Cerebral palsy is a term that describes a group of disorders that affect movement control. "Cerebral" refers to the brain and "palsy" refers to muscle weakness and lack of control. There is not one specific cause of cerebral palsy, but it can be caused by injury to the brain before, during or after birth. A child may acquire cerebral palsy after birth as a result of damage to the brain in the first months or years of life.

There are three types of cerebral palsy - spastic, which results in difficult and stiff movements; ataxic, which results in the loss of depth perception and sense of balance; and athetoid, which causes uncontrolled and involuntary movements. The effects of cerebral palsy, depending upon which areas of the brain have been damaged, include mental retardation, seizures, impairment of speech, hearing or sight, abnormal perception and sensation, problems in gait and mobility, involuntary movement and muscle spasm or tightness.

There are many causes of cerebral palsy, and one of the most important causes is an insufficient amount of oxygen reaching the newborn or fetal brain. Oxygen supply can be interfered with by the placenta separating prematurely from the uterus wall, an unusual birth position of the baby, labor that is either too long or too quick or a problem with circulation in the umbilical cord.

Many times when there is lack of oxygen the doctors and nurses should be able to identify fetal distress by interpreting the fetal monitor strip correctly. If the doctor fails to do a cesarean section (C-section), or to do it quickly, the child will lose oxygen and develop cerebral palsy or brain damage. If the infant does not get enough oxygen, the brain can be injured.

There are many factors that suggest an injury occurred as a result of improper medical care, or insult to the brain during the birthing process, including the infant demonstrates poor sucking after birth; seizures develop within 24 to 48 hours; the child is floppy at birth; the skin is blue or dusky at birth; the infant needs resuscitation at, or shortly after birth because he/she is not breathing; a baby who was born full-term, but does not go home at the same time as the mother; there was no indication of trauma or infection during the pregnancy; there is no history in the family of brain damage; the infant has problems maintaining temperature after birth; the bag of waters was ruptured for more than 24 hours; and there is meconium (fecal) staining on the baby at the time of delivery.

Some examples of complaints by mothers where the medical negligence resulted in a child being born with cerebral palsy include the doctor failed to do a C-section or do a C-section sooner; the doctor failed to diagnose fetal distress (the baby was having problems during labor); they did not interpret the fetal monitor strip correctly; they did not act soon enough when the bag of water broke, there was bleeding, when the labor did not progress and took too long and blood pressure got to high; the doctor gave too much Pitocin and injured the baby; they did not refer the patient to a doctor specializing in high risk pregnancies; and there wasn't a pediatrician present at delivery when they knew there might be problems with the baby.

Another type of birth injury is Erb's palsy, Brachial Plexus Palsy or Shoulder Dystocia, which occurs when excessive lateral traction is applied to the fetal neck region during delivery. This can cause a child's muscles to be torn, resulting in a limp arm.

The brachial plexus is a group of nerves that run from the shoulder to the spine. These nerves control muscle movement in the hands, arms and shoulder. Erb's palsy is the damage to the upper plexus and Klumpke's palsy is damage to the lower plexus. Children with Erb's palsy have lack of movement in the arm and shoulder, while children with Klumpke's palsy have diminished movement in the wrist and hand.

When a doctor is negligent by not providing the proper obstetrical care, sometimes damage to the nerves can result. These types of injuries usually occur during the natural delivery of a larger infant. When the baby is too large to pass through the mother's pelvis, his or her shoulder may become lodged behind the mother's pubic bone after the head has been delivered. Many times the doctors attempt to continue with a natural delivery, as opposed to a C-section and can stretch the neck excessively causing nerve damage.

Doctors should be able to identify the potential for a large baby by the following factors: Gestational diabetes, which generally is associated with larger babies. The doctor always should prenatally timely screen and treat for this condition. Excessive weight gain during pregnancy greatly increases the chance of a large baby, especially with mothers over 30 years old. An obese mother also has a greater risk of giving birth to a large infant. If a mother previously has delivered a large infant, there is a greater chance that the next infant also will be very large. Also, the fundal height or McDonald measurement should be considered. These measurements are recorded during pre-natal visits to a doctor. It's an external measurement taken from the top of the pubis to the top of the uterus. If these measurements are too large the physician should be able to determine if there is a large baby. If a doctor recognizes these indicators of a probable large baby, he/she should confirm his/her suspicion through the use of an ultrasound. The doctor may be liable if he/she doesn't use the correct delivery technique, including the McRoberts maneuver, Wood's corkscrew maneuver and suprapubic pressure. A C-section also should be done when appropriate. To determine medical negligence in birth injury cases, all of the child's medical records must carefully be evaluated and studied. One must look for deviations from the standard of care and look over the neonatal records and the fetal heart monitor strip. The labor and delivery records must be examined for irregular readings on the fetal heart monitor, meconium staining and fetal scalp blood pH determination.

A trained staff member must be available to activate the fetal heart monitor, inspect and analyze the strip continuously and intervene when fetal distress is observed. Cardiac arrhythmia (irregular heartbeat), bradycardia (slow heartbeat) and tachycardia (rapid heartbeat) are all signs of fetal distress.

Another cause of fetal distress is meconium or fetal feces. Also, one must determine if there is resulting fetal hypoxia, which is insufficient oxygen to the tissues, and if there is an abnormal blood pH. There is a decrease of the blood pH, or acidosis, when there is a buildup of acid level in the blood due to the fetus not receiving enough oxygen. There is a long history of linking oxygen deprivation and the pH reading to babies born with brain damage. Too low pH level will establish fetal distress and in many cases an immediate C-section should follow.

The medical providers caring for the expectant mother and the fetus are responsible to assure that they provide adequate care during the pregnancy, during labor and delivery and immediately after the delivery of the infant. Failing to do so can result in the doctors and nurses being held accountable for the outcome of the pregnancy. The problems that may be encountered include: failure to interpret and respond to the changing conditions of the fetus during labor; failure to act on changes in the mother's condition during pregnancy; failure to order specific tests during pregnancy, and not interpreting these tests correctly; failure to perform a C-Section in the presence of fetal distress; and failure to deliver the infant when the membranes have been ruptured for more than 24 hours.