns, which can be a sign of brain damage

It is also worth bearing in mind that the severity of the oxygen deprivation will also affect the presentation of the condition in various ways:

• Mild asphyxia - the baby may be unusually irritable, have difficulty sleeping or feeding, or demonstrate signs of hyper-alertness
• Moderate asphyxia - the baby may lack movement and energy, with reduced muscle tone and a pale appearance, and will be at a higher risk of seizures
• Severe asphyxia - in addition to the symptoms of moderate asphyxia, the baby will barely react to stimulation, have low blood pressure, and be unable to breathe independently

If your baby experienced any of these symptoms following a traumatic birth, then it is vital that they are diagnosed as soon as possible, in order to ensure they are receiving the correct care.

What long-term health problems occur when a baby is starved of oxygen at birth?

Oxygen starvation at birth can lead to various health issues, ranging from mild to severe. Some potential problems include:

• Hypoxic-ischaemic encephalopathy (HIE) - this is a common form of brain injury caused by oxygen deprivation, which can lead to neurological issues, developmental delays and cerebral palsy
• Cognitive and developmental issues - a lack of oxygen to the brain can result in lifelong learning disabilities and other developmental problems
• Cerebral palsy - this is a group of disorders affecting movement, muscle tone and posture. It is often caused by brain damage before, during or shortly after birth, and a lack of oxygen is a common cause. To learn more, visit our Cerebral Palsy hub
• Hearing and vision impairments - the parts of the brain responsible for hearing and vision can become damaged by failing to receive enough oxygen, leading to impairments in these areas
• Epilepsy - seizures can result from brain damage caused by birth asphyxia, and epilepsy may develop as a long-term consequence
• Behavioural and emotional problems - children who have experienced birth asphyxia may be more likely to experience behavioural and emotional issues, including attention deficit hyperactivity disorder (ADHD)

Many of these conditions are lifelong, and will require the child to receive support throughout their lifetimes, meaning long-term adjustments for families.

How can oxygen starvation at birth be treated?

If your baby is suspected of having experienced birth asphyxia, it is absolutely crucial to ensure they receive assessment by specialist doctors and undergo tests such as an MRI scan of their brain to check for damage. However, the immediate priority will be to stabilise your baby and ensure they are receiving a flow of oxygen.

The below may happen in the immediate aftermath of your child’s birth. 

• Resuscitation - if a baby is not breathing or is struggling to breathe, medical professionals may be required to provide temporary life support or mechanical respiratory support via a breathing tube, allowing regular breathing patterns to be established
• Inhaled nitric oxide therapy - nitric oxide is provided to the baby's lungs via a breathing tube, which helps to lower blood pressure and open up the blood vessels in the lungs, which in turn elevates oxygen levels and reduces the risk of brain damage
• Medication - certain medications may be administered to help manage seizures or other complications resulting from oxygen starvation at birth

A treatment called cooling may be recommended, whereby the baby is placed in a special wrap filled with fluid that brings their normal body temperature down by a few degrees. Cooling is done for three days before the baby’s temperature is gradually returned to normal. Studies have shown that cooling can limit the extent of brain damage caused by birth asphyxia. 

Additionally, babies and children who have experienced birth asphyxia may require long-term specialist carers available to help them with their day-to-day routine and support that includes, physiotherapy, occupational therapy and speech therapy to address their developmental and physical challenges.

How can medical negligence contribute to a lack of oxygen at birth?

While some cases of birth asphyxia cannot reasonably be prevented, medical negligence can sometimes play a role. This happens when the doctors, midwives and nurses responsible for caring for the mother and baby fail to exercise their duty of care and make an avoidable mistake that results in the baby being deprived of oxygen.

Examples of medical negligence that may contribute to a baby being starved of oxygen at birth include:

• Failure to monitor the baby's heart rate - healthcare professionals should monitor the baby's heart rate during labour to detect signs of distress. If they fail to do so, they may miss critical warning signs, leading to oxygen deprivation
• Delayed or inappropriate response to foetal distress - if healthcare professionals do not respond promptly or appropriately to signs that the baby is in trouble, it can lead to prolonged oxygen deprivation and subsequent brain damage
• Mismanagement of high-risk pregnancies - this includes cases involving conditions affecting the mother such as pre-eclampsia, Group B Strep or gestational diabetes, which require careful management. Negligent care during these pregnancies can increase the risk of oxygen deprivation during birth
• Inadequate management of labour - if healthcare professionals fail to recognise and address complications during labour, such as umbilical cord issues, it can heighten the risk of birth asphyxia

If you suspect that medical negligence contributed to your child's oxygen deprivation at birth, it is essential to seek legal advice from a specialist solicitor. They can help you understand your rights and explore the possibility of pursuing a medical negligence claim.

By getting in touch with the specialist birth injury solicitors at JMW, we will be able to advise you on your rights. When you make a claim, you will be able to hold those responsible for your child's injury accountable for their mistakes, while also obtaining the compensation that will help your family to cover the cost of any long-term care and support that your child will require.

To find out more about making a birth injury compensation claim, simply call us on 0345 872 6666, or complete our online enquiry form and we will call you back to discuss the next steps to take.