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A Complete Guide to Cerebral Palsy as a Result of Birth Injury

Cerebral Palsy Birth Injury Lawsuits

Every year, instances of medical malpractice lead to very serious traumatic birth injuries. Cerebral Palsy (CP) is one of the more common and serious conditions caused by birth injuries occurring during labor and delivery. Although there are many birth complications that can cause Cerebral Palsy, in this section, our Florida Cerebral Palsy and birth trauma attorneys will focus specifically on the forms of birth trauma that cause CP.

What is Cerebral Palsy?

The term cerebral refers to “of the brain” and palsy refers to “paralysis”. The disorder known as Cerebral Palsy actually refers to many different disorders all relating to a person’s inability to control certain muscles. People suffering from CP may also suffer from tremors, seizures, and other impairments.

Cerebral Palsy should not be confused with a disease. Instead, it is a disorder that occurs when there is damage to the brain either during or shortly after birth.

Cerebral Palsy affects every person in a different way. Depending on the location and extent of the brain damage, a person’s body movements, muscle control, muscle coordination, muscle tone, reflex, posture, and balance may all be affected. These can all occur simultaneously, in varying level of severity, or a person may just have one of these issues.

Cerebral Palsy, as a disorder, does not progress. However, the symptoms may worsen or improve over time, depending on other factors, therapy, treatment, etc.

People who suffer from Cerebral Palsy may also experience impairments with vision, learning, hearing, and speech. CP suffers may also experience epilepsy and intellectual impairments, as well.

Most Cerebral Palsy cases are a result of abnormal brain development while the fetus is in utero or from brain injury during delivery. These injuries may be caused by medical accidents, medical malpractice, obstetrician negligence, infections, or genetic disorders.

Cerebral Palsy Statistics

  • 1 in 278 children are born with or develop some type of Cerebral Palsy
  • 764,000 children and adults have Cerebral Palsy in the US
  • 8,000 children are diagnosed every year with Cerebral Palsy in the US
  • 30% of children with Cerebral Palsy suffer from a seizure disorder
  • $6 million dollars is the average lifetime cost of caring for a person with CP

CDC Cerebral Palsy Statistics

Symptoms of Cerebral Palsy

According to Mayo Clinic, signs and symptoms of Cerebral Palsy can vary greatly from one affected individual to another. Considering that Cerebral Palsy mostly causes muscle movement and coordination issues, a majority of symptoms are associated with these areas. However, other brain functions and conditions can be symptoms of CP.
Muscle and coordination symptoms of CP are:

  • Muscles that are either too stiff or too weak
  • Stiff muscles with exaggerated reflexes (spasticity)
  • Stiff muscles with normal reflexes (rigidity)
  • Lack of muscle coordination (ataxia)
  • Involuntary movements or tremors
  • Slow, writhing movements (athetosis)
  • Delays in a child’s motor skills development, such as using arms to push up, sitting up alone, crawling, or walking
  • Child favoring one side of their body (reaching with one hand or dragging one foot)
  • Difficulty walking, (walking on toes, a crouched gait, crossing knees while walking, a wide gait, or asymmetrical gait)
  • Difficulty with sucking or eating
  • Delays in speech development
  • Excessive drooling or problems swallowing
  • Delay of fine motor skills (picking things up, putting food in mouth, etc.)

These muscle issues may affect only one side of a child, one limb, or it may affect all areas of the body in different degrees of severity.

The brain damage that caused the Cerebral Palsy may also contribute to other neurological issues, besides muscle development and control. Those with Cerebral Palsy may also have:

  • Difficulty with vision, hearing, and speech
  • Intellectual and learning disabilities
  • Seizures
  • Abnormal touch or pain perceptions
  • Oral diseases
  • Mental health/psychiatric conditions
  • Urinary incontinence
  • Autism spectrum disorder (ASD)
  • Chronic pain or discomfort
  • Attention deficit hyperactivity disorder (ADHD)

Cerebral Palsy birth injury lawsuit attorney Florida

Types of Cerebral Palsy

Cerebral Palsy occurs in approximately two to four out of every 1,000 births in the United States and Europe, according to CDC. However, the types of Cerebral Palsy cases vary. The four types are Spastic, Athetoid/dyskinetic, Ataxic, and some mixture of the three.

  • Spastic CP makes up about 70% of all cases, making it the most common type of Cerebral Palsy. Spastic CP is caused by damage to the brain’s motor cortex, often characterized by stiff, exaggerated movements.
  • Athetoid/dyskinetic makes up about 10% of CP cases. This type is caused by damage to the areas of the brain that controls balance and coordination, known as the basal ganglia. This type is often characterized by involuntary tremors.
  • Ataxic CP makes up another 10% of cases. Ataxic Cerebral Palsy is characterized by lack of coordination and balance and is caused by damage to the cerebellum. This is the part of the brain that connects to the spine.
  • Some mixture of the previous 3 types makes up the final 10% of cases. Mixed CP is diagnosed when an individual exhibits symptoms from more than one of the above types.

Cerebral Palsy is also typed depending on the location of the paralysis. These location types are:

  • Monoplegia – Paralysis of one limb.
  • Diplegia or Paraplegia – Paralysis of two limbs, usually the legs.
  • Hemiplegia – Paralysis on only one side of the body.
  • Quadriplegia – Paralysis of the whole body, usually including the face.
  • Double hemiplegia – Paralysis of the whole body, however mostly the arms are affected.

Causes of Cerebral Palsy due to Birth Injury

Asphyxiation during Birth

Asphyxiation literally refers to a lack of oxygen reaching the brain. Birth asphyxia occurs when a baby’s brain and other organs don’t receive enough oxygen in utero, during delivery, or after birth. Without oxygen, waste products (acids) build up in the cells, causing damage to the tissue; this is what causes the brain damage. This damage may be temporary or permanent, as is the case with Cerebral Palsy. Asphyxiation that occurs during delivery may be the result of medical malpractice or neglect if the physicians did not act appropriately or with a reasonable amount of care. Asphyxia causing brain damage may also fall under medical practice when it occurs before birth or after birth if the doctors played some role in its effect. For example, if a doctor failed to warn a mother about a possible complication. Birth asphyxiation may be caused by early detachment of the placenta, the rupturing of the uterus during birth, or the umbilical cord getting pinched.  All these things can cause oxygen deprivation to the child and could result in Cerebral Palsy.

Intracranial Bleeding

Sometimes during delivery, trauma can occur to the baby’s head, resulting in intracranial hemorrhages, more commonly known as brain bleeding. These hemorrhages can range from minor to severe, with the latter resulting in permanent brain damage, Cerebral Palsy, or even death.

Intracranial bleeding resulting in CP is often the result of mismanaged delivery or a failure to diagnose and prepare for some other condition, like macrosomia, cephalopelvic disproportion, abnormal presentation, trauma from prolonged labor, irregular blood pressure, asphyxia, and blood disorders.

It is the physician’s job to closely monitor the mother and baby for potentially threatening issues and fetal distress. In these scenarios, a doctor may use the assistance of delivery instruments and/or special delivery techniques. If these methods will not suffice or fail, a C-section should be offered to minimize the risk of intracranial hemorrhage and Cerebral Palsy.

[Read more about healthcare mistakes that lead to birth injuries.]

The Misuse of Delivery Instruments

During difficult deliveries, doctors may use instruments to help them successfully deliver the child.  The most common two are vacuum extractors and forceps. If these tools are not used correctly, they can cause brain damage, and as a result, Cerebral Palsy. After all, these are very real tools, with very real power, being applied to an infant child’s head during a traumatic birth injury.

The brain damage caused by these instruments’ misuse includes: brain bleeds, cerebral contusions, tearing of blood vessels and brain tissue, compression of the brain, restricted blood flow to the brain, and/or skull fractures.

Forceps are large tongs that are used to grip the baby’s head. As the delivery takes place, the physician uses the forceps to help the guide the baby as they pull them out. One can easily see how the misuse of this tool could cause damage.

Vacuum extractors are exactly what they sound like, a vacuum with a small, soft cup attachment that is placed on the baby’s head to guide it out during delivery. If this suction is too great or applied unevenly, it can damage the infant’s skull and brain.

Fetal or Maternal Infections

Pregnant mothers and their unborn babies are particularly susceptible to infection during pregnancy, labor, and delivery.  Many of these infections can be passed on to the unborn baby and can cause serious issues, like Cerebral Palsy, if not diagnosed and treated properly. Prenatal infections are most dangerous to the baby in the early weeks after conception. These infections can cause the mother’s immune system to react in a normal way to fight them off, but these immune system reactions can also cause inflammation to the baby’s brain that interferes with normal development. Some of the more common infections include:

  • Group B Streptococcus
  • Chorioamnionitis
  • Cytomegalovirus (CMV)
  • Rubella
  • Meningitis (dangerous to babies after they’re born)

Complications during Birth

As C-sections become increasingly common in the US, fewer and fewer physicians are developing the skills necessary to handle emergency situations. It is imperative that a mother and her family ensure that their delivering physician is well-versed in these procedures since most birth injuries occur because of some unexpected complication.

Delayed C-Section

One of the most common causes of birth injury is a delayed cesarean section or C-section. A physician may fail to schedule a C-section when warning signs were present before the delivery or they may wait too long to call for a C-section when things are going wrong.

A delayed C-section can lead to many different birth injuries, including Cerebral Palsy. The risks of delaying a C-section for an infant in distress include:

  • Lack of oxygen to the brain or other organs (major cause of CP)
  • Physical injuries during C-section surgery
  • Physical developmental delays caused by delay
  • Possible death due to asphyxiation

One tragic example of a delayed C-section that led to Cerebral Palsy occurred in 2002 in Norwalk, Connecticut. In this case, Cathy D’Attilo and her husband, Dominic, sued Dr. Richard Viscarello, of Maternal-Fetal Care and Stamford Hospital, for $58 million after repeated instances of negligence led to their son being born with CP and other debilitating injuries.

According to the court documents, D’Attilo visited her doctor just two days before she went into labor. It was at this visit that the doctor detected D’Attilo’s amniotic fluid had reduced significantly, indicating that emergency action was needed. However, instead of scheduling an emergency C-section, the mother was sent home. The baby was left to partially suffocate in the womb.

After further mistakes were made on the operating table, their baby was finally born. Unfortunately, because of the mistakes made prior to the delivery, their son will forever suffer from seizures; be unable to speak, crawl, sit up, or stand; or reach the milestones of a healthy child.

Breech Birth

A breech birth occurs when a baby enters the birth canal feet or butt first, as opposed to head first, which is the normal presentation. Breech births are often handled with a C-section since the child’s position can greatly delay the birthing process and cause further complications. If there is any significant delay in delivery, the baby’s brain can be damaged. Breech births may also cause pinched umbilical cords, oxygen deprivation, head entrapment, injury to the brain and skull, or damage to the internal organs. Of course, all of these are dangerous to the baby.

Cephalopelvic Disproportion (CPD)

Cephalopelvic disproportion (CPD) injuries occur when a baby’s head or body is too large to pass through the mother’s pelvis. A doctor’s failure to diagnose this issue before delivery may cause an emergency situation that may result in the need for a C-section, or worse, injury during delivery. Ideally, surprises should be as limited as possible.

Two of the most common issues associated with CPD are shoulder dystocia and fetal macrosomia.

Shoulder Dystocia

Shoulder dystocia occurs when a baby’s shoulder gets stuck behind the mother’s pubic bone or tailbone. Shoulder dystocia can also cause other injuries besides CP, including Erb’s Palsy and Klumpke’s palsy

Macrosomia

Macrosomia is a term that refers to a baby that has grown too large for safe delivery in the womb. This commonly occurs during post-term pregnancies but can occur earlier for other reasons also. Of course, this issue can greatly complicate vaginally delivery and may prompt a physician to use delivery instruments or call for an emergency C-section. As we’ve learned, these can be dangerous to a baby’s health.

Placental Abruption

Placental abruption is another serious complication that can result in Cerebral Palsy. This condition occurs when the placenta separates from the uterus before the fetus is delivered. Because the placenta is responsible for delivering oxygen and nutrients to the baby, the lack of these things can cause brain damage and Cerebral Palsy, or possibly even kill the unborn baby.
The placenta abruption may even cause excessive bleeding, which can be dangerous to both the mother and the baby.

Uterine Rupture

The uterus is the sac in which the baby is encased during development. When this sac ruptures prematurely, it can potentially expel the unborn baby into the mother’s abdomen. This puts the baby at very high risk of fetal asphyxia which can cause Cerebral Palsy.

Uterine rupture may occur because of a pre-existing injury, from pressure during pushing, or because of a previous C-section scar. This issue is part of a greater complication called Vaginal Birth After C-section (VBAC). Because of the risk associated with vaginal births after a previous C-section, mothers should be closely monitored for these complications. A failure on the obstetrician’s part to warn or assess a mother for these complications can be regarded as medical negligence.

Post-Term Pregnancy

When a mother is still pregnant past her due date (usually 41 or 42 weeks after conception), the potential for traumatic injury increases. This increase in injury risk increases the risks for Cerebral Palsy due to complications.

Some issues that can arise due to a post-term pregnancy include:

  • Postmaturity Syndrome
  • Macrosomia
  • Uteroplacental insufficiency
  • Fetal Distress/Nonreassuring Fetal Assessment
  • Meconium aspiration/asphyxiation
  • Shoulder dystocia
  • Oligohydramnios
  • Umbilical cord compression

Other Causes of CP from Birth Injury

  • Premature Rupture of Membranes (PROM)
  • Strong Contractions and Hyperstimulation
  • VBAC (Vaginal Birth After C-Section)
  • Preeclampsia
  • Umbilical Cord Prolapse and Compression
  • Nuchal Cord

Diagnosing Cerebral Palsy

Cerebral palsy is difficult to diagnose in a child early on. This is due to their lack of muscle development and motor skills, which are used for comparison to diagnose CP.  Typically, Cerebral Palsy is diagnosed around 18 months of age as symptoms become more noticeable.

Cerebral Palsy often begins to come to mind when parents start to notice that their children are not reaching developmental milestones. It is at this point that a parent should seek a complete diagnosis so they can appropriate care and treatment.

Observational Diagnosis of CP

When a child is suspected of having cerebral palsy, they will often be observed by their physician through routine appointments. Often this is because CP can’t be diagnosed right away in a young infant. The process requires careful monitoring over a period of months.

Observational diagnosis involves monitoring a child’s motor skills, like holding their head, rolling over, sitting upright, crawling, walking, and picking up and holding objects.

Doctors will also assess a child’s development by evaluating their posture, reflexes, and muscle tone.

Moderate to mild cases of Cerebral Palsy often go undiagnosed for years, since these children often reach normal milestones, but only suffer restrictions in minor or few areas. Severe cases can usually be diagnosed between 18 months and two years old, as the child should have developed some normal motor skills be then.

Imaging Tests to Diagnose CP

Imaging tests, like MRIs and CT scans, can be used to image the brain in order to assess and determine the cause of other conditions associated with CP like seizures.

MRI testing can be used to pinpoint neurological issues in children who are showing signs of CP. It may also be used to determine the cause of the cerebral palsy.

CT scans can help eliminate other conditions or diseases that may appear to be CP. They can also detect the potential complications and causes, like brain bleeding or skull fractures.

Cranial ultrasounds may be used for a quick look at a baby’s brain tissue before other tests are done. The most common use is to look at the brain matter as it develops over time since the procedure is quick and rather non-invasive to the infant.

Electroencephalogram (EEG) is used to measure the electrical activity of a child’s brain when a child suffers from seizures. Because cerebral palsy and epilepsy are often connected, doctors use this test to help with a CP diagnosis.

Doctors may also perform other tests on a child to evaluate other common issues associated with CP, for example:

  • Hearing tests
  • Vision tests
  • Speech tests
  • Intellectual tests
  • Blood tests

The 5 Levels of Severity in Cerebral Palsy

According to HeathLine.com, Cerebral Palsy severity can be categorized into 5 levels:

Level 1 – Fully independent, a person can walk on their own without limitations and can perform most physical activities with only minor balance or coordination issues. Level 2 – Can walk long distances without limitations, but can’t run or jump; may need assistive devices, such as leg and arm braces or wheelchair; trouble balancing on uneven surfaces.
Level 3 – Can sit with little support and stand without any support but requires assisting devices such as crutches or a wheelchair to move around.
Level IV – Ability to walk is severely affected but can walk with the use of assistive devices; able to move independently in a wheelchair
Level 5 – Significant restrictions involuntary control; needs support to maintain head and neck position; need support to sit and stand.

If You Think Your Child Has Cerebral Palsy…

If you think your child has CP, learn all that you can about the warning signs and observant. Get them an evaluation with a Cerebral Palsy specialist as soon as possible, especially if your child’s primary care physician has brought up concern for this issue before.

If your child is:

  • Not meeting normal developmental milestones
  • Walking in an abnormal way
  • Having trouble with motor skills
  • Having trouble sitting up
  • Or having trouble speaking

…you may be noticing early signs of CP. These cases, like all other personal injury cases, have a statute of limitation. In Florida, medical malpractice cases are limited to two (2) years from the date the patient knew or should have known that an injury occurred. Seek help right away.

As we mentioned, it can be hard to diagnose a child with CP early, but the sooner the better. The sooner a diagnosis is made, the faster treatment can begin, increasing your child’s odds of improving. Finding out as soon as possible will also help you and your family to get the compensation you need before it’s too late.

Florida Cerebral Palsy Birth Injury Attorneys

Receiving compensation for your child’s Cerebral Palsy caused by birth injury is not an easy process; it’s one that will require the help of an experienced birth injury attorney to help prove your medical negligence case.

For families dealing with this issue, financial compensation is often necessary for therapy, surgery, assistive technology, physicians’ visits, and more. The cost can easily reach into the millions for a lifetime of care. This is why it’s so important to hire an experienced birth injury attorney who has worked these types of cases before. Hiring the right attorney can make all the difference in getting the level of compensation your family will need.

Our lawyers will evaluate the details surrounding the pregnancy, delivery, and any complications that arose that may have led to your child’s Cerebral Palsy. We will collect medical records, imaging, OB/GYN records, and hospital documentation to determine if your child’s CP could have been caused by a negligent birth injury.

We will then build your case and present it to the court. This process will involve evaluating the hospital’s insurance coverage, liability, and potential fault.

Cerebral Palsy lawsuits are complex, but hiring a trustworthy and zealous birth injury lawyer will help you to have the best chance possible when perusing your case. The experienced Cerebral Palsy and birth injury attorneys at Dolman Law Group have the resources and experts to help you and your family with your personal injury case. If your loved one has been diagnosed with Cerebral Palsy, contact our skilled birth injury attorneys today for a free evaluation of your case.

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