Was your baby's cerebral palsy diagnosis due to negligence?

The birth of a baby is traditionally heralded with much anticipatory joy and excitement. When the birth involves complications, those feelings are muted and can quickly evolve into worry and sadness.

Obstetricians can sometimes ameliorate birth complications by taking detailed medical histories of the expectant mothers and ordering a battery of prenatal tests for women with suspected or diagnosed high-risk pregnancies. But even then, there are no guarantees.

What happened to my baby?

That may be the hardest question any obstetrician ever has to face, trying to explain the inexplicable to a desperate mother trying to cope with a newborn who faces developmental challenges in the months and years ahead. Yet the mother is owed a candid response from the doctor who was in charge of her care and delivered her infant.

Cerebral palsy is one unfortunate but common condition that can arise from complications shortly before, during and just after an infant's birth.

What are the causes of cerebral palsy?

Any time the fetus or just-delivered infant is deprived of oxygen, cerebral palsy can result. Research has shown that 9 percent of cerebral palsy diagnoses are attributable to asphyxia, or lack of oxygen.

A common type of brain damage due to asphyxia at birth is hypoxic-ischemic encephalopathy (HIE). HIE can cause impaired motor skills and severe cognitive and developmental delays. While the extent of the damage is not always apparent at birth, a baby's impairments emerge as he or she grows and fails to hit the milestones at the usual developmental stages. By the time a child enters the pre-school years of 3 and 4, usually the severity of the condition is able to be determined.

The most severe cases of HIE result in profound brain damage and infant death, either as a stillborn or very shortly after the birth.

What are the risk factors for HIE-related cerebral palsy?

Any time a fetus is deprived of oxygen, there is a risk of HIE. Some cases are unavoidable, such as when the expectant mother experiences trauma in an auto accident of significant fall.

But others can be traced to obstetrical negligence and mismanagement of the mother's pregnancy, as can occur with unmonitored acute maternal hypotension.

Additional risk factors include, but are not limited to, the following:

• Cardiac complications
• Limited blood flow to the infant's brain during the birth process
• Lack of oxygenated blood related to impaired lung function
• Placental abruption
• Increased cranial pressure that reshapes the head, causing either bleeding or limited flow of blood
• Medical negligence
• Uterine rupture from trauma
• Cephalopelvic disproportion that leads to birth injuries
• Intrapartum hemorrhaging
• Ruptured vasa previa
• Umbilical cord complications, e.g., prolapsed cord
• Stressful labor and delivery

When it's the doctor's fault

Clearly, not all of the above can be anticipated and avoided by even the most astute and observant physician.

One example of a possible case for negligence is if a fetus is abnormally large, or just disproportionately large for the mother carrying it. An obstetrician can easily determine, through ultrasound tests and other diagnostic measures, that a Caesarian birth must be done as opposed to the traditional vaginal method. Failing to do so would make linking the resulting damage to the infant to the doctor's negligence fairly simple.

Not all cases are so simple, though, which is why any parent of a baby suffering from birth complications should seek professional legal guidance when determining the available options.

It may be possible for the parents of an infant diagnosed with birth complications to pursue damages against the obstetrician, midwife and/or medical facility if their child's impairment can be linked to negligence.