Part 2 of Max’s story: How Max got cerebral palsy.

Earlier, we wrote about a boy named Max who has cerebral palsy.  Max does the things that other 11 year old boys do, except he usually needs some help.  Cerebral palsy has caused Max’s muscles to be really tight, so he needs help holding a spoon and playing video games, and he uses a special bike so he can ride around the neighborhood with other children.  When Max speaks, his words sound a little garbled because the cerebral palsy affected his facial muscles.  If Max isn’t focusing, he drools.

Max’s mother, Ellen, had an uneventful pregnancy.  At 5 a.m. on a morning close to her due date, Ellen started to have some cramps.  Her husband Dave drove her to the hospital, where the staff immediately gave her Pitocin (oxytocin) to start labor.  After that, Ellen was given an epidural that didn’t seem to work, so physicians gave her another one.   Labor didn’t start for a several hours, and when Ellen finally started pushing, nothing happened.  Max failed to progress.  At 11:00 p.m., physicians decided to perform a C-section delivery.  This wasn’t an emergency C-section; everyone was very calm.

Shortly after the C-section began, Ellen heard her baby boy cry through the mental fog caused by the anesthesia.  The next morning, Max stopped breathing and turned blue when Ellen tried to feed him.  Dave called a nurse, who hit Max on the back and blamed the breathing cessation on mucus.  Two hours later, Max stopped breathing again while Ellen was holding him.  This time, nurses took the baby boy to the neonatal intensive care unit (NICU).  Later that evening, Ellen and Dave went to see little Max in the NICU.  While they were at the elevator, a physician asked them if the delivery physician had used forceps.   The couple told him no, and asked him why he asked.  The doctor then told them that Max was having seizures.

Dave and Ellen were shocked and started crying.  When they saw their innocent baby boy in the NICU hooked to tubes and wires and attached to monitoring devices, Ellen almost became hysterical.  The 7 pound boy was unconscious and receiving very strong anti-seizure medication.  The couple later learned that a resident just happened to notice Max’s feet twitching.  When the staff attached the baby to an EEG machine, they realized his brain was continuously seizing.

One or two days later, an MRI was used to take pictures of Max’s brain.  A few hours after the MRI, the physicians sat down with Dave and Ellen and told them that their son had brain damage.  The parietal, temporal and occipital lobes were damaged, but luckily, the brain stem had been spared.  The brain stem affects functions such as heart rate and breathing.  The physicians explained that Max may have severe intellectual disabilities and he may never walk or talk.  He could also have problems with his eyesight and hearing.

When Ellen finally was able to hold Max, she noticed that he would thrust his tongue out and arch is back.  Her heart sank because she knew these were signs of cerebral palsy.

There were unknown delays and challenges ahead for baby Max.  He was at risk of having a seizure disorder.  Some victims of this type of brain damage are unable to swallow, and damaged brains can have trouble regulating the body’s temperature.

WHAT CAUSED MAX’S BRAIN DAMAGE?

When Ellen arrived at the hospital complaining of cramping, physicians should have immediately started fetal heart rate monitoring so they could determine if the baby was in distress.  Heart rate monitoring must be ongoing during labor and delivery so that physicians are alerted the instant a baby starts to get into trouble.  Cramping can be an indication of a few very serious pregnancy complications, such a placental abruption and uterine rupture.  Both conditions can cause a decrease in the flow of oxygen-rich blood to the baby, and if the baby isn’t delivered in a timely manner, the lack of oxygen can cause the baby to have permanent brain damage.

In addition, arrested labor puts a baby at risk of receiving decreased oxygen.  Furthermore, epidurals can cause labor to be prolonged or arrested.  Physicians did administer Pitocin, which can start labor and cause intense and frequent contractions, which are also very risky.  However, it does not appear as though Pitocin had this effect on Ellen.

Sometimes the fetal heart monitor is not used or is not attached properly and physicians are then unaware when a baby is in distress.  Often, the staff monitoring the mother and baby are not skilled at interpreting fetal heart tracings, and the staff will miss the fetal distress.  When a baby is in distress, it means he is being deprived of oxygen and must be delivered immediately.  Most of the time – especially when labor is arrested – a C-section is the safest way to quickly deliver the baby and get him out of oxygen-depriving conditions.

In Ellen’s case, it appears as though her cramping was not alarming to anyone, a fetal heart rate monitor was not used, and physicians had no sense of urgency in delivering baby Max.  Indeed, they even took their time when they decided to perform a C-section.

Max is lucky that physicians discovered his continuous seizure activity when they did, although it certainly would have been better if they had discovered the activity sooner since the more frequent and severe the seizure activity, the more brain damage a baby will likely get.  Brain damage causes seizure activity and seizure activity can cause more brain damage.  This is why it is critical for seizures to be recognized and treated immediately.

When a baby is at risk of having seizures, he must be closely monitored.  Some NICU’s around the country are equipped with continuous EEG monitoring equipment, and the incidence of cerebral palsy has decreased at these centers.

All babies that have had a risky delivery, such as those whose mother had placental abruption or a prolonged labor, must be closely monitored not only for seizure activity, but also for any signs of brain damage.  The reason for this is that babies who suffer brain damage caused by oxygen deprivation (HIE) should be given brain cooling (hypothermia) treatment within 6 hours of the oxygen depriving incident (which often occurs during labor and delivery).  Brain cooling helps prevent and minimize permanent brain damage and cerebral palsy.

Ellen may have experienced placental abruption or uterine rupture along with the prolonged and arrested labor, which means Max was likely deprived of oxygen for a very long time.  He should have been closely monitored after birth.  In fact, when he had his first period of breathing cessation (apnea) and turned blue, he should have received closer monitoring.  In addition, when Max had his first seizure, physicians should have verified HIE and began brain cooling treatment.  Max never received this very important treatment.

This is a very sad story that highlights the importance of close monitoring during labor and delivery – including paying attention to signs in the mother that might indicate a serious pregnancy condition – as well as the need to act with a sense of urgency when a baby is in (or could be in) distress.  Failing to quickly deliver a baby by an emergency C-section can cause permanent brain damage and lifelong problems for a baby.

HELP FOR CHILDREN WHO HAVE CEREBRAL PALSY

The attorneys at Reiter & Walsh ABC Law Centers have been helping children with cerebral palsy for over two decades.  Jesse Reiter, the firm’s co-founder, has been focusing on birth injury cases his entire 25+ year career, and most of Jesse’s cases involve helping children who have cerebral palsy.  When he takes a case, he spends a lot of time getting to know the child and family he is helping so that he can fully understand the child’s needs.  Jesse has won many awards for his advocacy of children, and he is currently recognized as being one of the best medical malpractice lawyers in America by U.S. News and World Report 2014, as well as one of the 10 Best Attorneys in Michigan by Super Lawyers magazine. Reiter & Walsh ABC Law Centers is also recognized as being one of the best law firms in the country by U.S. News and World Report 2014.

Cerebral palsy is a difficult area of law to pursue due to the complex nature of the disorder and the medical records that support it. The nationally recognized attorneys at Reiter & Walsh ABC Law Centers have decades of experience with cerebral palsy cases. To find out if you have a case, contact our firm to speak with an experienced attorney.  We handle cases in Michigan, Ohio, Texas, Washington, D.C. and throughout the nation.  We have numerous multi-million dollar verdicts and settlements that attest to our success, and no fees are ever paid to our firm until we win your case.  Email or call us at 888-419-2229.

Part 1: Why Max and other kids with special needs should not be pitied.

Part 3: How to help ensure the health of your baby after birth and prevent cerebral palsy.

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