Child Injury Laws - By Jonathan Rosenfeld

As medical malpractice lawyers involved in different types of birth injury cases, we recognize that the specific events that occur behind the scenes can be difficult to compartmentalize.  While the fact patterns behind different incidents may vary-- or overlap, the following areas have become consistent aspects in some of our cases.  Consequently, we have expanded the birth injury section at Rosenfeld Injury Lawyers, to further refine the expanse of birth injury cases we get involved with.

Please take a moment and review this expanded section with pages devoted to:

• Cerebral Palsy
• Death of mother during childbirth
• Meconium Aspiration 
• Group B Strep
• Perinatal Encephalopathy / Oxygen Deprivation 
• Erb's Palsy / Shoulder Injury
• Stillbirth
• Twin-to-twin transfusion syndrome
• Untreated jaundice in newborns
• Uterine Rupture
• Placental Abruption

Of course, no family anticipates that these terms will ever become part of their vocabulary.  However, if the situation should arise, our team of medical malpractice attorneys remains committed to seeing your case through with the interest of you and your child first and foremost.

Decades ago there were few medical treatments available for children with CP to resume a semblance of a normal life.  Thankfully, advances in medical techniques used to control the symptoms of cerebral palsy now allow children with different types of CP to live active and rewarding lives.

I began to consider the tremendous strides made in cerebral palsy treatment when I read about a young man with a potentially disabling form of CP, who beat down the hurdles to become an accomplished athlete. 

For most of us, the prospect of jogging more than a few miles sounds like an unpleasant—and sweaty task.  However, for a teenage boy with spastic cerebral palsy, running a few miles is really just a warm-up!  The amazing story of Matthew Taylor was recently highlighted in an inspirational news article, “Teen once told he’d never walk now running half-marathon”. 

At six months of age doctors diagnosed Matthew with a type of CP, known as spastic cerebral palsy that severely limited the use of his arms and legs. Given the typically grim prognosis, doctors were somewhat skeptical as to Matthews’s future ability to use his legs--- let alone walk without the use of crutches or a walker. 

In spite of his doctors’ skepticism, Matthew proved them wrong.  At 21-months,  and after undergoing intensive physical therapy sessions, Matthew took his first steps--- without the use of any assistive devices. 

While it would have been nice for Matthew to have resumed ‘normal’ development at the conclusion of his physical therapy sessions, the challenges placed upon him with his cerebral palsy continued through his childhood development. Conversely, advancement in his physical development was accomplished only through more intensive physical therapy sessions and the use of botox injections to reduce the spasticity in his legs.

Nothing worth accomplishing is ever easy. 

Once Matthew began to experience teenage growth spurts, the injections and therapy began to lose their effectiveness as his bones and muscles continued to grow in poor configuration making a simple walk very difficult.

In order to correct the anatomical difficulties, Matthew required several surgeries to re-position Matthew’s femur (femoral derotational osteotomy), lengthen his hamstrings and implant a pump programmed to release muscle relaxants such as Baclofen. 

Matthew continued to excel.

With the treatments, the spastic conditions that plagued Matthew were soon able to be controlled and he was able to resume many of activities that other teenagers take for granted--- like using a television remote control with his hand--- to athletics, cross-country to be exact.  Years after fighting to regain control of his spastic cerebral palsy, Matthew Taylor found himself on his high school’s cross country team.

Continuing on with his goal-setting mentality and blessings from his treating doctors, Matthew plans on pushing his passion for running as he participates in even more grueling events like a 15k race and even a half marathon.

Situations like this really deserve to be highlighted because of the improvements the medical community has made with respect to the different types of treatments available to control cerebral palsy, I can attest firsthand to the tremendous efforts required on behalf of the individual and their family as they fight their way through the daily battles this condition throws their way.

Related:

Botox Considered as a New Therapy for Cerebral Palsy Patients

What is spastic cerebral palsy?

Life Changing Spinal Surgery Allows Young Boy With Cerebral Palsy to Walk

Cerebral Palsy Victim Becomes Star Softball Pitcher

Children with severe cerebral palsy usually require a lifetime of intensive medical care.

Treatment often involves major corrective surgeries to help properly re-align a child’s hips and spine. While it’s a widely known that the surgeries involve great risks, a big question still remains: Do these surgeries, when successful, actually improve child’s quality of life?

In a recent blog entry from Children’s Hospital Boston, Rachel DiFazio, a nurse with the hospital’s CP Program, said that after 21 years of working with CP children, she still wasn’t sure.

“I’ve always wondered what the outcomes were of surgeries,” said DiFazio. “We have a lot of X-ray data and range-of-motion data, but we don’t really know if it gets any easier to take care of these children; whether life gets a little bit easier after the surgery, and in what ways.”

To try and answer her own questions, DeFazio recently launched a research study based on surveys. The study takes a look at the “complete picture” of the physical, familial and financial impacts that surgeries have on children and their families.

“Before surgery, we ask the parents to tell us about their child’s quality of life, about their own lives as caregivers, and about the effects on the family as a whole - including siblings and on the family’s finances,” said DiFazio. “I’d like to see how the whole family is doing. These are questions that have never been addressed before in this population of severe CP patients, largely because we haven’t had the instruments to do so in a systematic way.”

According to a recent study from the Children’s Hospital at Johns Hopkins University, most children with severe CP will eventually require spinal surgery. Recovery from surgery usually takes about a week. Recent CDC data indicates that the total lifetime cost for treating a person with CP is approximately $900,000.

Related:

Reconstruction of Dislocated Hips in Children with Cerebral Palsy

Hopkins Children’s Study Finds Some Patients with Cerebral Palsy Have Asymmetric Pelvic Bones

Economic Costs Associated with Mental Retardation, Cerebral Palsy, Hearing Loss and Vision Impairment

Treatment Options for Patients with Cerebral Palsy Are Dependent On Proper Diagnosis From Medical Community

Given the state of our high-tech delivery rooms, it might seem contradictory that most major birth injuries occur as a result of simple human communication problems.

We like to assume ALL doctors know exactly what they’re doing, at all times. Especially during the high-stress experience of labor.

But study after study has proved that teamwork breakdowns are more threatening to a baby’s health than anything else - simply because there’s so much to keep track of, at such a risky time.  

In 2008, a group of 16 hospitals called “the Premier Alliance” tried to change that, by implementing what they called “care bundles.” Care bundles are a series of protocols that apply to a singular birth event, and work best when used a team, in tandem.

“What we were trying to do is to make care delivered in the birth process more effective,” said Susan DeVore, Premier’s chief operating officer. “Our goal is to get [the injury rate] to as close to zero as possible, with zero being the only acceptable number.”

Care bundles can apply to any number of birth situations, but they’re most often used for two events: The decision whether or not to use pitocin to induce labor, and the use of vacuum extractors in more difficult vaginal deliveries.

In the case of a vacuum extraction birth, a “care bundle” would consist of:

• An in-depth discussion of between the doctor and patient about the risks and benefits of the procedure
• A documentation of the conversation
• An exam to ensure that the baby’s properly positioned
• Plans for emergency staffers to be on call, should a C-section be required

According to a recent Wall Street Journal article, Premier Alliance experienced an eleven precent drop in birth injuries since it started its care bundle programs.  It also reduced the number of babies with insufficient oxygen by 31 percent.

Recently, the federal government awarded $3 million each to two groups working on improving obstetrical safety - St. Louis-based Ascension health, and Minneapolis-based Fairview Health Services.

“I have a mental checklist now of what to do,” said Dr. Paul Burstein, a doctor at an Ascension Health hospital in Milwaukee. “It’s given me more confidence. And I know other members of the team are on the same page.”

Related entries from Child Injury Laws blog:

Lights, Camera, Baby Delivery! Are Parents Entitled To Film The Birth Of Their Children?

Is the rush to induce labor, jepordizing the safety of mother and baby?

Are Cesarean Sections Helping Or Hindering The Health Of Mother & Infant?

Birth Asphyxia: A Doctor's Delay, A Lifetime Of Medical Complications

As medical malpractice lawyer, who has worked on cases involving cerebral palsy, I've noticed a good deal of confusion regarding all aspects of CP.  

Like many medical conditions, it seems like the more we study this troubling condition, the more questions we have.

I've tried to draw out some particularly useful information from trusted sources to address many of the issues I come across in cerebral palsy cases.

What is cerebral palsy?

Cerebral Palsy (CP) is a condition (CP is sometimes referred to as a group of symptoms) that can affect the brain and nervous system functions including movement, posture, learning, hearing, seeing, and thinking. 

It is caused by brain injury or abnormal development of the brain that occurs before, during, or shortly after birth (brain damage occurring after age 5 is not considered cerebral palsy). 

Most problems occur in the womb, but problems can happen anytime during the first two years of life as the child’s brain develops.  It is estimated that almost 800,000 children and adults in the United States are living with symptoms of cerebral palsy.  And, the CDC (U.S. Centers for Disease Control and Prevention) estimates that every year about 10,000 babies born in the United States will develop cerebral palsy.  

What are the types of cerebral palsy?

There are actually several different types of cerebral palsy:

• Spastic – muscle stiffness and movement difficulties (occurs in 70% of children with CP)
• Athetoid (or dyskinetic) – involuntary and uncontrolled movements (occurs in 20% of children with CP)
• Ataxic – disturbed sense of balance and depth perception (occurs in 5% of children with CP)
• Mixed - (usually spastic and athetoid types are combined and may also involve severe mental retardation)

Symptoms assciated with cerebral palsy

Signs and symptoms of cerebral palsy usually present themselves during infancy or preschool years.  Symptoms can vary significantly between people and range from minor clumsiness to severe spasticity (muscles are continuously contracted).  In addition, the disability symptoms associated with cerebral palsy can be limited to one limb or one side of the body, or they can affect the whole body. 

Symptoms of CP usually become evident before a child has reached the age of two, but they can begin as early as three months.  Brain damage does not worsen after the damage has occurred; however, the symptoms may change as the individual grows and matures.

Symptoms include:

• Spasticity (stiff muscles and exaggerated reflexes)
• Rigidity (stiff muscles with normal reflexes)
• Joint contracture (joints are tight and do not open up all the way)
• Too stiff or too floppy muscle tone
• Ataxia (lack of muscle coordination)
• Athetosis (slow, writhing movements)
• Difficulty walking (walking on toes, crouched gait, scissors-like gait, wide gait)
• Tremors
• Delays in reaching motor skills milestones (sitting up alone, crawling)
• Favoring one side of body (reaching with only one arm, dragging one leg while crawling)
• Excessive drooling or difficulty swallowing
• Delays in speech development or difficulty speaking
• Difficulty with precise motions

Oftentimes, the brain problems that lead to cerebral palsy conditions can also cause additional neurological problems such as:

• Difficulty with vision and hearing
• Intellectual disabilities or mental retardation
• Speech problems (dysarthria)
• Seizures
• Abnormal touch or pain perceptions
• Dental problems
• Urinary incontinence

Causes of cerebral palsy

Oftentimes, the exact cause of cerebral palsy is unknown because it usually stems from an abnormality or problem in brain development before the child is born.  Factors that can cause problems with brain development include:

    •    Oxygen deprivation (hypoxia)
    •    Fetal stroke
    •    Genetic defects
    •    Bleeding in the brain
    •    Infant infections (encephalitis, meningitis, herpes simplex infections)
    •    Maternal infections (ex. rubella)
    •    Traumatic head injury
    •    Severe jaundice

Risk Factors and Prevention of Cerebral Palsy

CP affects 2-4 of every 1,000 infants and premature babies are at a slightly increased risk of developing cerebral palsy (CP is 10 times more common in premature infants).  Moreover, CP is more common in low birth weight infants (less than 3.3 pounds). 

A study in the American Journal of Obstetrics and Gynecology that looked at the times of delivery of two million neonates in California over fourteen years suggests that night births are linked to an increased risk of brain disorders such as epilepsy, cerebral palsy, and encephalopathy. 

Babies born between 10 p.m. and 4 a.m. were 22% more likely to develop cerebral palsy and other brain conditions because of lack of oxygen during delivery.  The authors suggest that medical errors and poor staffing in hospitals overnight may account for the higher incidence of brain problems.    

In many cases, the exact cause of CP is unknown, which makes prevention difficult.  However, if you are having a baby, there are steps you can take to lower the risk of CP.  These efforts include:

• Maintaining a healthy diet
• Proper prenatal medical care
• Review medications with your doctor
• Controlling diabetes, anemia, hypertension, seizures, and nutritional deficiencies during pregnancy
• Vaccination against diseases
• Practice good child safety (prevent head injuries)

Treatment for cerebral palsy

There is no cure for cerebral palsy.  However, many children benefit from physical therapy and special education.  Treatment is based on the individual’s symptoms and the need to prevent complications.  Usually, the earlier the treatment begins, the better chance the child has of overcoming disabilities or learning new ways to accomplish tasks. 

Treatment plans should include a team of professionals (doctor, dentist, social worker, nurses, therapists (occupational, physical, and speech), and specialists for specific symptoms.  Treatment plans can include self and home care, special education and schooling, glasses, hearing aids, muscle/bone braces, walking aids, wheelchairs, surgery, and medications to address seizures, spasticity, drooling, and tremors. 

The good news is that most children with CP survive into adulthood.  Long-term care may be required depending on the severity of symptoms, but a comprehensive care plan can help the individual be as independent as possible and reach their highest potential.  

Research efforts are underway to improve the treatment and diagnosis of cerebral palsy, but ultimately, prevention is the key for curing CP.  Researchers at Duke University are looking into stem cell therapy to treat cerebral palsy patients.  They are hoping that the stem cells can help regenerate cells in the brain that never developed because of lack of oxygen during birth, which could alleviate symptoms.  

If your child is diagnosed with cerebral palsy, there are support groups and circles that can help you cope with CP and its effects.  The following organizations offer good resources:

• NINDS
• United Cerebral Palsy
• U.S. Centers for Disease Control and Prevention

In addition, your doctor should be a good source for local community groups.  Cerebral palsy requires long-term and loving care.  You should encourage your child’s independence and take an active role in advocating for your child.  If you do not think your child is receiving the best possible care, you should speak up on your child’s behalf.  Proper care for cerebral palsy requires that each and every professional treating your child work together to ensure the best outcome for your child.  

Resources:

Seer Press News: Cerebral palsy more likely to develop in babies born during night time, study says

Seer Press News: Stem cells for treatment of cerebral palsy

HealthCommunities.com: Cerebral Palsy Signs and Symptoms

Mayo Clinic: Cerebral Palsy

Merck: Cerebral Palsy

Cerebral Palsy Lawyers FAQ

NCBI: Cerebral Palsy

National Institute of Neurological Disorders and Stroke (NINDS): Cerebral Palsy Information Page

Kids Health: Cerebral Palsy

Two years of litigation has achieved a $7.5 million settlement in a birth injury lawsuit initiated by the grandparents of a child born with cerebral palsy.  As reported in the Chicago Sun Times, the medical malpractice lawsuit was brought against Christ Medical Center and treating obstetricians for their respective roles in the way they responded to a situation involving signs of fetal distress of a baby born at the hospital in 2002.

As with many birth injury lawsuits, the allegations of medical malpractice centered around the delay of hospital staff and treating physicians had with respect to taking action upon learning of the potential dangers facing the baby. The delay in responding to signs of fetal distress was blamed for oxygen deprivation and ensuing complications including brain damage and cerebral palsy.

Now, 9-years-old, and with significant care-related needs, the funds from the settlement can be used to provide for the extensive skilled-care needs that this child will need for the remainder of her life.  In addition to the care, some of the funds will likely be used to modify the child's home to make it more accommodating for specialized physical needs such a wheelchair access.

Significant Settlements For Birth Injury Cases:

While settlements such as this are indeed eye-popping for their significance, it is important to remember that the funds from the settlement of birth injury lawsuit are intended to provide for the needs of these children for the remainder of their lives.  In the case of a child with cerebral palsy, many physicians will opine that these children will have a normal life expectancy --- similar other children their age.

Additionally, in situations involving funds awarded to children in cerebral palsy or other types of birth injury cases, the funds are customarily put into a trust or other type of restrictive account where a only a parent or guardian can access the funds for the direct needs of the child.  

Many times, a judge oversees the administration of the funds to further protect the child from improper acts of a third-party--- and to assure that the funds last protect the needs of the child in the future.  Usually, an annual accounting is ordered to be filed with the court where all expenditures and trust income is accounted for in order to detect any issues as quickly as feasible.

Further distinguishing funds set-aside for a child's birth injury, is how the funds are to be invested.  Unlike accounts used for investment and growth, accounts established for special needs children are intended to utilize extremely conservative--- and inherently safer--- types of investment vehicles to further assure the needs of the child can be provided for in the future regardless of the overall economic volatility.

Related:

A lack of oxygen, or Hypoxic Ischemic Encephalopathy, is the frequent cause of baby brain damage at birth

Parents Settle Medical Malpractice Lawsuit Where Child Suffers Brain Injury At Birth

Life Expectancy: Cerebral Palsy

Life expectancy in children with cerebral palsy, BMJ 1994; 309 doi: 10.1136/bmj.309.6952.431 (Published 13 August 1994)

Diagnosing Cerebral Palsy

A pending matter, my office is working on involves a boy who sustained a brain injury due to the doctors' delay in perfoming a c-section.  The condition referred to as; hypoxic Ischemic Encephalopathy (HIE), also known as perinatal encephalopathy, may result when the brain does not receive enough oxygen (hypoxia).  HIE can refer to any brain injury caused by oxygen deprivation, but it often refers to an injury common to newborns that can cause long-term disability and death.  

HIE in newborns is caused by injury or complication during birth where the fetus or newborn suffers oxygen deprivation.  Causes of HIE include:

• Birth injury
• Perinatal asphyxia
• Delivery complications with delayed delivery
• Umbilical cord wrapped around neck of infant
• Trauma to the brain during delivery process

In the United States, HIE occurs in one to eight of every 1000 births.  If HIE is severe, the mortality rate is around 20% with deaths occurring mostly in the first week of life, with 25% of survivors suffering permanent neurological defects.  For infants who survive severe HIE, up to 80% of them develop serious complications, 10-20% develop moderate disabilities, and up to 10% have no complications.  For infants with moderately severe HIE, 30-50% have serious complications, and 10-20% have minor neurological problems.  

The lack of oxygen occurs to the brain as a whole not just one part of the brain.  HIE results in brain injury as a result of oxygen deprivation (hypoxia) and reduced cerebral blood flow.  Brain cells require proper circulation to receive oxygen and remain viable.  If the brain does not receive proper circulation and oxygen, the cell membranes of brain cells become compromised and the neurons die.  Within five minutes of oxygen deprivation, a child may suffer from irreversible brain damage.  

The extent of damage depends on how long the brain is without oxygen.  Brief oxygen deprivation may cause only minor brain cell injury while longer deprivation can cause damage to more sensitive areas of the brain including the hippocampus (plays an important role in memory).  

The damage can cause long-term disability, mental retardation, epilepsy, seizures, learning disability, delayed development, and cerebral palsy.  (See Rosenfeld Injury Lawyers “Cerebral Palsy” and Child Injury Laws Blog “The Needs Of Children With Cerebral Palsy Need Special Consideration for Their Optimal Functioning”)  

Diagnosis of HIE usually includes a physical exam along with any of the following tests: CT scan, MRI scan, electrocardiogram (EKG, ECG), blood test, electroencephalogram (EEG), or ultrasound.  In cases of severe HIE, treatment involves resuscitation, mechanical ventilation (artificial respiration) to help with breathing, oxygen treatment, medicine to help control seizures, and treatments to help with circulation.

If your child suffered a preventable brain injury from hypoxic ischemic encephalopathy (HIE) because doctors were negligent in the delivery of your child, you may be entitled to compensation.  Please give us a call for free legal consultation today regarding your potential claim.  Our legal consultations are always free and confidential.  (888) 424-5757.

Thank you to Heather Kiel, J.D. for her work on this Child Injury Laws Blog entry.

Resources:

eMedicine: Hypoxic-Ischemic Encephalopathy

Children’s Memorial Hospital: Hypoxic Ischemic Encephalopathy

NYU Langone Medical Center: Hypoxic Ischemic Encephalopathy

Neuropathology: Cerebral Ischemia and Stroke

Pediatrics: Interventions for Perinatal Hypoxic-Ischemic Encephalopathy

Rosenfeld Injury Lawyers: Cerebral Palsy

Child Injury Laws Blog: The Needs Of Children With Cerebral Palsy Need Specia Consideration for Their Optimal Functioning

Perinatal Encephalopathy / Oxygen Deprivation At Birth

For children with cerebral palsy, many face a lifetime confined to a wheelchair due to their inability to walk or balance.  While the underlying reasons behind walking difficulties may be multi-faceted (cognitive defects, muscle spasms, orthopedic disorders) a new study may help to pave the way for allowing more mobility in children with CP.

Researchers at John's Hopkins Children's Center, discovered that many children with cerebral palsy have a significant asymmetry in hip alignment.  Using a 3-D CT scanner, Hopkins researchers looked at 27 children with cerebral palsy and quickly discovered that all of them have a severe misalignment (greater than 10 degrees) in their pelvic bones.

Though some children with CP have scoliosis and other types of orthopedic conditions that require surgery, the new research suggests that surgeons need to address the pelvic alignment issues as well to achieve a maximum level of functionality for the children. 

Read more about this recent study relating to children with cerebral palsy here.

Resources:

Validation of a Model of Gross Motor Function for Children With Cerebral Palsy (PDF) Physical Therapy . Volume 80 . Number 10 . October 2000

Space-age Therapy Suit Aids Cerebral Palsy Patients

Prevention of dislocation of the hip in children with cerebral palsy (PDF) J Bone Joint Surg [Br]

2005;87-B:95-101.

As a lawyer, who litigates birth injury cases, I've noticed that there is still quite a bit of confusion about c-section deliveries.  I've noticed that many doctors fail to adequately explain the procedure to their patients and many times is is done so during a particularly stressful time--- like when the woman is in labor!!

Why are they needed? Are there risks to mother or baby?

Below is some information that I have learned over the years as well as some terrific resources regarding this potential confusing medical procedure.

A cesarean delivery (C-section) is a surgical delivery of a baby requiring an abdominal incision and a uterine incision.  C-sections can be elective or medically necessary. 

Reasons for a C-section include:

    •    Stalled labor (failure to progress)
    •    Baby has reduced oxygen supply (changes in baby’s heartbeat)
    •    Baby is in breech (feet or buttocks first) or transverse position (side or shoulder first)
    •    Carrying multitudes (twins, triplets)
    •    Problem with placenta
    •    Problem with umbilical cord
    •    Baby has a large head
    •    Mother has medical condition (heart condition, genital herpes)
    •    Baby has a health concern

If your doctor determines that a C-section is medically necessary, a delay in the procedure can cause preventable injury to the mother or the baby.  

In other situations, the mother requests a C-section (elective c- section).  There are many reasons that can lead to this decision:

    •    Convenience of scheduling
    •    Fear of vaginal birth (fear of labor and pain)
    •    Fear of sexual dysfunction after birth
    •    Avoiding vaginal birth compilations
    •    Previous vaginal birth complication

There are risks associated with C-sections because it is a surgical procedure.  Risks to the mother include:

    •    Longer recovery time
    •    Surgical injury (to nearby organs)
    •    Wound infection
    •    Endometritis (inflammation and infection of the uterine lining)
    •    Increased bleeding
    •    Reaction to regional anesthesia
    •    Blood clot
    •    Increased risk of complications during future pregnancies

Risks to the baby include:

    •    Breathing problems (transient tachypnea, respiratory distress syndrome)
    •    Fetal injury (nicks or cuts on the baby’s skin)

Besides the medical risks, C-sections also require a longer recovery.  You may require help with childcare or household help in the weeks following your C-section.  This can be difficult for some families, especially because some C-sections are last minute emergency decisions.  Therefore, it is important to prepare for the possibility of a C-section birth even if you plan on vaginal delivery.

It used to be that if you had a C-section, you could not have a vaginal delivery in the future.  But now, a vaginal birth after C-section (VBAC) is possible in many cases. 

So, choosing a C-section for your first child does not necessarily preclude you from experiencing a vaginal birth with subsequent children.  In women who choose a VBAC, 60-80% have a successful vaginal delivery.  Factors that improve the chances of a successful VBAC including:

    •    Only having one prior low transverse uterine scar (most common uterine incision)
    •    Pregnancy is progressing normally and mother and baby are healthy
    •    Labor begins naturally on-time or before your due date
    •    You have had previous successful vaginal delivery

The C- section procedure can usually be completed in less than an hour.  First, the health care team cleans the abdomen, place a catheter in the bladder, and start an IV line to provide fluid and or medication.  Then, regional anesthesia in delivered, which in most cases is a spinal block. 

Next, the doctor makes two cuts, one to the abdominal wall, and another to the uterus.  Finally, the doctor removes the baby, clamps the umbilical cord, removes the placenta, and closes the incisions with sutures.   Following a C-section, the mother and baby usually stays in the hospital about three days, while health care professionals help monitor your pain and help you recover.  (C-section birth video)

It is important that you discuss delivery options with your the health care provider, so an informed, safe, and healthy decision can be made.  If fear is your primary motivator in requesting an elective C-section, it is important to talk to your doctor first about your concerns. 

Oftentimes, a frank and open discussion with a medical professional can help you understand what to you can expect.  Why people like to tell birth horror stories to expectant moms is beyond comprehension.  There is nothing wrong with telling these people that they can share their, supposedly well-intentioned, stories after you have your child.  

Determining whether a C-section is necessary requires the risks and benefits to be weighed.  The health of the mother, the health of the baby, the mother’s wishes, the mother’s medical history, and any complicating factors must all be considered when deciding whether a C-section or vaginal birth is appropriate. 

It is important to remember that although C-sections are a relatively common procedure, it is still abdominal surgery that carries with it the risks and complications of any surgery.  Some people even assert that medical literature is fraught with misinformation because it is written to defend birth trauma lawsuits.  This just further reinforces the importance of finding a health care provider that you trust, so that all decisions are made with you and your baby’s best interest in mind.  

Some people believe that many C-sections performed are unnecessary, putting both the mother and the baby at increased risk for complications.  In 2004, 29% of all babies born in the United States were born by C-section.  In a CNN article, one woman (Barbara Stratton) discusses how her obstetrician induced her labor a week early because she was worried that the baby would be too large if they waited. 

Ms. Stratton ended up requiring a C-section because her labor would not progress.  Then, the baby ended up weighing only 8 pounds, 7 ounces, which was much smaller than the obstetrician had thought.  Ms. Stratton reported that she suffered from pain every day for a year and a half after she gave birth to her son by cesarean section, which affected the quality of her mothering.  She advocates that women should ask questions about whether induction or a C-section is absolutely necessary.  

There are also cases where birth injuries occur as a result of a preventable delay in a C-section procedure.  For example, in the case of a California woman, Aliscia Towles, the mother alleges that her son was stillborn because doctors at Centinela hospital Medical Center failed to immediately deliver her son when it was apparent he was in fetal distress. 

Doctors gave Ms. Towles Pitocin to accelerate labor, but this failed to help her labor progress, and instead caused a change in the baby’s heart rate.  Ms. Towles alleges that her doctor purposely delayed the delivery of her baby to increase the chance that the baby would die before delivery because of increased chance of brain injury.  

It is important to feel that you have an advocate during your delivery, so that your concerns and wishes are taken into consideration.  If you do not feel like your doctor is taking the time to answer your questions about vaginal births and C-sections, you may want to look for a new doctor or enlist a birth advocate to be present during the delivery.  If the unthinkable happens and you or your baby suffers an injury during a C-section, either because the C-section was unnecessary or the procedure was delayed, you may be entitled to compensation.  

Special thanks to Heather Keil for her assistance with this Child Injury Law entry.

Sources:

Opposing Views: The Necesarean – When Is A C-Section Really Necessary?
Mayo Clinic: C-section
Mayo Clinic: Elective C-section – Keep fear out of the decision
Mayo Clinic: VBAC (vaginal birth after C-section)
CNN Health: Five ways to avoid a C-section
Baby Center: Giving birth by cesarean section
ChildBirth.org: The Cesarean Section FAQ
The Women’s Health Activist: Cesarean Section When It’s Not Medically Necessary – Safe Practice or Risky Decision?

Within the first few moments babies are pulled from the womb doctors administer the first test of their young lives.  Known as an Apgar score, doctors use the scale to evaluate each infants physical condition --- and determine if there are any deficiencies that require additional medical addention— or that need to be monitored.

Doctors usually will perform an Apgar test on the baby within the first few minutes of birth, with a follow-up to test to be given shortly thereafter or as necessary.

Five, different factors are evaluated when calculating a babies Apgar score:

• Heart rate (pulse)
• Breathing (rate)
• Grimace (responsiveness to stimuli)
• Activity (muscle tone)
• Appearance (colorization in skin)

Each factor is given a score of 0, 1 or 2, then the scores are added together to calculate a baby’s Apgar score on a scale of 0 to 10. 

In the past, Apgar scores weren’t given particular weight when it came to determining a babies long-term health as child developmental needs vary considerably. 

Now, new research tends to question this long-held assumption as there does indeed appear to be a correlation between low Apgar scores and a later diagnosis of Cerebral Palsy.

In evaluating more than 500,000 children born in Norway, the study analyzed the Apgar scores in children who were diagnosed with Cerebral Palsy.  The results revealed that children with Apgar score below three were more than 100 times more likely to be diagnosed with Cerebral Palsy than their higher scoring peers.

Certainly, more research needs to be conducted in this important field of infant vitality, but the now that the connection between Apgar scores and Cerebral Palsy has been strengthened, the next step would be to evaluate if there is an explanation for the low Apgar score at the time of delivery.

Though genetic factors and pre-mature births can impact Apgar scores, other explanations may related to physician error during delivery. The following conditions are related to to Apgar scores in children as suggested by brighthub.com:

• Precipitous delivery. Hypoxia (oxygen deficiency) can occur from a fast birth due to strong contractions or trauma to the baby's head.

• Nuchal cord. If the cord is wrapped around the fetal neck (one or more times) and obstructs blood flow, hypoxia can occur.

• Prolapsed cord. When the cord becomes trapped in the vagina before the fetus is delivered, hypoxia can occur from obstructed blood flow.

• Placenta previa or abruptio placentae. Both can cause low infant Apgar scores because the placenta separates from the uterus before delivery, interrupting blood flow.

• Meconium aspiration. The fetus can have a bowel movement (meconium) in utero when distressed and may inhale some into their lungs, thus causing respiratory problems.

• Maternal analgesics and/or anesthetics. Narcotic drugs (normally given within 4 hours before birth) that pass from mom to fetus can suppress their ability to breathe.

• Preterm infants. Immature lungs and hypoglycemia are a couple of problems that can occur with preterm infants.

• Other common causes of low Apgar scores include maternal and fetal factors, such as maternal hemorrhage or fetal heart problem.

If you suspect that your child’s low Apgar score was a predecessor to a later discovered brain injury or Cerebral Palsy, we would honor the opportunity to discuss your potential legal rights with you today without any cost or obligation for you. (888) 424-5757

Resources:

Association of cerebral palsy with Apgar score in low and normal birthweight infants- population based cohort study (PDF) by Kari Kveim Lie, senior researcher,1 Else-Karin Grøholt, senior researcher,1 Anne Eskild, professor2,3

Apgar Score MedicineNet.com

Regional Brain Volume Abnormalities and Long-term Cognitive Outcome in Preterm Infants (PDF) JAMA, October 18, 2000—Vol 284, No. 15

Should parents be concerned if their child has been diagnosed with meconium aspiration syndrome?

Learning about childbirth and talking to the doctor can help address any anxieties or concerns that parents may have.  

In most cases, labor progresses normally, but problems and complications can occur.  Umbilical cord compression is one possible complication that can lead to serious injuries.  

During labor, the umbilical cord can become stretched and compressed, which can result in a decrease in blood flow.  This can cause periodic changes in fetal heart rate (variable decelerations).  

Fetal heart rate monitors can usually detect these abnormalities, so doctors can monitor the fetus for any serious problems.  (See Child Injury Laws – “The needs of children with cerebral palsy need special consideration for their optimal functioning”)

Cord compressions are actually pretty common, occurring in about one in ten deliveries. Most times the umbilical cord straightens out and the fetus does not go through any real distress.  However, if the fetus shows signs of distress such as decrease of fetal blood pH or heart rate worsens, an emergency cesarean section might have to be performed.  

In one unfortunate case, a Florida couple’s son died when he was three years old after a brain seizure.  The boy suffered serious and permanent brain injury during delivery when his umbilical cord wrapped around his neck, cutting off his blood supply.  

The couple filed a medical malpractice claim in 2005 where they were awarded $60.5 million to provide medical care for the child over his lifetime.  Their child could not sit, speak, or eat and required constant care including a feeding tube.  The baby’s injuries could probably have been prevented if doctors were monitoring the fetal heart rate to look for signs of distress.  (See Child Injury Laws “Delay in performing c-section results in baby’s brain damage & costs doctor $3 million”)  

If your child suffered an injury during delivery, we would honor the opportunity to speak with you for a free case evaluation.  

Thank you to Heather Keil, J.D. for her assistance with this Child Injury Laws Blog entry.

Sources:

Medicine Net: Childbirth Complications

Chicago Birth Injury Lawyer Blog: Couple Awarded $10.2 Million for Wrongful Death Lawsuit

Pub Med: Umbilical cord compression associated with amniotomy – laboratory observations

Pub Med: Regional cerebral blood flow changes during severe fetal asphyxia produced by slow partial umbilical cord compression

Why is umbilical cord compression a concern for the fetus?

Pub Med: Amnioinfusion for umbilical cord compression in labor

Child Injury Laws: Delay in performing c-section results in baby’s brain damage & costs doctor $3 million

A New York jury recently awarded $3 million to a teenage girl who sustained multiple injuries, including cerebral palsy, due to the obstetrician's delay in performing a cesarean section (c-section).  According to the testimony at trial, the doctor waited between three to four hours to perform the requested procedure. 

A c-section was requested because the baby had been diagnosed with fetal asphyxia (lack of oxygen) when the umbilical cord was compressed.

In determining that the doctor deviated from the acceptable standard of care, the jury determined that the delay caused the babies brain injury. 

Moreover, jurors didn't believe the arguments presented by the doctor that the child's brain injuries were genetic and perhaps brought about by inadequate prenatal care.

The proceeds from this medical malpractice lawsuit will be used to provide future medical care for the child. 

Delays in performing c-sections

Fetal distress is often associated with hypoxia-- a reduction or loss of oxygen to the baby. Fetal hypoxia is associated with the baby's heart rate.  Medical staff therefore need to carefully monitor fetal heart-rates and look for abnormal drops or decelerations in the baby’s heart rate or by other well recognized changes in the fetal heart rate pattern.

In the event of meaningful changes in a babies heart rate, obstetricians and obstetrical nurses should timely respond to the changes-- which may be a sign of potentially dangerous fetal distress. In some circumstances the abrupt changes in the condition of the fetus will necessitate the prompt delivery of the baby by cesarean section (c-section).

In cases where the babies heart rate is not monitored or goes ignored, prolonged fetal distress may result.  The prolonged fetal distress can lead to permanent and irreversible brain injury, also known as hypoxic-ischemic encephalopathy.

Therefore, signs of fetal distress need to be acknowledged and communicated to physicians who are trained to handle cases involved stressed fetuses.  In many cases, physicians will order a prompt delivery by cesarean section. Timely performed c-section deliveries are recognized as an important step in preventing babies from devastating injuries such as brain damage and cerebral palsy.

Related:

Predictors of Outcome of Neonates with Hypoxic Ischaemic Encephalopathy Admitted to the Neonatal Unit of the University Hospital of the West Indies.pdf JOURNAL OF TROPICAL PEDIATRICS, VOL. 57, NO. 1, 2011

The association between birth condition and neuropsychological functioning and educational attainment at school age- a cohort study (PDF) Arch Dis Child 2011;96:30–37. doi:30 10.1136/adc.2009.176065

Effect of Treatment of Subclinical Neonatal Seizures Detected With a EEG (PDF) Pediatrics 2010;125;e358-e366; originally published online Jan 25, 2010

Parents Launch Investigation into Child’s Death, Saying Severely Delayed C-Section was to Blame

Diffusion-weighted and Conventional MR Imaging in Neonatal Hypoxic Ischemia- Two-year Follow-up Study (PDF) Radiology: Volume 249: Number 2—November 2008

A recent study completed by researchers at University of California, San Francisco determined that black infants have higher rates of cerebral palsy than other nationalities. The study is one of the first large-scale evaluations of infants born with low-birth weights and diagnosis of cerebral palsy.  

Head researcher Dr. Yvonne Wu, lead a team that evaluated medical records from 6.2 million children born in California between 1991 and 2001.  After analyzing the data based upon children with cerebral palsy severe enough to qualify for state services, the study compiled the following:

• 8,400 of the 6.2 million children evaluated in the study were diagnosed with cerebral palsy
• Of the 8,400 babies born with cerebral palsy: 758 were black,  2,878 were white, 3,963 were Hispanic and 656 were of Asian descent
• Black infants were about 30% more likely than white infants to have cerebral palsy
• Low birth weights drastically increased the likelihood of a child with cerebral palsy

Though the study didn't necessary reach any physiological conclusions for the racial disparities, researchers suggest that the frequency of pre-natal care and educational levels of the parents may be at least partially to blame for the increased cerebral palsy rates.

Clearly, more medical research is needed in this important area that effects children of all races and nationalities.  If your child has been diagnosed with cerebral palsy or is just developing 'slowly', we would honor the opportunity to speak with you for a free case evaluation.  Many cases involving cerebral palsy or 'slow development' are traceable to physician or hospital negligence.

Related:

Prenatal Events and the Risk of Cerebral Palsy in Very Low Birth Weight Infants — Am J Epidemiology (PDF)

Medical Facilities Concentrating On Assisting Children With Cerebral Palsy

Blacks' higher cerebral palsy risk, birth weight tied, Neurology February 22, 2011

The Needs Of Children With Cerebral Palsy Need Special Consideration For Their Optimal Functioning

Cerebral palsy is a group of neurological disorders usually caused by brain abnormalities early in development.  The disorders affect muscle coordination and body movement.  Most children are born with cerebral palsy, but symptoms may not be detected until months or years later.

There are three types of cerebral palsy:

• Spastic cerebral palsy – stiff muscles with jerky movement
• Athetoid cerebral palsy– uncontrolled movements, writhing
• Ataxic cerebral palsy – poor balance and coordination
• Also, a mixed type of cerebral palsy can occur, which is a mix of the different types of cerebral palsy.

Causes of Cerebral Palsy

Cerebral palsy is usually caused by non-progressive brain abnormalities in the part of the brain that control muscle function (“non-progressive” means that the brain abnormality does not cause ongoing brain degeneration).  Brain damage can occur during pregnancy (problems with the brain’s blood supply or genetic conditions) or after the brain has developed (later in the pregnancy, during delivery, or in the child’s first years of life. 

These post-natal causes include:

• Brain damage
• Strokes
• Brain infections (bacterial meningitis, viral encephalitis)
• Head injury  

Many cerebral palsy cases do not have a defined cause.   Research is underway to identify pregnancies most at risk, so that strategies to prevent cerebral palsy can be developed.

Cerebral Palsy Risk factors include:

• Premature birth (less than 37 weeks)
• Low birth weight (less than 5.5 pounds)
• Multiple babies
• Breech birth (feet-first)Toxic substances
• Severe jaundice (hyperbilirubinemia)

The Centers for Disease Control and Prevention (CDC) tracked the number of school-age children with cerebral palsy through the Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP).  In 1996 and determined that 1 in 278 children age 8 had cerebral palsy.  In 2000, the number of 8-year-olds with cerebral palsy was estimated at 1 in 323. 

Common Symptoms Of Cerebral Palsy 

Cerebral palsy can cause a variety of symptoms and disabilities depending on what part of the brain was damaged.  The most common symptoms are lack of muscle coordination during voluntary movements (ataxia), stiff muscles, exaggerated reflexes, asymmetrical walking gait, tremors, and difficulty with precise motions. 

Children who suffer from cerebral palsy usually have trouble with movement and posture.  The disorder can also result in contractures (muscles pull so tightly on the bones that the limbs curl), malnutrition (caused by problems swallowing or feeding).  Other associated problems include: difficulty with vision, hearing, and speech, dental problems, seizures, urinary incontinence, and dental problems. 

Treatment For Children With Cerebral Palsy

There is no cure for cerebral palsy, but treatment and therapy can make a difference.  Although there is no cure, some causes of cerebral palsy are preventable.  Head injuries can be prevented with proper seat belt use and bike helmets, and of course preventing child abuse.  Therapies such as physical therapy, occupational therapy, and speech therapy can improve some of the symptoms and disabilities.  Medications such as muscle relaxants and Botox can help relax contracted muscles.  Many people suffering from cerebral palsy require long-term services and care, depending on the severity of symptoms. 

Children suffering from cerebral palsy can benefit from early diagnosis and treatment of the condition.  Although there is no cure, therapy (physical therapy, speech therapy, medicine) can help improve their capabilities and life.  Children are resourceful and resilient, and when helped by therapy, they can learn new ways to accomplish tasks. 

Medical-Legal Issues Involved In Cerebral Palsy Cases

The debilitating nature of cerebral palsy for both child and family can be imposing from both an emotional and financial standpoint.  Consequently, all cerebral palsy cases should be evaluated from a medical-legal standpoint to determine if a physicians or hospitals negligence is responsible.  

In cases where negligence can be established, the family of the child may be entitled to substantial damages for past and future medical care as well as other elements of damages designated in the jurisdiction.  In order to determine the feasibility of a recovery, families dealing with a CP child should seek legal guidance as soon as feasible from a lawyer that handles birth injury matters.

Thanks to Heather Keil, J.D. for her assistance with this Child Injury Laws entry.

Resources:

eMedicineHealth: Cerebral Palsy

National Institute of Neurological Disorders and Stroke: Cerebral Palsy Information Page

Medline Plus: Cerebral Palsy

Cerebral Palsy Resource Center

Science Alert: Mere Cerebral Palsy Risks Found

Kids Health: Cerebral Palsy

CDC: Cerebral Palsy

Medicine Net: Cerebral palsy

Mayo Clinic: Cerebral palsy