Cerebral palsy: Was it caused by medical negligence?

If your child was born with cerebral palsy and there were complications during delivery you should seek legal advice, says lawyer Mal Byrne.

The origins of cerebral palsy are still a mystery and the subject of scientific debate.  Cerebral palsy is a profoundly disabling condition and sufferers need lifetime care.  Hence, governments and private bodies continue to invest substantial research funds on finding the causes and origins of cerebral palsy and what can be done to both prevent and treat the condition.

Cerebral Palsy is usually diagnosed shortly after birth and can be caused by hypoxia (lack of oxygen to the foetus during delivery).  Even scientists who dispute the extent to which cerebral palsy is caused by hypoxia or lack of oxygen to the foetus during delivery agree that some children with cerebral palsy have acquired the condition as a result of hypoxia due to problems during delivery.

If your child was born with cerebral palsy and there were any complications or concerns during the delivery, you should seek legal advice.  Unless the birth was at home, the heart rate of the foetus would have been monitored from the beginning of delivery to end.  When a foetus is compromised during delivery, for example if the cord is in a dangerous position, the foetal heart rate drops.  Usually, when a foetus shows signs of distress, doctors will try and accelerate the birth by forceps, a Vontouse device or caesarean birth.  If foetal distress was evident during your baby’s delivery and doctors delayed unnecessarily in facilitating delivery and your baby has cerebral palsy, medical negligence may have occurred and you should consult a lawyer so the matter can be investigated.

If you do consult a lawyer, the first step would be for the lawyer to obtain a copy of the records of the delivery of the baby including the trace of the foetal heart rate.  The lawyer will then send the records to an experienced obstetrician and gynaecologist and consult with the doctor on whether they consider that the delivery of the baby was delayed unnecessarily, and if so, whether that delayed delivery caused the cerebral palsy.

Whilst there is debate about the extent of the link between foetal hypoxia during delivery and cerebral palsy, there is a consensus statement that has been developed by a series of international colleges and universities for obstetrics and gynaecology that set out a list of criteria by which doctors should define whether cerebral palsy has been caused by an acute hypoxic event during delivery.

The current consensus statement lists eight criteria.  Three of those criteria are described as essential and the remaining five are described as “criteria that together suggest an intrapartum timing but by themselves are non-specific”.

The three essential criteria are as follows:

1. Evidence of a metabolic acidosis in intrapartum foetal umbilical arterial cord, or very early neonatal blood samples (pH less than 7.00 and base deficit greater than or equal to 12 mmol/L);

Usually metabolic acidosis is determined by assessing the foetal cord blood gas data.

2. Early onset of severe or moderate neonatal encephalopathy (disturbed brain function) in infants of more than 34 weeks gestation;

3. Cerebral palsy of the spastic, quadriplegic or dyskinetic type.

The five non-specific criteria are as follows:

4. A sentinel (signal) hypoxic event occurring immediately before or during labour;

5. A sudden rapid and sustained deterioration of the foetal heart rate pattern usually after the hypoxic sentinel event where the pattern was previously normal;

6. Apgar scores of 0-6 for longer than 5 minutes.  When a baby is born, staff immediately assess its muscle tone, pulse, grimace responses, appearance (colours) and breathing and assign a score out of 10 which is called the Apgar score.  The test is done as soon as the baby is born and repeated 5 minutes later.

7. Early evidence of multisystem involvement;

8. Early imaging evidence of acute cerebral abnormality.

However, don’t be put off seeking legal advice if you don’t think that your child meets some of the criteria set out above, even the essential criteria. Every case is different and only an experienced qualified specialist can really give an opinion on whether your child should be classified as one who acquired cerebral palsy from delayed delivery.

For assistance with your legal matter or further information contact your nearest TGB office.