Cerebral Palsy ("CP") is the most widespread physical disability in both the U.S. and the world. According to estimates published by the United Cerebral Palsy Foundation, over half a million people in the U.S. alone are currently living with CP. Worldwide the number of people with CP is approximately 16 million. In contrast to other types of disabilities, the underlying causes of CP are generally well recognized and understood. Cerebral palsy is triggered by developmental abnormality or injury to the cerebral cortex in the still developing brain of a fetus or baby. The cerebral cortex is located in the outer rim of the brain and is primarily responsible for controlling the movement of the body. The neurologic damage resulting in CP occurs during a specific window of time when the brain is still developing - from pregnancy to 1 week after birth. Trauma or injury to a baby's brain during this stage causes the cerebral cortex to develop abnormally. As a result, when the child gets older their brain is not able to maintain normal control over certain areas of the body. The injury to the brain during development causes signals from the cerebral cortex to become scrambled. There is nothing physically wrong with the child's arms, legs, and other body parts, their brain is simply not able to control them normally.
All CP cases are ultimately the result of neurologic damage during the development of the brain. However, the originating cause of the injury to the baby's brain comes in several different types and can occur during different phases. The potential causes of brain injury triggering CP can be categorized based on the phase of development that injury occurred in (1) prenatal; (2) childbirth; and (3) neonatal.Prenatal Causes of Cerebral Palsy
A large percentage of brain injuries that result in CP are caused by events occurring sometime during pregnancy (the prenatal phase). There are a number of known events or conditions occurring during pregnancy that that can cause cerebral palsy:
- Developmental Abnormality: environmental and genetic abnormalities can disrupt normal brain development of the fetus during pregnancy. Abnormal myelin development and prenatal cell migration problems are the 2 most common genetic abnormalities. That cause cerebral palsy. These genetically inherited conditions are often triggered or made worse by environmental factors (e.g., drug or alcohol use during pregnancy).
- Maternal Infections: maternal and placental infection are correlated to preterm births. Prematurity is predictive of cerebral palsy. Recent studies have determined that certain maternal viral infections can damage the brain of the fetus and lead to cerebral palsy. These studies have linked viruses such as chicken pox, rubella, and cytomegalovirus (CMV) to increased risks of CP. The reason for this is that these particular viral infections prompt pregnant mothers to release protein receptors called cytokins. During pregnancy, high levels of cytokins in the mother's bloodstream can cause inflammation in the head of the fetus which can eventually damage the baby's brain.
- Chorioamnionitis: chorioamnionitis is a bacterial infection in the amniotic fluid or fetal membranes. It is caused by bacteria in the mother's vagina which travels up to the uterus and sometimes infects membranes or amniotic fluid. If not diagnosed and managed chorioamnionitis can disrupt the supply of oxygen to the fetus and cause damage to the brain. According to a study by the University of California, chorioamnionitis makes cerebral palsy 4 times more likely to occur.
- Prenatal Asphyxiation: prenatal asphyxiation occurs when the supply of oxygen to the fetus is cut off or restricted. Without constant oxygen brain cells in the fetus quickly decay and die. Membrane ruptures, umbilical cord problem, and drug use are among the most common causes of prenatal asphyxiation.
Oxygen deprivation occurring during the labor and delivery process is the other leading cause of cerebral palsy. When the supply of oxygen to the baby is interrupted during childbirth it can quickly result in damage to the baby's brain. There are a variety of known events or complications during labor & delivery that can potentially threaten oxygen supply to the baby. In most cases, oxygen delivery can be restored before any damage is done but this requires prompt and effective medical intervention.
- Umbilical Cord Problems: the most common cause of oxygen deprivation during childbirth is obstruction or compression of the umbilical cord. The umbilical cord is essentially the baby's lifeline until they are delivered and start breathing on their own. During a vaginal delivery, the umbilical cord can become obstructed in a number of ways. Umbilical cord prolapse is one of the most common problems. It occurs when the cord drops down into the cervix ahead of the baby instead of after. This creates a dangerous situation because as the baby comes down onto the prolapsed cord it can easily become compressed. Another common problem is when the umbilical cord because twisted around the baby's neck (nuchal cord).
- Head Trauma: external trauma to the baby's head during delivery can also lead to brain injury and result in cerebral palsy. The use of excessive force or improper use of birth assistance tools such as vacuum extractors or forceps frequently ruptures blood vessels and causes swelling in the baby's head which can eventually injure the baby's brain.
- C-Section Delays: injury to a baby's brain from oxygen deprivation during delivery can often be avoided if doctors recognize signs of fetal distress and perform a prompt emergency C-section.
Below are case summaries for recently reported verdicts and settlements from medical malpractice claims involving cerebral palsy. These cases demonstrate that the underlying cause of cerebral palsy usually has little or no impact on the final value of a malpractice claim.
- Hamilton v. TJ Sampson Community Hosp. (Kentucky 2018) $18.2 million: In this case, the baby suffered a hypoxic brain injury when she became stuck in the birth canal for a prolonged period of time. The plaintiff mother alleged that the nursing staff negligently failed to reduce the amount of epidural being administered, which impeded the plaintiff's ability to push. As a result, the child became stuck in the birth canal and was deprived of oxygen for a time. The baby was diagnosed with spastic cerebral palsy as a result of the oxygen deprivation during birth. The case went to trial and the jury in Barren County awarded $18.2 million.
- Dixion v. United States (Florida 2017) $33 million: This is a classic example of a cerebral palsy malpractice case based on a negligent failure to perform an emergency C-section in response to signs of distress. The fetal heart monitor was showing a "category 3" heart rate indicating a serious lack of blood and oxygen. This usually calls for an immediate emergency C-section but the OB-GYN on duty chose to ignore the monitor as a "false positive." The mother repeatedly asked for a C-section but the doctor told her to keep pushing and restarted Pitocin. The plaintiff alleged that the doctor's refusal to do a C-section and continuation of the Pitocin in light of the signs of fetal distress was negligent and resulted in a 90 min restriction of oxygen to the baby. The baby suffered a significant brain injury and was diagnosed with severe cerebral palsy. After a bench trial in the U.S. District Court for the Southern District of Florida, the judge awarded the plaintiff $33 million in damages.
- Wollcott v. Prusky (Ohio 2016) $28 million: After being reassuring throughout most of labor and delivery, the fetal heart monitor strips suddenly deteriorated. Despite this warning sign doctors opted not to perform an emergency C-section. When the baby was eventually delivered he was not breathing but a resuscitation team had not been arranged in advance. The temporary lack of oxygen resulted in brain damage and the baby was later diagnosed with cerebral palsy. A jury in Akron awarded $28 million in damages.
Cerebral palsy is often the result of medical negligence during labor & delivery. Despite the best intentions, doctors and nurses make mistakes. If your child has recently been diagnosed with cerebral palsy you should strongly consider consulting an experienced birth injury attorney. The birth injury lawyers at Miller & Zois have handled hundreds of cerebral palsy cases. We can investigate the facts of your case and help figure out whether your child was injured by a medical error. Call at 800-553-8082 today or get a free online consultation.