There are well-known risk factors that can increase the chances of someone developing cerebral palsy before, during or directly after their birth (see Causes of cerebral palsy).
If these factors are not managed well, or the mother does not receive standard medical treatment during her pregnancy or labour, then clinical negligence could be responsible for a baby developing cerebral palsy.
Where a child has been injured as a consequence of negligent medical treatment provided to their mother during pregnancy, the child is entitled to bring a claim on their own behalf for the injuries sustained. This is in accordance with the Congenital Disabilities (Civil Liability) Act 1976.
If you suspect that your, or your child’s cerebral palsy was brought about by negligent treatment, then please contact our team on 0800 923 2080. We are experts in investigating cerebral palsy claims and can help you establish whether or not the condition was brought about by negligence.
Here you can read more about the ways that clinical negligence can lead to cerebral palsy.
You can find out more about medical negligence and the legal implications by visiting our section on medical negligence law.
Undiagnosed intrauterine growth restriction
If health providers fail to competently manage intrauterine growth restriction in pregnancy and this leads to a child developing cerebral palsy, you may be able to pursue a medical negligence claim.
Intrauterine growth restriction (IUGR) is when a baby’s growth slows down or stops during pregnancy. This might happen because of problems with the placenta, which is the organ responsible for supplying oxygen and nutrients to the fetus.
A baby suffering from growth restriction can suffer complications during pregnancy, labour and in the neonatal period. These complications include oxygen deprivation, low blood sugar and jaundice.
If these complications are not managed correctly, the baby could suffer permanent brain damage leading to cerebral palsy.
Concerns about growth restriction can be identified during pregnancy, usually during the regular measurements of the fundus (pregnancy bump) carried out by midwives at routine antenatal appointments.
If IUGR is diagnosed or suspected, then it should lead to more careful monitoring of the baby, including growth scans. A decision may be taken to deliver the baby by caesarean section if there are concerns about the baby’s wellbeing.
Examples of negligence relating to the management of IUGR include:
- Failing to carry out regular and competent growth measurements during pregnancy
- Failing to identify concerns with growth measurements and/or refer for further investigations
- If IUGR is suspected, failing to carry out more careful monitoring of the baby’s wellbeing
- Failing to act on concerns as to the baby’s wellbeing and arrange early delivery by caesarean section.
Failure to treat and manage maternal infection
If health providers fail to provide appropriate medical treatment for maternal infections and this leads to a child developing cerebral palsy, then there may be grounds to pursue a medical negligence claim.
Mothers can suffer from different infections during pregnancy, labour and delivery that can prove life threatening if passed on to their fetus or new baby. If these infections are not treated correctly, the baby could suffer severe brain damage. An example is group B streptococcus infection which can lead to meningitis and permanent brain damage.
Examples of negligence relating to the management of maternal infection include:
- Failing to deliver the child without delay when there are signs of fetal distress together with maternal infection
- Failing to treat maternal infection with appropriate antibiotics during labour and/or delivery
- Failing to provide appropriate antibiotics to the baby in the newborn period when there were signs of maternal infection during labour and/or delivery.
Negligent monitoring of the baby during labour
Midwives and obstetricians should carefully monitor the baby’s condition during labour and act on any signs of distress.
In low-risk labours, monitoring is carried out by intermittent auscultation, where the baby’s heart rate is listened to at regular intervals, but not continuously. If the midwives are concerned about the baby’s wellbeing, then further investigations and monitoring should be considered, including continuous monitoring of the baby’s heart rate by cardiotocography (CTG).
A CTG will produce a trace of both the fetal heart rate and maternal contractions. The features of the fetal heart (including rate, variability and accelerations/decelerations) are then categorised as normal/reassuring, non-reassuring or abnormal and, based on these features, the overall CTG trace is then graded as normal, suspicious or pathological. Where a trace is suspicious or pathological the midwife should call an obstetrician urgently.
Depending on the situation, the obstetrician may take a fetal blood sample (FBS) to check whether there is acidosis. This is an indication of oxygen deprivation.
If the sample is reassuring then labour will usually continue with close monitoring of the CTG trace and possible further blood samples.
If the sample is not reassuring, an emergency caesarean section should be considered. If the labour is too far advanced for a caesarean section to be practical, the obstetrician should assist the delivery (using forceps or ventouse) without delay.
Examples of negligence relating to the monitoring of fetal wellbeing during labour include:
- Failing to carry out appropriate monitoring, either at inappropriate intervals, or using only intermittent auscultation when continuous monitoring was indicated
- Failing to correctly interpret a CTG trace
- Failing to perform a fetal blood sample when indicated by the CTG trace
- Failing to act on a pathological CTG trace and/or non-reassuring fetal blood sample and delaying delivery when urgent delivery by caesarean section was indicated.
Negligent failure to advise or perform a caesarean section
Either before or during labour, there may be signs that a vaginal delivery is inappropriate and that the mother should instead undergo a planned or emergency caesarean section. Risk factors include the position of the baby, lack of progress in labour and/or signs of fetal distress.
Examples of negligence in relation to the need for a caesarean section include:
- Failing to recommend/offer an elective caesarean section in the presence of known risk factors for vaginal delivery
- Failing to identify and advise that delivery should be expedited by caesarean section after labour has commenced when there are signs of fetal distress.
Negligent neonatal care
Newborn babies can suffer a number of complications that can damage their developing brain if not promptly diagnosed and treated.
The most common complications that give rise to claims of clinical negligence include:
- Failing to diagnose and/or treat neonatal infection, such as group B streptococcus infection which can lead to meningitis and brain injury.
- Failing to diagnose and/or appropriately treat hypoglycaemia (low blood sugar). Some babies have particular risk factors for hypoglycaemia, such as prematurity or babies born to a mother who had diabetes during pregnancy, and therefore require more careful monitoring. Other babies may not have risk factors, but may show recognised signs of hypoglycaemia requiring further investigation and prompt treatment.
- Failing to diagnose and/or appropriately treat jaundice (hyperbilirubinemia). Some babies have particular risk factors for jaundice, such as being born before 38 weeks gestation, or a sibling who suffered jaundice requiring treatment. These babies would require more careful monitoring following their birth. Other babies may not have risk factors, but may show recognised signs of jaundice that require further investigation and treatment. Failing to diagnose and/or treat jaundice in a newborn baby can lead to the baby suffering kernicterus, which is a particular type of damage to the brain leading to cerebral palsy and hearing loss.
Negligently managed umbilical cord prolapse
An umbilical cord prolapse is when the umbilical cord (which transfers oxygen and nutrients from the placenta to the baby) descends through the opening of the womb before the baby does. In turn, the cord becomes trapped when the baby is being delivered, depriving it of oxygen and potentially causing brain damage or death.
Because of the risks to the baby, umbilical cord prolapse is an obstetric emergency and the baby should be delivered by emergency caesarean section.
If there are risk factors for cord prolapse, i.e. a baby in the transverse position, then the waters should be broken under controlled conditions. The operating theatre should be prepared to perform an emergency caesarean section should the cord prolapse.
Examples of negligence relating to the management of umbilical cord prolapse include:
- Failing to diagnose, or late diagnosis, of umbilical cord prolapse
- Delay in delivering the baby following diagnosis of umbilical cord prolapse
- Failing to relieve the pressure on the umbilical cord by applying pressure to the presenting part of the baby
- Failing to place the mother on her left side during anaesthetic procedures.
Negligently managed breech presentation
If the baby is in a position to be delivered bottom first, instead of head first, it’s in the breech position. There are additional risks associated with delivering a breech baby vaginally, including an increased risk of oxygen deprivation that can cause brain damage and cerebral palsy if not managed correctly.
If a breech presentation is diagnosed during pregnancy, and the baby’s position does not subsequently change, then there should be a discussion with the mother about the risks and benefits of a caesarean section versus a vaginal delivery. If there are significant risk factors associated with a vaginal delivery, the mother should be advised to have a caesarean section.
If the breech presentation is not diagnosed during pregnancy or labour, the mother might proceed with a vaginal delivery without knowledge of the risks involved.
Examples of negligence relating to the management of a breech presentation include:
- Failing to advise the mother of the options for delivery, including the risks and benefits of all options, following diagnosis of a breech presentation
- Failing to carry out appropriate examinations during pregnancy and/or labour to appropriately diagnose the position of the baby, and therefore failing to diagnose breech presentation
- Failing to act on signs of distress during an attempted breech vaginal delivery.
Negligently managed shoulder dystocia
Shoulder dystocia is an obstetric emergency where the shoulder of the baby becomes impacted (stuck) against the mother’s pelvis during vaginal delivery following delivery of the baby’s head. If the baby’s shoulder is not released swiftly then the baby will be deprived of oxygen. This can cause brain damage leading to cerebral palsy.
Allegations of negligence can be made if there is a failure to carry out appropriate steps in response to a shoulder dystocia that could lead to a delay in the delivery and the baby being deprived of oxygen.
A baby/child/adult may also have grounds for pursuing a claim in the event of suffering injury as a result of shoulder dystocia during their birth, where their mother had known risk factors for shoulder dystocia, but was not informed of these or given the option of an elective caesarean before proceeding with a vaginal delivery which she would have opted for.
You can find out more about shoulder dystocia in our Erb’s palsy section.
What is the importance of umbilical cord blood results?
If a baby has suffered brain damage due to a lack of oxygen (hypoxic-ischemia), then the umbilical cord blood results will be examined to try to establish the likely timing of this damage, e.g. whether it happened immediately before delivery or some time before.
In order to function normally, the body has to stay at a constant pH (pH figures are used to specify the acidity or basicity (alkalinity) of a solution). The body achieves this by maintaining a healthy balance between chemical acids and chemical bases.
Most of the energy in the body is produced from a chemical reaction that turns sugar (glucose) and oxygen into carbon dioxide and water. This process is called aerobic respiration. When the body is deprived of oxygen it can create energy by an alternative reaction that turns glucose to lactic acid. This process is called anaerobic respiration.
Both lactic acid and carbon dioxide are chemical acids. A build up of these chemicals results in the blood becoming acidic (acidosis). Oxygen and glucose are transported around the body in the blood. In the womb a baby receives oxygen- and glucose-rich blood from the mother via the umbilical vein. The umbilical artery carries carbon dioxide and other waste products away.
After birth, blood will usually be taken from the umbilical cord to measure the pH value of the blood from the umbilical artery and the umbilical vein. The results will also illustrate the level of carbon dioxide in the blood and the base deficit. The base deficit represents the amount of chemical base that would need to be added to the acidic blood to turn it back to a neutral pH. All of this information can provide valuable clues to the condition of the baby just before and during delivery.
For example, if a cord prolapse occurs during delivery and becomes compressed, the flow of oxygen-rich blood to the baby – and the flow of carbon dioxide and other waste products away from the baby – would be disrupted, causing a build up of carbon dioxide. To compensate, the baby will start making energy from anaerobic respiration, resulting in the build up of lactic acid. As the level of carbon dioxide and lactic acid builds up, the pH drops and the amount of chemical base needed to neutralize the acid or base deficit increases.
- Normal umbilical arterial blood will have a pH of between 7.18 and 7.38 and a base deficit of between -8 to 0
- Normal umbilical venous blood will have a pH of between 7.25 and 7.45 and a base deficit of between -8 to 0.
If the damaging period of oxygen deprivation occurred immediately prior to birth, then the umbilical cord blood results will usually show a low pH (typically less than 7) and a base deficit of greater than -12. This is relevant when arguing that delivery should have taken place earlier to avoid injury.
If the umbilical cord blood gas analysis does not show any evidence of acidosis, it may indicate that the damage did not occur immediately prior to delivery.
The results will also be compared with blood taken from the baby shortly after delivery.