Cerebral Palsy - Birth Asphyxia, Hypoxic – Ischemic Encephalopathy (HIE) and Fetal Heart Rate Monitoring
Cerebral Palsy is a nonspecific term often used to describe babies who have a variety of neurologic deficiencies including mental retardation, weaknesses, spasticity and paralysis of upper and lower extremities, speech difficulties, vision and hearing problems, inability to chew solid foods, difficulties swallowing, lack of toilet training, delayed and inability in achieving development milestones including turning over, crawling, sitting up, standing and walking. Some children with cerebral palsy never achieve any of these milestones. Typically, as children with cerebral palsy grow older, their brain does not grow in proportion with their body and they develop an abnormally small head (microcephaly). Cerebral palsy can be a type of birth injury, It is sometimes referred to as birth asphyxia, perinatal asphyxia, or hypoxic-ischemic encephalopathy (HIE).
Cerebral Palsy can have a variety of causes, such as inherited (genetic, or chromosomal disorders), metabolic disorders, drugs taken and infections during pregnancy, various abnormalities of the placenta, and obstetric and for neonatal malpractice.
Obstetric malpractice cases where there has been brain damage inflicted on a baby are probably the most aggressively defended of all malpractice cases. Parents of brain damaged children with cerebral palsy are often told by doctors that the cause of their child’s condition is either unknown, genetic, or from an infection or some other cause, when the true causes is obstetric malpractice.
A common defense tactic in obstetric malpractice cases is to have a host of physicians in a variety of specialties including perinatology, pediatric neurology, neonatology, neuroradiology, dysmorphology (a subspecialty in pediatrics dealing with genetic, inherited problems) and other specialties testify that cerebral palsy resulted from an infection during the pregnancy, an inherited disorder, drugs taken during the pregnancy, some unidentifiable syndrome (“God’s will”), asphyxia occurring earlier in the pregnancy and prior to labor and delivery, or a placental abnormality, anything but lack of oxygen during labor and delivery leading to birth asphyxia.
Fetal Heart Rate Monitoring and Fetal “Distress”
A common cause of cerebral palsy due to obstetric malpractice is failing to recognize and act upon abnormalities on the fetal heart rate tracing. Fetal heart rate monitoring is an extremely important part of obstetric care, and every obstetrician, family practitioner, midwife and obstetric nurse providing care to patients in labor and delivery is required to know how to read a fetal heart rate tracing.
Patients in labor are typically connected to a fetal heart monitor which records a baby’s heart rate and corresponding uterine contractions. The baby’s heart rate changes in frequency and uniformity from minute-to-minute, referred to as “variability”, which results in a normally jagged appearance of the line recording the baby’s heart rate. A constellation of findings on the fetal heart tracing is used to help make sure the baby is receiving enough blood and oxygen, is tolerating labor, and that it is safe to allow labor to continue. Sometimes during labor, as a result of any of a number of conditions and sometimes for reasons that are not readily identifiable, an unborn baby will receive inadequate blood flow and oxygen through the placenta. The baby is usually able to tolerate this for varying periods of time, but eventually, and usually after starting first in association with contractions, the baby’s reserves become depleted, and the baby starts to accumulate acid in its blood. Unless this is corrected, acid accumulates in tissues, causing damage to the brain and other organs, including kidneys, liver, and heart. This is called “asphyxia”.
Babies who are born asphyxiated may have low Apgar scores (0-5) and a “neonatal neurological syndrome”, with lethargy, vital sign abnormalities and sometimes seizures in the newborn fluid. Very severe asphyxia can cause death of the baby while still in the womb, or in the first few days or weeks of life. If a baby who had birth asphyxia survives, the child usually develops cerebral palsy.
The purpose of fetal heart rate monitoring is to prevent birth asphyxia. As asphyxia develops in the womb, the fetal heart rate tracing will typically show progressive abnormalities such as decreased variability, absence of “accelerations” (short increases in the fetal heart rate, often in association with fetal movement), the fetal heart rate being too fast or too slow, or decelerations (drops in the fetal heart rate in association with contractions). Development of these findings on a fetal heart tracing are sometimes referred to as “fetal distress.” Fetal distress requires interventions such as giving oxygen and fluid to the mother, and turning her on her side to improve blood flow to the uterus and the placenta. If these do not work within a short period of time, prompt cesarean section delivery may be necessary. Delay may result in the baby sustaining devastating brain damage.
In consultation with obstetricians, perinatologists, pediatric neurologists, midwives, obstetric nurses, pathologists, pediatric neurologists, life care planners, economists and other professionals, the lawyers at the Sweeney Law Firm will work with medical specialists to analyze prenatal records, labor and delivery records, newborn and pediatric records, imaging studies including ultrasounds, CT scans and MRIs of the brain and other sources of information to determine if malpractice occurred. If so, Sweeney Law Firm may be able to recover damages pay for your baby’s injuries and to provide the money necessary to compensate your baby for his or her emotional and physical pain and suffering, loss of quality of life, lost income and to help pay the tremendous cost of rehabilitation, physical and occupational therapy, medical and nursing care which may be required to give your child the best chance to maximize his or her abilities.
If your baby has been diagnosed with cerebral palsy, call the Sweeney Law Firm at 260-420-3137, or toll free at 1-866-793-6339. Get answers to your questions. Learn your legal rights. There is no cost or obligation for us to evaluate your case.
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