Giving birth to a child is an eagerly anticipated, exciting and life-changing experience. But regrettably, sometimes mistakes in maternity care can happen and tragically, these can have serious and far-reaching consequences, not only for the baby but also for their family.

Mistakes made during pregnancy, labour and shortly after birth can result in a lack of oxygen and blood flowing to a baby’s brain. This is known as hypoxic-ischaemic encephalopathy (H.I.E) or birth asphyxia. It can cause brain injury and this can result in the condition, cerebral palsy.

What is cerebral palsy?

Cerebral palsy is a lifelong neurological condition that affects muscle control and movement. The condition is not progressive, so the injury to the brain itself will not change over time.

Children with cerebral palsy will experience difficulties in controlling their muscles and movement.

The main symptoms of cerebral palsy are muscle weakness, muscle stiffness, random and uncontrolled body movements, balance and coordination problems, seizures or fits and swallowing difficulties.

These symptoms affect different parts of the body and will vary in severity from child to child. Sometimes, the symptoms are noticeable in babies but also, they can become more noticeable as a child gets older and struggles to develop in line with other children and in particular, fails to meet developmental milestones.

In mild cases, intelligence is unaffected, but a child may still have learning difficulties, sometimes meeting the criteria for other conditions including Autistic Spectrum Condition and ADHD. In severe cases, intelligence and mental development will be impaired and the child will have both communication and learning difficulties

Children with cerebral palsy have complex needs. They will need specialist care, therapy and treatment. They will also require specialist equipment and the home may need to be adapted to suit their needs, especially if mobility is impaired. Arrangements will also need to be made to ensure their education needs are being adequately met. Parents will want reassurance that their children will be given the specialist input they deserve to help them to thrive

No two children will be affected in the same way. It’s therefore important to ensure that the child’s care and therapy package and also their education is tailored to meet their specific needs.

Where children have very profound cerebral palsy with severe postural difficulties and complex needs, life expectancy may be shortened. However, recent research indicates that in milder cases, many children with cerebral palsy have a similar life expectancy to non-disabled people.

What can cause cerebral palsy and how can I tell if it has been caused by medical negligence?

Cerebral palsy can be caused by injury to a baby’s brain, either during pregnancy, labour, birth and/or shortly after birth.

Injury to the brain can occur as a result of a lack of oxygen to the brain, infection and also a combination of lack of oxygen to the brain and infection. Placental abruption, umbilical cord-prolapse or uterine rupture can all affect oxygen and blood supply to the brain, as can delays in delivering a baby.

Fetal distress may be a sign of placental abruption, umbilical cord-prolapse or uterine rupture. Where there are signs of fetal distress, a speedy delivery is essential to ensure the safety, health and well-being of the baby. When these warning signs are not heeded and acted upon promptly by healthcare professionals, there can be a delay in delivering a baby and during this delay, the baby may be deprived of oxygen causing brain damage.

Typical signs of fetal distress that should cause concern are worrying changes in the baby’s heart rate which should be detected through competent fetal heart rate monitoring. There may also be reduced fetal movement and there may be traces of meconium (the baby’s first stool) of a greenish/brown tinge in the amniotic fluid. Additionally, birthing mothers may complain of pain, fever or chills and or nausea. Typically further investigations should be carried out and maternity care escalated from a midwife to an obstetric registrar (a junior doctor), with delivery of the baby expedited where these worrying signs feature.

Shoulder dystocia is when, during a vaginal birth, a baby’s shoulder gets stuck behind the mother’s pelvic bone. Extra help is therefore required to deliver the baby and any delay in spotting this complication and in extracting the baby safely can impact on oxygen and blood reaching the baby’s brain.

Where there is a maternal infection that has not been detected or has not been adequately treated or monitored, it could spread from the mother to the baby in the womb, making the baby more vulnerable to brain injury. The infection, Group B Strepotoccus (Group B Strep)  if active in the mother can cause the baby to suffer meningitis, which can cause brain injury and cerebral palsy.

In cases where a mother has an infection, signs such as a higher than usual temperature should be apparent and should trigger concern and result in the mother receiving anti-biotic treatment.

Where a treating team is aware a mother has tested positive for Group B Strep, a failure to administer anti-biotics to reduce the risk of infection to the baby may result in the baby contracting meningitis and sustaining a brain injury or even very sadly passing away.

Babies with meningitis may exhibit the following symptoms:

• A high temperature
• Cold hands and feet
• Vomiting
• Breathing quickly
• Pale, mottled or blotchy skin
• Spots or a rash
• Fits/seizures
• Being very sleepy and difficult to wake
• No interest in feeding.

The longer a baby’s brain is exposed to a lack of oxygen and blood supply, it usually follows the greater the extent of the brain injury. Every minute counts. When warning signs are missed, detected too late or actioned too late, the impact on the baby’s brain can be severe.

Often, the parents who approach us have a sense something went wrong during their baby’s birth. They might recall a sudden emergency unfolding, heralded by the sounding of the alarm and a rush to deliver the baby. Also, they will say that they knew something was not quite right when the baby was delivered. Babies who have sustained a brain injury will often be born in poor condition. They may be floppy and lifeless, requiring resuscitation and the minutes taken to resuscitate the baby can be fraught with anxiety and distress. Memories of the birth can be clouded by trauma. Babies may then need to be cared for in a hospital Special Care Babies Unit and may have difficulties feeding and in time, with development and meeting developmental milestones. They may experience fits.

Hospitals are under a duty to investigate serious incidents which have caused significant trauma, at the very least to enable learning and if mistakes were made, to ensure they are not repeated. In some cases where substandard treatment has occurred (but not all), serious incident investigations will take place and a report will be prepared by the Trust concerned and shared with the baby’s parents. This is a clear indication there are concerns about the standard of maternity care provided.

Investigating whether cerebral palsy has been caused by medical negligence

To investigate whether cerebral palsy has been caused as a result of a mistake made by a healthcare professional, one of the first steps a specialist solicitor will take will be to access the relevant maternity, labour and neonatology records. They may also take a detailed statement from you to ensure they have a clear understanding of the events surrounding the labour and birth of your child and also your specific concerns.

Then, if having reviewed the medical records they feel able to take your child’s claim further, they will notify the Trust concerned and will gather evidence from relevant medical experts, usually in the fields of midwifery, obstetrics, neonatology, neurology and neuroradiology as to the standard of care provided and if there was standard care, on whether this caused your child to suffer a brain injury.

These sorts of claims can be funded by a Conditional “no win, no fee” Agreement, so if the claim is ultimately unsuccessful, there is nothing for you to pay. In the event the claim is successful, then both the award of compensation and the reasonable costs of the winning party will be paid by the defendant.

Compensation for medical negligence

If it can be successfully proven that your child has cerebral palsy due to medical negligence, a claim for compensation can be made against the Defendant.

The aim of the compensation is to put the child in the position they would have been in had the negligence never happened.

Compensation is sought to meet the complex lifelong needs of the child, including their care and therapy needs, any medical treatment they require, specialist housing and equipment, assistive technology etc. If their earnings potential has been affected, there will also be a claim for loss of earnings.

For many parents, compensation brings peace of mind that their child’s complex lifelong needs will always be met and that they will receive the specialist input they require to flourish and thrive.

What action should you take if you suspect your child may have cerebral palsy caused by medical negligence?

Often, parents who approach us have a sense something went wrong. They want to make sure the same thing doesn’t happen to other families whilst also ensuring that they have the resources to properly meet their child’s complex and evolving needs and to help them to thrive and enjoy life.

If you feel that your baby may have cerebral palsy or brain injury  as a result of medical negligence, then you may wish to speak with specialist and experienced child brain injury solicitor to explore your options further.

Claudia Hillemand is head of the Child Brain Injury team at Bolt Burdon Kemp Solicitors.

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