Cerebral palsy (CP) is a neurological disorder caused by brain damage or abnormal brain development, often occurring before, during, or shortly after birth. One area of concern in obstetrics is whether cerebral palsy is linked to malpractice during breech births, which are deliveries where the baby is positioned feet or buttocks first instead of head first.
Breech births inherently carry higher risks compared to head-first deliveries, including an increased chance of oxygen deprivation to the baby’s brain, which can lead to cerebral palsy. The risk is particularly significant if the breech presentation is not diagnosed before or during labor, leading to an unplanned vaginal delivery without appropriate precautions or interventions[1].
Medical malpractice in the context of breech births can involve several failures:
– **Failure to diagnose breech presentation:** If healthcare providers do not perform adequate examinations during pregnancy or labor to identify the baby’s position, they may miss the breech presentation. This can result in proceeding with a vaginal delivery without the necessary preparations or warnings to the mother[1].
– **Failure to inform and advise the mother:** Once breech presentation is diagnosed, medical professionals are expected to discuss delivery options, including the risks and benefits of vaginal delivery versus cesarean section. Neglecting to provide this information can be considered negligence, especially if the mother would have chosen a safer delivery method had she been properly informed[1].
– **Failure to act on signs of fetal distress:** Breech vaginal deliveries can be complicated by emergencies such as shoulder dystocia, where the baby’s shoulder becomes stuck during delivery. This can cause oxygen deprivation leading to brain injury and cerebral palsy. If the medical team fails to recognize and respond promptly to such emergencies, it may constitute malpractice[1].
Shoulder dystocia is a critical factor in birth-related brain injuries. It can occur during vaginal delivery when the baby’s shoulder is impacted against the mother’s pelvis after the head is delivered. If not resolved quickly, the baby can suffer from oxygen deprivation, which is a known cause of cerebral palsy[1]. Malpractice claims often arise when there is a delay or improper management of shoulder dystocia, including failure to perform necessary maneuvers or to opt for a cesarean section when risk factors are present[1][4].
In addition to breech presentation, other birth injuries linked to medical negligence that can cause cerebral palsy include improper use of delivery tools such as forceps or vacuum extractors. These instruments, when misused, can cause trauma to the baby’s head or nerves, potentially leading to brain damage[3][5]. For example, excessive force or incorrect application during assisted delivery can result in fractures, nerve injuries, or brain bleeds, all of which increase the risk of cerebral palsy[3][5].
It is important to note that not all cases of cerebral palsy are due to malpractice. Some brain injuries occur despite appropriate medical care. However, when negligence is involved—such as failure to diagnose breech presentation, failure to inform the mother, improper management of delivery complications, or misuse of delivery instruments—there may be grounds for legal claims[1][3][4].
Medical literature and legal case reviews emphasize that careful monitoring, timely diagnosis, and appropriate intervention during breech births are crucial to minimizing the risk of cerebral palsy. Elective cesarean section is often recommended for breech presentations to reduce the risk of birth trauma and oxygen deprivation
