Causes of Birth Injury

Many things can happen at birth, which if not promptly and properly acted upon can lead to an acute or chronic lack of oxygen that can cause the brain damage, which in turn causes the symptoms of cerebral palsy. Most commonly, the failure to properly respond and intervene in a developing fetal distress situation can cause brain damage. Usually during labor, a mom is hooked up to an electronic fetal monitor. This records the baby's heart rate superimposed over a measurement of mom's uterine contractions. Certain patterns of heart rate versus contractions are normal. Others are abnormal and need to be investigated. If abnormal patterns of fetal heart rate versus uterine contractions persist over a long enough period of time, they indicate that the baby is not getting sufficient oxygen which can lead to brain damage. There are books and countless articles on the interpretation of fetal monitoring patterns and there is much controversy in the literature over what they show and what they don't show.

Other problems can arise at birth that can cause a lack of oxygen. Uterine rupture is one. Too much oxytocin, a drug that is used to stimulate labor or a drug used to induce labor called prostaglandin gel can also cause lack of oxygen leading to brain damage.

Most of these cases, however, are vigorously defended on the issue of proximate cause. Whatever happened during the labor and delivery, the defense will always argue that the baby's brain damage and cerebral palsy was not related to any lack of oxygen that is evidenced by the record, but rather was caused by one of a number of non-physician management causes. They will usually argue that the damage occurred long before the labor and delivery started due to genetics, inherent metabolic disorders, infection, or mom's conduct during the pregnancy (drugs, smoking, delayed or sporadic prenatal visits). The defense in most cases will be able to find a pediatric neurologist who will testify that no matter what happened during the birth, the resulting brain damage was related to some prenatal or non-birth factor.

These alternative explanations can, on the surface, sound quite logical and persuasive. There are probably five to ten papers coming out every week on the causes of brain damage and cerebral palsy. Many of these are written, quite frankly, to help defendants defend these cases throughout the country. The American College of Obstetricians and Gynecologists (ACOG) issued a technical bulletin that is often used to provide "authority" for the proposition that hardly any brain damage and cerebral palsy is caused by lack of oxygen during the labor and delivery.

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