Cerebral Palsy

Cerebral Palsy is a term used to describe a group of chronic conditions affecting body movement and muscle coordination. It is caused by damage to one or more specific areas of the brain and is not an abnormality of the nerves or muscles.

This damage usually occurs –

• During development of the foetus
• Shortly before or after birth
• During birth During infancy

There is no combination of factors that always results in CP and it is well recognised that the foetal brain is well equipped to sustain periods of relative deprivation of oxygen. A surprising number of babies who have a very stormy time during and soon after birth go on to do very well, and conversely, some babies who have fairly uneventful births develop cerebral palsy.

Diagnosis usually involves a period of waiting for the definite and permanent appearance of specific motor problems but most cases can be diagnosed by 18 months. Until recently there was a wide spread belief that all cases of cerebral palsy were a result of birth complications but, following extensive research, it is now realised that this is not so. Even though the cause of many cases of CP is not known it is estimated that about 10% can be directly attributable to brain damage during birth. These fall broadly into two groups:

• Spastic quadriplegia CP involves rigidity and involuntary jerky muscular contractions of all four limbs and is usually caused by a prolonged period of hypoxia. Mental capacity is often affected in this type of CP.
• Athetoid CP is characterised by involuntary writhing movements of the limbs and is usually caused by hypoxia of a shorter but more profound duration. In this type of CP the intellect is often preserved.

Listed below are some of the possibly negligent actions that can result in brain damage in some children during development and birth;

• Failure to order specific tests during pregnancy and not interpreting these tests correctly.
• Failure to identify foetal distress.
• Failure to perform (or delay in performing) a Caesarean Section when there is evident foetal distress.
• Excessive use of Vacuum Extraction.
• Failure to deliver baby when the membranes have been ruptured for more than 24 hours.
• No paediatrician present at birth when problems could have been foreseen.

Cerebral palsy due to birth injury cases are very complex and JMW Medical Negligenc Solicitors are recognised as leading specialists in this field. Recently they have recovered compensation of £1,800,000 for one of their clients. It is essential to have a solicitor experienced in this field of medical negligence law because these cases are often strongly contested and it takes the skill of a specialist solicitor to recover maximum damages that can be in the millions of pounds. Legal aid is available for these claims and most children will qualify as it is only the child's income and assets that are taken into account.

For an assessment of your potential claim, please click here to complete our online enquiry form and one of our specialists will contact you shortlyor please contact us on 0845 402 0001.

Martin developed cerebral palsy after he was asphyxiated at birth due to a delay in performing a caesarean section. He had shown signs of foetal distress for over half an hour and the lack of oxygen to the brain caused severe brain damage.

Martin, now 17, is entirely dependent on his parents for all aspects of his daily activities, including feeding and dressing. He has no mobility and has severe communication difficulties. He will require speech therapy, physiotherapy and specially adapted housing and transport, as well as round the clock care, for the rest of his life.

The Trust where Martin was born, rather unusually, admitted full liability for his injuries and the case was eventually settled, after a lot of negotiating, for £4 million. This was a structured settlement based on a life expectancy of 60 years, and will ensure that Martin’s needs will be met for the rest of his life and that there will be someone to care for him after his parents have died.

On the 6th July 1982 Mrs D was referred to hospital for her first ante natal clinic appointment. This was her first pregnancy. The pregnancy continued uneventfully and she was admitted to hospital in labour on the 27th April 1983 when she was 40 weeks pregnant. On admission, to hospital the baby’s heart rate was checked and found to be regular. Shortly afterwards, Mrs D was 3cms dilated and her waters were broken.

The babies heart rate was monitored by way of CTG trace however, the trace was subsequently lost by the hospital. The notes showed a drop in the baby’s heart rate at 0130 hours on the 28th April 1983 to 60 beats per minute (bpm). At 0140 hours further dips were recorded in the notes, with the fetal heart rate (FHR) dropping to 60-70 bpm with contractions. The FHR recovered to 120/130 bpm thereafter.

At 0200 hours the notes recorded a drop in the fetal heart rate to about 75 bpm. At 0230 hours the a further drop in the FHR to about 80 bpm took place. By 0245 hours Mrs D was fully dilated, with the head at the spines. By 0255 hours the FHR was 134 bpm and at 0305 hours 132 bpm.

At 0325 hours the FHR dropped to 60 bpm with contractions and by 0330 hours the FHR was still at 60 bpm and a doctor was informed for the first time of difficulties. At 0330 hours, Mrs D was given local anaesthetic and at 0340 hours an episiotomy was performed. Baby D was born at 0345 hours. The Obstetrician did not attend until after the delivery.

D was born in a very poor condition with an Apgar score of 1 at 1 minute (alternatively 3 at 1 minute in the paediatric records). The score improved to 2 at 5 minutes and 5 at 10 minutes. A note by the then Paediatric Registrar recorded “babe’s tracing shows early loss of beat to beat variation followed by some major dips down to 60 bpm. Obstetrician called just prior to delivery but babe delivered. Babe blue, floppy, heart rate greater than 100. Bag and mask 30 seconds/attempted intubation – failed. Registrar called…”. At 0430 hours D had a seizure and was administered Diazepam. D was subsequently diagnosed as suffering from cerebral palsy due to birth asphyxia.

Our investigation of the claim was hampered by the lack of the CTG trace. We argued that the umbilical cord was looped (not tightly) around her neck. When she passed down the birth canal the cord was compressed between a part or parts of the maternal pelvis and D.

We argued that any reasonably competent Midwife and Obstetrician should have appreciated that the situation demanded the need for close monitoring, with intervention to secure delivery as soon as the circumstances permitted in the event of any sign of fetal distress. We alleged that had appropriate steps been taken D would have been born well before she was deprived of oxygen and suffered injury.

The case was strongly defended by the hospital. It argued that the dips in the baby’s heart rate were normal and did not require any earlier intervention than in fact took place. The Defendant was persuaded to commence negotiations some 4 weeks before trial. Eventually an offer of settlement in the sum of £1,800,000.00, subject to Court approval, was reached.

D’s mother had previously been told by another solicitor that her daughter had no case. Fortunately with the help of legal aid we were able to pursue the case to a successful conclusion