ST. PETERSBURG — After hours of pushing, Michelle Morales' labor was not progressing.
As exhausted as she was, Morales thought she was going to keep trying to deliver the baby. But instead, her obstetrician asked nurses to bring in a device called a vacuum extractor.
Placing a soft suction cup on the baby's emerging head, the doctor eased Landon Harrington into the world at 4 pounds, 3 ounces on Sept. 30, 2009.
Landon now is a beautiful little boy with serious disabilities. He is blind, has cerebral palsy and likely will never walk on his own.
His parents and their lawyer blame brain hemorrhaging caused by the vacuum extraction device. They contend it should never have been used on a preterm infant like Landon, who arrived five weeks early, and he should have been delivered by caesarean section.
They say they're telling their story to alert others to the dangers of the device, which Morales, 29, knew little about when she went into labor.
Looking back, Morales said she and her husband should have asked more questions.
"You need to stand up for yourself and your child," she said. "We don't want this to happen to another family.
Fueling their case against vacuum extraction: Morales' obstetrician approached her to make a legal settlement for Landon's injuries, a move Morales' lawyer had never seen in his 23 years of practice.
But some medical experts say it may be difficult to determine whether it was the vacuum device that caused Landon's condition. His prematurity or the difficult labor might have damaged him, even without the device. And a C-section delivery could have led to another set of problems.
One thing does seem clear: Cases like Landon's could be one reason why C-section births in the United States continue to climb, even as public health experts contend this trend is dangerous for mothers and babies.
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Modern vacuum extractors date to the 1950s. They're used when the cervix is fully dilated and the baby's head has reached the mother's pelvis, but after hours of intense pushing, the labor stops progressing and the doctor believes mother, baby or both are at risk.
In 1995, 9.4 percent of births in the United States were assisted with the use of vacuum extractors or, to a lesser extent, forceps. Nearly 21 percent of births were done by C-section then.
By 2008, as the C-section rate soared to almost 33 percent nationally and 38 percent in Florida, the devices were used in just 3.9 percent of U.S. births.
Morales had never heard much about vacuum extraction before it was used to help deliver Landon, her first child, at Bayfront Medical Center in St. Petersburg.
She and her husband, Timothy Harrington Jr., 29, said they knew right away that something was wrong with Landon. "He wasn't crying," Morales said.
They said they were told the next day their son had scattered brain hemorrhaging. Over the course of his initial 56-day stay at All Children's Hospital, and subsequent doctor visits and hospital stays, they said Landon was diagnosed with brain damage, cerebral palsy, blindness, seizures and spasms.
Morales left her job with a local TV station to care for Landon. Her husband works as an insurance agent.
On a recent visit to the couple's St. Petersburg apartment, Landon lay on his back on an activity mat, kicking his legs. He wore a light-blue silicone bracelet inscribed with "Landon Timothy" and "Mr. Strong," just like the ones two members of the Tampa Bay Rays wore last season to show support for him and his family.
"When you're pregnant, you never imagine that something could potentially go wrong," Morales said. "The past 17 months have been a whirlwind. It's been really tough."
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In February 2010, Morales said she received a call from her obstetrician, Dr. Beth Diner. The doctor asked the couple to meet with her, her attorney and insurer to discuss a settlement.
After the meeting, the couple, who say they had been too busy caring for Landon to consider a lawsuit, hired Tampa lawyer David Eaton.
The couple settled with Diner for $250,000, according to public records. Diner did not return messages seeking comment.
As he investigated the case, Eaton thought Bayfront should bear some responsibility, and filed suit.
One of the main arguments in the suit is that a vacuum extractor should not be used to deliver preterm infants. Eaton said two Bayfront nurses who assisted knew this, but failed to stop Diner. Plus, he contends, the hospital should have had a policy banning its use for preterm babies, as some hospitals do.
Bayfront spokeswoman Kanika Tomalin said the hospital believes what happened to Landon reflects not on the hospital or its nurses, but on the difficulty of the delivery and the judgment of Diner, who has privileges at Bayfront but isn't a Bayfront employee. Rather than a blanket policy, it relies on physicians to make decisions they believe will provide the best outcome.
"Doctors make hard choices each day. This is one of those choices this physician made," Tomalin said.
In the suit, Eaton cites experts, medical journals, manufacturer's literature and governmental advisory boards to establish the risks of vacuum extractors.
The American College of Obstetricians and Gynecologists notes that most authorities recommend against its use on babies born at less than 34 weeks because of the risk of brain hemorrhage. Landon was born at 32 weeks.
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But Dr. Lewis Rubin, chief of neonatology at Tampa General Hospital and the University of South Florida, said vacuum extraction in preterm births "absolutely can be safe."
"Over more than 25 years in practice, I have seen large numbers of premature babies who have been delivered by vacuum," he said.
A 1995 study done at the University of Florida Health Science Center indicated that preterm babies as small as 3 pounds, 5 ounces delivered with vacuum extractors fared as well as preemies delivered without the device.
Excessive bleeding and brain hemorrhage also can occur in vaginal deliveries of preterm babies where a vacuum extractor isn't used, Rubin said.
Nor is a C-section any guarantee. "There are many instances where caesarean is more risky," he said.
Those risks include breathing problems for the child and increased bleeding, uterine infection and blood clots for the mother. In fact, the maternal mortality rate for C-sections is three to seven times greater than for vaginal deliveries, according to the American College of Obstetricians and Gynecologists. A C-section can also create problems with future pregnancies.
But Rubin believes no woman should, as Morales says she did, go into delivery without first understanding all of the options.
"The best way to affect the highest quality care for a pregnant woman and her infant is to have informed, frequent conversations among all parties," he said.
Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330.