Medication Errors During Labor and Delivery: Risks to Mothers and Newborns

Medications play an important role in labor and delivery. They can help manage pain, stimulate contractions, prevent infection, control bleeding, and address complications that threaten the health of a mother or newborn. But when a medication is prescribed incorrectly, administered at the wrong dose, or not properly monitored, the consequences can be serious. A preventable medication error during childbirth can cause maternal complications, fetal distress, oxygen deprivation, or other lasting injuries.

Kalfayan Merjanian, LLP represents families in serious birth injury medical malpractice cases throughout California. Understanding how medication errors occur during labor and delivery, what harm they can cause, and how medical records are evaluated can help families determine whether an injury warrants further investigation.

What Types of Medication Errors Can Occur During Labor and Delivery?

Medication errors can happen at different stages of care. A physician may prescribe the wrong medication or dosage, a nurse may administer a drug incorrectly, or a healthcare provider may fail to recognize a dangerous reaction. Errors can also involve the timing of medication, the method of administration, or a failure to monitor the mother and baby after treatment begins.

Some of the medications commonly used during labor and delivery require particular care because they can affect uterine contractions, blood pressure, breathing, bleeding, or fetal oxygen supply.

Incorrect Medication or Dosage

A medication error can occur when a provider selects a drug that is inappropriate for the patient’s condition, prescribes an incorrect dose, or fails to account for relevant medical information. A dosage that is too high can cause dangerous side effects, while a dose that is too low may fail to treat a condition effectively.

For example, medications used to induce or strengthen labor must be administered carefully. A dose that is too high or increased too quickly can cause excessively frequent or prolonged uterine contractions. These contractions can reduce the time available for blood and oxygen to reach the fetus between contractions, potentially contributing to fetal distress.

Errors involving pain medication, anesthesia, antibiotics, or medications used to control blood pressure can also create risks. The appropriate medication and dosage depend on the patient’s medical history, stage of labor, clinical condition, and other factors.

Medication Administration Errors

Even when a physician orders the correct medication, an error can occur during administration. A healthcare provider might give the wrong drug, use the wrong route, administer a dose too quickly, or provide medication to the wrong patient.

Intravenous medications require particular attention because the drug enters the bloodstream directly. Errors involving infusion rates, concentrations, or pump settings can result in a patient receiving significantly more or less medication than intended.

Medication errors can also occur when providers fail to follow established protocols for verifying prescriptions, checking patient identity, confirming allergies, or documenting administration. In a busy labor and delivery unit, these safeguards are important because several medications and treatment decisions may be involved at the same time.

Failure to Monitor Medication Effects

Proper medication administration does not end when a drug is given. Some medications require ongoing monitoring to determine whether they are producing the intended effect or causing dangerous complications.

For example, a patient receiving medication to induce labor may need close monitoring of contraction frequency, contraction duration, and fetal heart rate. If contractions become too frequent or prolonged, providers may need to reduce or stop the medication and take other steps to protect the fetus.

Similarly, medications used for pain control or anesthesia can affect breathing, blood pressure, and other vital functions. Providers must recognize concerning changes and respond appropriately. A failure to monitor a patient’s condition or act on warning signs can turn an otherwise manageable medication risk into a serious medical emergency.

Which Labor and Delivery Medications Require Careful Monitoring?

Several categories of medications are commonly used during childbirth. Each has a specific purpose, but each also carries risks when prescribed, administered, or monitored improperly.

Pitocin and Other Labor-Inducing Medications

Pitocin is the brand name for synthetic oxytocin, a medication used to induce labor or strengthen uterine contractions. When medically appropriate, it can help labor progress. However, excessive dosing or inappropriate administration can cause uterine tachysystole, a condition involving too many contractions within a given period.

Frequent contractions can limit the fetus’s opportunity to recover between contractions and can contribute to abnormal fetal heart rate patterns. If providers fail to recognize the problem or respond promptly, the baby may experience reduced oxygen supply.

Depending on the circumstances, appropriate intervention can include reducing or stopping the oxytocin infusion, repositioning the mother, administering other medications, and evaluating whether expedited delivery is necessary. The appropriate response depends on the mother’s and fetus’s condition.

Magnesium Sulfate

Magnesium sulfate is commonly used to prevent seizures in pregnant patients with severe preeclampsia and, in certain circumstances, for fetal neuroprotection when preterm delivery is expected. It can also affect the mother’s nervous system and respiratory function.

Excessive magnesium levels can cause toxicity, potentially leading to diminished reflexes, muscle weakness, low blood pressure, and respiratory depression. Proper dosing and monitoring are important, particularly when a patient has impaired kidney function or other risk factors that affect how the medication is processed.

Providers must recognize signs of toxicity and respond appropriately. Depending on the patient’s condition, treatment may require stopping the infusion, checking magnesium levels, supporting breathing, and administering calcium gluconate as an antidote.

Opioids and Epidural or Spinal Anesthesia Medications

Medications used for labor pain relief can affect both the mother and baby. Opioids may cause maternal sedation and respiratory depression, while certain medications used in epidural or spinal anesthesia can cause significant drops in maternal blood pressure.

A sudden decrease in maternal blood pressure can affect blood flow to the placenta and contribute to fetal heart rate abnormalities. Providers must monitor the mother’s vital signs and the fetal response, particularly after an epidural or spinal medication is administered.

The amount, timing, and type of medication matter. An error involving the wrong dose, an unintended route of administration, or inadequate monitoring can create risks that require prompt treatment.

Antibiotics and Medications for Other Pregnancy Complications

Antibiotics may be administered during labor to prevent or treat infections, including group B streptococcus (GBS) infection. A failure to administer indicated antibiotics at the appropriate time can increase the risk of newborn infection.

Medication errors can also involve drugs used to manage high blood pressure, prevent seizures, control postpartum bleeding, or treat other complications. For example, medications used to control severe hypertension must be administered carefully because both inadequate treatment and excessive blood pressure reduction can create risks.

The fact that a complication occurs after medication is given does not automatically establish negligence. The relevant question is whether the medication was selected and administered appropriately and whether providers responded to the patient’s condition according to accepted medical practices.

How Can Medication Errors Harm Mothers During Childbirth?

Medication errors can cause immediate complications or contribute to injuries that require extended treatment. The nature of the harm depends on the medication, the dosage, the timing of the error, and the mother’s underlying health.

Excessive doses of certain medications can cause respiratory depression, dangerously low blood pressure, abnormal heart rhythms, or other serious reactions. Errors involving medications used to control contractions can contribute to uterine complications, including uterine rupture in certain circumstances, particularly when other risk factors are present.

Medication errors can also contribute to severe postpartum complications. For example, an incorrect or delayed medication used to manage postpartum hemorrhage can interfere with efforts to control bleeding. Severe blood loss can cause shock, organ damage, and the need for emergency surgery or blood transfusions.

Other potential consequences include medication toxicity, allergic reactions, kidney or liver complications, and neurological injuries. Some patients require intensive care or experience lasting effects that interfere with their ability to work, care for their families, or perform everyday activities.

How Can Medication Errors Harm a Newborn?

A medication error during labor can affect a newborn directly or indirectly through changes in the mother’s condition, uterine activity, or placental blood flow.

One significant concern is fetal oxygen deprivation. If an excessive dose of a labor-inducing medication causes contractions that are too frequent or prolonged, the fetus may not receive adequate oxygen between contractions. If healthcare providers fail to recognize fetal distress and take appropriate action, the baby can suffer hypoxic-ischemic injury, which occurs when the brain does not receive enough oxygen and blood flow.

Depending on the severity and duration of oxygen deprivation, potential consequences include:

• Hypoxic-ischemic encephalopathy (HIE), a form of brain injury associated with reduced oxygen and blood flow.
• Seizures and other neurological complications.
• Cerebral palsy or developmental disabilities.
• Organ damage and complications requiring intensive neonatal care.
• In severe cases, permanent disability or death.

Medication errors involving opioids or anesthesia can also affect a newborn’s breathing, alertness, and ability to transition after birth. The extent of the risk depends on the medication, dose, timing, and circumstances of delivery.

A failure to provide indicated antibiotics during labor can create a different type of risk. If a mother has an infection that requires treatment, or if GBS prophylaxis is indicated, an error or delay can increase the risk of newborn infection. Serious infections can progress to sepsis or meningitis, potentially causing lasting harm.

Not every newborn complication following maternal medication use is preventable. Some medications are medically necessary despite their known risks. A birth injury investigation must consider whether the benefits and risks were properly evaluated, whether the medication was administered correctly, and whether the mother and baby were monitored and treated appropriately.

What Evidence Helps Determine Whether a Medication Error Occurred?

To pursue a negligence claim, the evidence must show that a healthcare provider failed to meet the applicable standard of care and that the failure caused injury. Evaluating these issues requires a detailed review of the medical records and the circumstances surrounding the medication’s use.

The medication administration record is often central to the investigation. It can show which medications were ordered, the prescribed dosages, when they were administered, and which healthcare professionals documented giving them. Comparing these entries with physician orders, nursing notes, and other records can help identify discrepancies.

Other important evidence may include:

• Labor and delivery records, including maternal vital signs and fetal heart rate monitoring strips.
• Physician orders, medication administration records, infusion pump settings, and pharmacy records.
• Nursing notes documenting patient assessments, medication responses, and communications with physicians.
• Laboratory results, toxicology testing, and records of medication levels when relevant.
• Neonatal records, including Apgar scores, blood gas results, neurological evaluations, and NICU treatment.
• Hospital policies, medication safety protocols, and applicable clinical guidelines.

The timing of events is particularly important. Investigators may need to determine when a medication was ordered, when it was administered, when warning signs first appeared, and how quickly providers responded. Fetal heart rate monitoring strips can be especially valuable when evaluating whether medication-induced contractions were associated with signs of fetal distress and whether the medical team took appropriate action.

Electronic medical records may also contain audit trails showing when information was entered, changed, or accessed. These records can help clarify the timing of documentation and communications among providers.

How Do Medical Experts Evaluate a Potential Birth Injury Medication Error?

Medical experts are often necessary to determine whether a medication issue involved a departure from accepted medical practices. The appropriate expert depends on the issues involved. An obstetrician may evaluate decisions about labor management and fetal monitoring, while a pharmacist or other qualified professional may assess medication selection, dosage, preparation, and administration. A neonatologist may evaluate the newborn’s injuries and whether they are consistent with medication-related complications or oxygen deprivation.

Experts generally examine the patient’s condition, the medication’s intended purpose, the applicable dosing and monitoring requirements, and the provider’s response to changes in the mother’s or baby’s condition. They may also consider whether a different course of treatment or earlier intervention would likely have prevented or reduced the harm.

Causation is a critical part of this analysis. Even when a medication was administered incorrectly, the claim must establish a connection between the error and the injury. For example, experts may need to determine whether excessive contractions caused fetal oxygen deprivation, whether delayed treatment contributed to an infection, or whether an anesthesia complication caused maternal or neonatal harm.

The investigation must also consider other possible causes of the injury. A newborn’s neurological condition, for instance, can have multiple potential explanations. Medical records, laboratory findings, imaging, and expert analysis help determine whether the medication error was a substantial factor in causing the injury.

What Should Families Do if They Suspect a Medication Error During Childbirth?

When a mother or newborn experiences an unexpected complication, families may not immediately know whether a medication error occurred. Obtaining complete medical records can be an important first step. These records should include labor and delivery documentation, medication orders, administration records, fetal monitoring strips, anesthesia records, and neonatal treatment records.

Families should also preserve any discharge paperwork, follow-up evaluations, and records from specialists who treat the mother or child after delivery. If the newborn has ongoing developmental or neurological concerns, continued medical evaluations can help document the child’s condition and future needs.

Hospitals may conduct internal reviews after serious adverse events, but families should not assume that an internal investigation will answer every question about whether negligence occurred. An independent review can help identify missing information, inconsistencies in the records, and potential departures from the standard of care.

California medical malpractice and birth injury claims are subject to legal deadlines. Claims involving public hospitals or other government entities can involve significantly shorter notice requirements. Prompt investigation can help preserve medical records, identify relevant witnesses, and determine which deadlines apply.

How Can Kalfayan Merjanian, LLP Help With a Birth Injury Medication Error Claim?

Medication errors during labor and delivery can have serious consequences for mothers and newborns. Determining whether negligence occurred requires more than identifying an unexpected reaction. It requires examining the medical orders, administration records, monitoring, clinical decisions, and timing of treatment to determine whether a provider’s conduct caused preventable harm.

Kalfayan Merjanian, LLP represents California families in serious birth injury and medical negligence cases. The firm’s trial attorneys can work with qualified medical experts to review the evidence, investigate potential medication errors, identify responsible parties, and pursue compensation for the injuries and long-term needs of affected mothers and children.

If you believe a medication error during labor or delivery contributed to an injury to you or your newborn, contact Kalfayan Merjanian, LLP to discuss the circumstances and learn about your legal options. A careful review of the medical evidence can help determine whether the harm was preventable and whether a claim may be appropriate.