To ask hospital to explain

Autism is a strongly heritable condition but autism can also be caused by various issues at birth. Lack of oxygen, born to mothers with preeclampsia, unusual feral position.
It's not only always hereditary

@BumpandBounce

but there certainly appears to be a causal link between the circumstances of the birth and the child’s current condition
No. There MAY be a causal link. There also may be no causal link at all.

Is the twin with autism the same child as the one with no heart beat prior to birth?

This sounds more likely to be significant than swapping out masks

I don’t claim to be a medical expert but I’m fairly sure my expert Consultant Neuropsychologist is…

“Children with mild HIE affecting the thalami and basal ganglia may experience a range of potential neurophysiological deficits including sensory processing issues, attention and executive function deficits, and emotional and behavioural dysregulation.”

As I say, I have a number of cases where we’ve successfully proved causation on similar facts.

OP must do what is right for her. Perhaps the best course of action is to engage in dialogue with the clinicians to determine what happened, or to seek some therapy to address her feelings about it. However, if she has concerns about the care received then she may want to seek legal advice.

(It’s worth mentioning that 80% of the enquiries we receive are turned down due to insufficient merit. We only get paid if we win so are not in the business of bringing spurious claims!)

Autism is developed in the fetus.. so this hasn't caused Autism.
Please remember that . It's a scientific fact.

In which case, as a medical negligence solicitor you would know that ASD and ADHD are NOT cognitive conditions!

@Weddingbells6 cooling is not without risks and would not be done unless clinically indicated. Apnoea at birth which is quickly restored with no loss of or very short loss of output is not an indication on its own. The fact the Ultrasound and EEG were normal is very reassuring as is the fact that their stay in nicu was short meaning no multi organ failure which you would expect with a hypoxic insult.
Do not listen to a solicitor that is biased on making money from misery for medical advice.
You would be best placed to contact your local
hospital where you gave birth and ask to have your notes explained and they may well do this for you if you cannot move forward. But ultimately you need therapy to move forward as this is not a normal feeling to have after this length of time. Most people have some degree of trauma from nicu baby and there are psychologists attached to nicu that parents are usually referred to. I know I seen one as routine. So your response is not abnormal. What is abnormal is to still feel like this 7 years later, so think about how to move forward. Whether it’s via gp or privately but I really recommend it.

I’m not ambulance chasing at all. If OP wants legal advice, I would direct her to the Law Society website or AvMA.

I’m simply highlighting that a child who has required resuscitation at birth may have suffered a hypoxic event as a result, and that could be the cause of the autism. I have plenty of cases involving similar facts.

It’s impossible to tell whether there has been any breach of duty but there certainly appears to be a causal link between the circumstances of the birth and the child’s current condition, It warrants further investigation… I don’t see why anyone would take exception to that. If there’s no case, then OP will be informed not to pursue the matter, but it may get her some answers,

@Ella31 I'm so sorry for what you've been through, I'm sorry for your losses 💔

Seems to be the best advice legally- but it’s been 7 years. I’m not sure how far you would get or how beneficial it would be.

As pp suggests I’d pay for a debrief to go over it with someone. Sounds traumatic.

This is bullshit. It is absolutely normal to try a different size of mask to check for the best fit, there is no implication whatsoever that the wrong size was used. Stop ambulance chasing.

sometimes the only way to know if the ideal size mask is being used is to try different sized masks and see which works best.

It's not acceptable that they tried to send you home when they couldn't detect a good heartbeat, and it's not acceptable that you had to push the cot yourself fresh out of theatre, but AFAIK there's no definitely proven association between autism and any of the events you describe.

You would not be unreasonable to ask for a debrief though, as that all sounds really traumatic. This should be available to you, either via the hospital you attended, or a private midwife can review your notes and debrief / counselling for a fee.

I’m a medical negligence solicitor.

Did Twin 2 have active cooling on NICU after birth? Or an MRI head at any point?

Cognitive conditions such as autism, ADHD or sensory processing issues are often seen in children who have suffered mild hypoxic ischaemic encephalopathy (HIE Grades 1-2) at birth. These conditions may not become apparent until the child gets older.

Ineffective resuscitation may contribute to oxygen deprivation. So, it’s possible that there could be a claim if the wrong sized mask was used.

In your shoes, I’d be inclined to contact a medical negligence firm and ask them to investigate.

How you feel is totally normal but you deserve care and someone to talk to. Seeing yout baby hooked up to machines and wires is so scary. You probably haven't been able to process that. All of us plan to leave the hospital unscathed with our babies. Doesn't always happen though so be good to yourself xxx

it's actually a sign of a good, functional team if someone felt able to make a suggestion to a doctor that might have improved the situation (and it's not uncommon to use different bits of kit to try and get things as good as possible looking after breathing in an emergency). Doesn't necessarily mean anyone was doing anything wrong at all. (DOI fwiw, am a doctor (anaesthetist) that is usually very happy for sensible suggestions from other members of the team)

@Ella31 I'm so sorry that happened to you.
Sending love. ❤️

My twins died in hospital last year after an emergency section. My first baby was born sleeping and my second died in the NICU 4 days later. Its so traumatic to have a baby in the NICU. And with multiples, your heart is completely torn. My first baby had already passed away but I felt so guilty not being with him as much when his brother was NICU but that was obviously the grief and trauma taking place. Counselling after traumatic birth is something you should look into as I think you really could benefit from it.

Most hospitals do offer this service, but not generally for births that happened 7 years ago.

I have noticed my hospital do a counselling type service for people who experienced a traumatic birth and want to have time to go through what happened. I would look into whether your hospital does anything similar as I think you need to process what happened.

My first was born via emergency csection because her heart rate wouldn't stop falling. I was really scared she wasn't going to make it. She is autistic but so are her brothers and they both had very straightforward elective csections. Medicine isn't an exact science, different doctors can do things very differently from each other and its considered reasonable. A doctor might take account of what a really experienced nicu nurse says and that's fine too, it's not an absolute split of power. As for the time rounds are performed it really is very variable, when I've been in hospital myself I might see the doctor at 730 am one day then 5pm the next, then not at all for a day because they've been dealing with medical emergencies or regular clinics. They likely couldn't tell you when the doctor would be there. I've also had different doctors on different days giving very different answers to what's happening next treatment wise. My youngest was in hospital for a while as a toddler. A comment on trying different size masks really means nothing.

If you think talking to them about it would help Id say do it, but you're not going to get the answers you're after. I know many autistic kids, some have birth trauma and/or were born early, it's not considered to have been related to that at all though. Its not something Ive seen referred too unless in the context of cognitive function or CP or things like epilepsy that have occurred WITH autism, but not the autism itself. I'm sorry for what you and your babies went through, unfortunately as far as answers go I don't think you'll get any, especially 7 years down the track when memories have faded.

The whole thing sounds traumatic for you and I think it’s really understandable to have questions. I know a couple of people who have had birth debriefs and found them really helpful. They were told some things they were worrying about were standard medical practice and that was reassuring, and other things were examples of their care falling short and I think that was validating.

I have twins too and I think it’s very hard for anyone who doesn’t have multiples to understand what it’s like when you have more than one baby in hospital. You can feel split and like you are failing one or both of your babies. It is much harder to advocate for them and gain all the information you usually would because you can’t be in two places at once. You are reliant on HCP seeking you out and giving you information in a way you aren’t with one baby, which understandably they are often too busy to do. Mothers of multiples are given lots of extra attention antenatally, but IME there is less consideration postnatally and communication can be poor. I think there could be learning in how to support multiple families better in the post natal/neonatal/NICU wards.

I hope you get some answers.

It’s quite normal for different sizes of masks to be tried to achieve optimum ventilation, that is nothing to worry about and 1 minute is extremely unlikely to cause any long term effects. Think about how long someone can hold their breath for - on average most people can hold their breath for 60 seconds. It certainly wouldn’t cause autism as that’s simply not how autism works.

It’s also quite normal for collaborative discussions amongst colleagues during a procedure. The doctor will have overall say in an emergency situation but that doesn’t mean they won’t take advice from colleagues where appropriate.

Expecting the doctor to leave the NICU and come and personally update you is just plain silly, I’m afraid. The doctor on a NICU nursery would have probably around 12 babies under their care on any shift. They will take handover from the previous shift, do rounds on those babies, update their notes and drug charts, adjust their prescriptions (most babies on NICU are on an absolute cocktail of meds that are tweaked often to try and achieve the right balance on any given day). And in the afternoon they will do all that again. Where do you think they would have time to leave the ward, find the family of each of their 12 patients, have a lengthy chat with each one, and still find the time to actually do their clinical work? If you wanted an update on your baby you could have just called the NICU, and they’d have given you one.

You can request a debrief of course, but you have waited 7 years so it will be someone reading the notes, not the doctor or midwife who actually treated you as they are likely to have moved on now.