Breech Babies (Feet First) and Cerebral Palsy
Even though there were significant advancements in medical science, cerebral palsy continues to be one of the most severe birth injury conditions associated with medical malpractice occurring during pregnancy, labor, and delivery. These types of birth injuries are usually caused by oxygen deprivation (fetal asphyxia) or brain bleeds (hemorrhaging).
Doctors classify several neurological disorders under cerebral palsy when the condition impairs muscle coordination and body movement. Nearly every child suffering from cerebral palsy was born with the condition and developed its complications in the days or months after their birth because of some form of brain damage. In many cases, the doctor will fail to diagnose the condition for years until the signs of the neurological disorder become more obvious. Usually, cerebral palsy (CP) is non-progressive, meaning it does not become worse over time.
CP and Breech Birth
Usually, CP is the result of an injury that occurs during the birthing process or immediately afterward. The condition can be the result of hypoxia, when the brain received insufficient levels of oxygen, ischemia when the brain is given a decreased flow of blood or hemorrhage/trauma which might be the result of injured brain tissue affected by ischemia or hypoxia. In many incidences, cerebral palsy is the result of a breech birth when the child is born feet or buttocks first instead of head first like in a normal delivery.
These types of deliveries can be extremely hazardous to the newborn who often face insurmountable difficulties when traveling through the birth canal and can prolong the birthing process for numerous reasons. In some cases, the physician might try to move the baby manually to a more natural head-first position by using hand manipulation outside of the mother’s abdomen while pushing the baby into a correct position.
The four different breech positions include:
- Frank Breech – When the newborn’s buttocks exit the birth canal first with the legs flexed at the newborn’s hips and the feet up by the sides of the head.
- Footling Breech – When one or both feet exit the birth canal first followed by the knees and buttocks.
- Complete Breech – The newborn’s knees and hips are flexed, and a seated cross-legged position with the opposing feet positioned on the sides of the buttocks.
- Kneeling Breech – The newborn exits the birthing canal while kneeling with both or one leg extended at the hips.
Does Breech Delivery Increase CP Risk?
A Norwegian study published in BMJ Open journals concern research involving more than 520,000 births of single babies born in full-term without any birth defect. Out of the more than one half million births, nearly 17,000 involved a breech birth delivery. Of these, nearly 8,000 cases were originally planned for vaginal delivery and of those, approximately 5,500 were delivered through the vaginal canal.
The study showed that children birth and a breach position whether through a cesarean section or vaginal delivery developed cerebral palsy at nearly equal rates to infants born in a traditional head down vaginal delivery. However, when the researchers looked at how the infants were delivered, they identified a slightly higher risk among newborns birth through cesarean section.
Those at most risk involved infants born by a cesarean section that were facing in a head down position. The researchers determined that they had a 2.5 times higher risk of cerebral palsy compared to children being birthed face down through the vaginal cavity. The research did show that vaginal breech birth deliveries lead to death more often than other forms of delivery.
The report stated that “because the Seri birth pose a risk for the mother and studies suggest that children born by cesarean have an increased risk of health problems, and because the team did not see an increased risk of cerebral palsy, the researchers concluded that vaginal delivery may still be recommended, particularly since the death rates observed were low.” However, the researchers suggested that the validity of their findings is only true if “provided incompetent obstetric care and treatment criteria for selection to vaginal delivery.”
Leading Birth Risk Factors of CP
Most cases involving cerebral palsy and other neurological disorder conditions occur because of complications that occur during pregnancy, labor or delivery. Certain factors including low birth weight and the position of the baby before delivery in the womb can cause significant nerve and brain damage. The leading risk factors associated with the development of cerebral palsy during labor and delivery include:
- Breech birth delivery when the baby is delivered through the vaginal canal feet or buttocks first;
- Hypoxia and asphyxia leading to loss of oxygen to the newborn's brain;
- Low birth weight of 5 pounds, 7 ounces or less;
- Microcephaly when the child is born with a small head;
- Infant seizures the developed shortly after the child was born;
- Maternal seizures;
- Maternal hypothyroidism and hyperthyroidism;
- Proteinuria when the mother’s urine has an excess of protein;
- Premature birth when the infant is born at the 37th week of pregnancy or earlier;
- Placenta problems that restrict the transfer of oxygen and nutrients to the fetus;
- Medical mistakes involving delivery inappropriately using forceps and vacuum extractors
Premature and underweight babies are at greater risk of developing neurological disorders including cerebral palsy. Also, pregnancies involving multiple births are at greater risk of developing cerebral palsy when necessary nutrients and oxygen deliveries from the placenta to numerous fetuses are compromised.
Developing CP Before or During Birth (Congenital CP)
Children who developed cerebral palsy before birth or during the childbirth process are often diagnosed with congenital cerebral palsy, which is its most common form of the disorder. The condition can develop from various causes that include:
- A maternal infection including urinary tract infection, chickenpox, rubella or CMV (cytomegalovirus);
- Newborns with low birth weight of 5 pounds or less;
- Side effects associated with infertility treatments that can cause a higher potential of birthing a premature baby with low birth weight;
- Multiple births including carrying twins, triplets or quadruplets;
- Uterine rupture;
- Placental medical issues;
- Incompatible blood types that could result in Rh factor-related diseases;
- Medical mistake caused by negligence;
- Jaundice that can develop into a severe brain damage disorder (kernicterus) that is developed by excessive bilirubin.
Many children with brain malformations developed cerebral palsy typically during fetal development before the 21st week of gestation when the fetus is at highest risk of developing cerebral palsy, brain damage or other medical condition.
When CP Develops After Birth
There is no greater joy than bringing a new child into the world. However, there are certain risk factors that are heightened after the newborn has arrived that increase their likelihood of developing neurological conditions including cerebral palsy. According to research, approximately 50% of all cases involving CP occur a month after the child’s birth. Doctors referred to this condition as “acquired cerebral palsy.” However, the child can also develop acquired CP while in the delivery room after their birth. These conditions often cause serious complications that do not display as obvious indicators until the child is in their first few years of life. Specific risk factors associated with cerebral palsy involve:
- Neurological problems associated with asphyxia (lack of oxygen);
- Sickle-cell to seize and other life-threatening infections;
- Vascular issues that developed shortly after the child’s birth;
- Head injuries occurring at childbirth or brain damage occurring in a severe accident or after being dropped;
- Severe jaundice;
Research indicates that approximately one out of every 10 cases involving cerebral palsy for the result of a lack of oxygen.
The Telltale Indicators of Cerebral Palsy
In some cases, parents and doctors are unable to detect file syndicators that their child’s development is compromised when compared to the normal stages of development. Some children begin lagging behind the early stages of development, especially in their motor functioning. This could be an early sign of undiagnosed CP. Nearly all children are diagnosed with the condition or another neurological problem that approximately 18 months of age. Some of these indicators include:
- Not smiling with or without prompting in the first three months after birth;
- Rigid or stiff movement;
- Limp or floppy movement;
- The inability to kick;
- The inability to hold their head up and 3 to 6 months of age;
- Difficulty moving their eyes;
- Movement that favors one side of their body;
- Delayed verbal communication;
- The inability to bring the hands of the mouth at three months of age;
- No sensitivity to light or sound;
- Not reaching for objects or rolling over in the early developmental stages;
- The inability to walk within 18 months after birth;
- Unusual or awkward muscle tone;
- The unfamiliarity with things or people.
It usually takes the longest amount of time to diagnose a child who suffers the mildest cases of cerebral palsy because many of the indicators are not apparent for months or years. Some children are not diagnosed with their condition until just before they enter school. Catching the early indicators of the late development can help with an early diagnosis of cerebral palsy. If the parent suspects that their child has delayed development because of a compromise motor disorder, it is imperative to get confirmation of the neurological disorder as soon as possible.
Recommendations by the American Academy of Pediatrics advise parents to have their children screened for developmental growth at nine months, 18 months, and between 24 and 30 months after birth. If the child is displaying abnormal development indicators, the screenings should occur more often. If the doctor identifies early signs of cerebral palsy, they will likely recommend taking the child to a neurologist for further examination and treatment.
Cerebral Palsy and Medical Negligence
Sadly, many children develop CP through medical negligence, errors, and mistakes. While it usually takes a doctor to diagnose serious medical conditions including congenital and acquired cerebral palsy, the physician can also cause brain damage during the mother’s pregnancy, labor, delivery and after the child was born.
The most common medical mistakes that involve the development of cerebral palsy include:
- Not identifying the need to perform an emergency C-section;
- Not monitoring the fetus, newborn or child’s heartbeat;
- Not identifying, diagnosing or treating umbilical cord problems or placental problems that could cause serious medical issues including CP;
- Not detecting or treating maternal infections;
- Not using the vacuum extraction and forceps assistive tools properly when used in the birthing process;
- Not providing adequate oxygen to the newborn during childbirth;
- Not monitoring the child’s oxygen levels;
- Making mistakes during surgical procedures.
Preventing Cerebral Palsy
Cerebral palsy and other neurological disorders can be caused by various means. However, there are certain steps in any parent can take during the pregnancy to heighten the child’s chances of preventing the development of cerebral palsy, including:
- Make sure that the pregnant mother keeps every prenatal appointment and undergoes routine medical care. Seeing the doctor regularly can help identify problems associated with neurological disorders early on.
- Ensure that the expectant mother keeps all vaccinations up to date especially rubella and chickenpox vaccinations.
- Get a check for Rh incompatibility to ensure the expectant mother and the fetus share a compatible blood type to avoid any medical issue that could cause cerebral palsy.
- Maintain a healthy weight during pregnancy to avoid elevated levels of insulin, and blood sugar levels that could increase fetal weight and lead to macrosomia for the baby is larger than normal for vaginal delivery.
Taking preventative measures before becoming pregnant and staying healthy throughout the pregnancy, labor and delivery can minimize the potential dangers involved in birthing a baby with congenital or acquired cerebral palsy. Any problems caught early on can provide numerous options to ensure the baby’s health before and after he or she is born.
Legal Solutions When Your Child has Been Diagnosed With CP After a Breech Pregnancy
If your child was diagnosed with neurological disorders including cerebral palsy, it is essential to speak with a medical malpractice attorney specializes in birth injury cases. An attorney working a family’s behalf can ensure that you are adequately compensated for your financial damages to make sure you have enough funds to raise your child who requires extensive care throughout their lifetime. Our team of attorneys assist clients with breech birth injuries that led to cerebral palsy. Let us evaluate your claim for compensation to determine if the injuries your newborn suffered were caused by the negligent or reckless actions of a medical professional.