Cerebral palsy (CP) can develop for many reasons, including abnormal brain development, infections, premature birth, bleeding in the brain, and complications that affect oxygen or blood flow. In some cases, medical malpractice can cause cerebral palsy, but a diagnosis alone does not mean malpractice occurred.
For parents, the key question is not simply, “Does my child have cerebral palsy?” Rather, it is, “What caused the brain injury or abnormal brain development, and could appropriate medical care have prevented or reduced the injury?”
A malpractice claim requires medical evidence showing that a healthcare provider’s care fell below the applicable standard and that the failure caused the child’s injury.
What causes cerebral palsy?
Cerebral palsy is a group of disorders affecting movement, balance, and posture. CP is caused by abnormal development of the brain or damage to the developing brain that affects a child’s ability to control their muscles.
The Centers for Disease Control and Prevention (CDC) explains that cerebral palsy can have different causes and risk factors. CP was once thought to be mainly caused by a lack of oxygen during birth, but current evidence indicates that oxygen deprivation during birth does not account for all cases. The CDC reports that 85% to 90% of CP is congenital, meaning the brain abnormality or injury occurred during prenatal development. In many cases, the specific cause is unknown.
That distinction is important when evaluating whether medical negligence occurred. Cerebral palsy itself does not establish that an obstetrician, nurse, hospital, or another healthcare provider did anything wrong.
When can medical malpractice cause cerebral palsy?
Medical malpractice may become an issue when a healthcare provider fails to respond appropriately to a complication and that failure caused a child’s brain injury. Potential situations include:
- Failing to recognize or appropriately respond to concerning fetal heart rate patterns
- Unreasonably delaying a medically necessary emergency C-section
- Failing to diagnose or appropriately treat certain maternal or newborn infections
- Failing to respond appropriately to an umbilical cord or a placental emergency
- Improperly managing severe newborn jaundice that progresses to kernicterus
- Failing to respond appropriately to conditions that may compromise the baby’s oxygen or blood supply
However, none of these circumstances automatically establishes medical malpractice. The relevant medical records, timing of events, applicable standard of care, and connection between the alleged error and the child’s brain injury all need to be considered.
For example, an emergency C-section may become necessary when complications place the baby at risk. A delay alone is not enough to establish liability. Medical experts generally need to determine when intervention was medically indicated, whether the care provided met the applicable standard, and whether an earlier delivery more likely than not would have prevented or reduced the injury.
These issues can be especially important when evaluating a potential injury related to a delayed or improperly performed C-section. Our resource on C-section injuries provides more information about the circumstances that may give rise to a claim.
How can oxygen deprivation cause brain injury?
A developing baby’s brain depends on a continuous supply of oxygenated blood. Certain complications can interfere with that supply.
The National Institute of Child Health and Human Development (NICHD) identifies placental abruption, uterine rupture, umbilical cord problems, very low maternal blood pressure, and severe trauma as circumstances that can interfere with oxygen reaching a baby’s brain.
A significant interruption of oxygen and blood flow can cause hypoxic-ischemic brain injury. Some children who experience this type of injury later develop cerebral palsy.
However, the presence of cerebral palsy does not prove that oxygen deprivation occurred during labor. Even evidence of an oxygen-related injury does not automatically establish negligence. Investigators must still determine what caused the oxygen interruption and whether healthcare providers had a reasonable opportunity to recognize and respond to the problem.
Does fetal distress mean malpractice occurred?
Not necessarily. Signs of fetal compromise can develop even when doctors and nurses provide appropriate care. In a potential malpractice case, the focus is generally on how the medical team interpreted the information available at the time and what they did in response.
A medical malpractice review may examine:
- Fetal heart monitoring strips
- Changes in fetal heart rate and variability
- Nursing notes
- Physician orders
- Maternal vital signs
- Labor progression
- Medications administered during labor
- Timing of calls and consultations
- Timing and reason for delivery
Because these records provide different pieces of the same clinical picture, the timing and sequence of events matter. A fetal heart tracing viewed in isolation may tell only part of the story and must be considered in the context of the other records and the care provided.
What does HIE have to do with cerebral palsy?
Hypoxic-ischemic encephalopathy (HIE) is a type of brain injury caused by reduced oxygen and blood flow to the brain. HIE and cerebral palsy are not interchangeable diagnoses. A baby may experience HIE without later developing cerebral palsy, while a child may develop cerebral palsy without having experienced HIE.
When HIE is suspected in a cerebral palsy malpractice case, lawyers and medical experts may review cord blood results, brain imaging, neurological findings, newborn resuscitation, and other clinical evidence to determine when and how the brain injury likely occurred.
The American College of Obstetricians and Gynecologists (ACOG) emphasizes that neonatal encephalopathy can arise through multiple causal pathways. Establishing a connection between an event during labor and a later neurological condition therefore requires consideration of the broader clinical picture rather than relying on a single finding.
Does a low Apgar score prove birth asphyxia?
An Apgar score describes a newborn’s condition shortly after birth, but it cannot by itself establish the cause of a neurological injury.
ACOG states that low 5- and 10-minute Apgar scores are associated with an increased relative risk of cerebral palsy at the population level. However, most infants with low Apgar scores do not develop CP. Apgar scores also can be influenced by prematurity, medications, resuscitation, and other conditions.
An Apgar score therefore needs to be considered alongside the newborn’s condition, medical records, and other clinical findings rather than used as a stand-alone measure of causation.
What must be shown for cerebral palsy to support a malpractice claim?
Although the exact requirements vary by state, a medical malpractice claim generally involves proving a duty of care, a breach of the applicable standard of care, causation, and damages.
In a cerebral palsy case, establishing causation can be especially important because CP can have many possible causes. Identifying a medical error and establishing that a child has CP are not enough on their own. Medical evidence must connect the alleged departure from the applicable standard of care to the child’s injury and show how that injury relates to the child’s condition.
Evaluating that connection may require input from medical specialists with relevant experience, such as obstetricians, neonatologists, or pediatric neurologists. The experts may review the medical records and other evidence to assess whether the alleged departure from the standard of care caused the child’s injury.
How can parents find out what happened?
Parents are rarely in a position to reconstruct a complicated labor and delivery from memory alone. Many important details exist only in medical records and other clinical data.
A cerebral palsy investigation may involve reviewing prenatal records, fetal monitoring strips, delivery records, newborn records, laboratory results, imaging, placental pathology, and electronic records. Taken together, these records can help establish what happened before, during, and after delivery.
The Killino Firm’s approach involves reviewing the medical evidence to determine whether a preventable birth injury may have contributed to a child’s condition. Families with questions about a diagnosis can learn more from our cerebral palsy lawyers. Contact us today for a confidential consultation.
Clients are not responsible for legal fees or expenses unless a financial recovery is obtained.
