Cerebral Palsy Caused by Breech Presentation

Breech Presentation Injuries and Birth Trauma

Cerebral palsy is one of the most serious conditions caused by birth injuries and medical malpractice during labor and delivery. Birth injuries that cause brain bleeds and  deprivation of oxygen-rich blood can cause cerebral palsy.

Cerebral palsy is a medical term used to describe a number of neurological disorders that impair body movement and muscle coordination.  Most children who have cerebral palsy are born with it or develop it soon after birth as a result of damage to the brain, although a diagnosis of the condition may not be made for a few years.  Cerebral palsy is usually a non-progressive health condition. This means that as debilitating and serious as the condition may be at its outset, it will not usually worsen over time.  Cerebral palsy does, however, have a lifelong – and costly – impact on affected babies and their families.

Injuries that can cause cerebral palsy usually occur around the time of birth.  Cerebral palsy is often due to a lack of oxygen to the brain (hypoxia), decreased blood flow to the brain (ischemia), or trauma and hemorrhage, which can injure the brain tissue and cause hypoxia and ischemia.

Although there are many birth complications that can cause cerebral palsy, this section will focus on cerebral palsy caused by breech birth.

Breech Birth

How is cerebral palsy caused by breech presentation?A baby typically is born head first, which allows for easy passage through the birth canal. Sometimes, however, the baby is in a breech position, which means either the feet or buttocks are positioned to exit the pelvis first. This position presents hazards to the baby during the process of birth due to difficulty in navigating through the birth canal.

There are four different types of breech positions:

  1. Frank breech: In this position, the baby’s buttocks come first, and her legs are flexed at the hip and extended at the knees, with the feet near the ears.
  2. Complete breech: Here, the baby’s hips and knees are flexed so that the baby is sitting cross-legged, with feet beside the buttocks.
  3. Footling breech: In footling position, one or both feet come first, with the buttocks at a higher position.
  4. Kneeling breech: When kneeling, the baby has one or both legs extended at the hips and flexed at the knees.

When a baby is in breech presentation, labor can be prolonged for multiple reasons.  First of all, physicians typically try to manually move the baby into the correct, head-first position, and they do this by pushing the baby into place from outside the mother’s abdomen.

If the baby cannot be turned into the proper position,  the physician must determine whether conditions exist that will allow a vaginal birth.  These conditions include the following:

  • The baby is full-term and is in the frank position
  • The baby’s heart rate is being closely monitored and the baby is not in distress
  • X-rays and ultrasound show that the size of the mother’s pelvis will allow a safe vaginal birth (cephalopelvic disproportion (CPD) is not present)
  • The hospital is equipped for and the physician is skilled in and prepared to perform an emergency C-section

If these conditions are not present, vaginal birth should not be attempted.  In fact, most physicians and the current medical literature recommend C-section delivery when a breech position is present because it is the safest method of delivery as it helps avoid birth injuries.

How Are Birth Injuries and Cerebral Palsy Caused by Breech Presentation?

Birth injuries that cause trauma, hemorrhages / brain bleeds and oxygen deprivation can cause cerebral palsy.  These injuries include the following:

  • Umbilical cord prolapse or compression: This is an emergency situation that occurs when the baby’s cord becomes compressed as the baby’s body travels through the birth canal.  This can partially or completely cut off the supply of oxygen-rich blood to the baby, which can cause severe hypoxia and cerebral palsy.  A baby with a compressed cord must be delivered immediately in order to minimize hypoxia, asphyxia and resultant cerebral palsy.
  • Nuchal cord: This is when the cord is wrapped around the baby’s neck.  This also is an emergency because the knots that occur with this condition can partially or completely occlude the flow of blood from the umbilical cord to the baby.  In addition, the cord can put so much pressure on the baby’s neck that blood flow to the baby’s brain is significantly decreased.  This lack of oxygen to the brain puts the baby at significant risk for cerebral palsy.
  • Fetal distress: Sometimes the forces and pressure of a difficult labor cause heart rate changes that lead to oxygen deprivation, ischemia and resultant cerebral palsy.
  • Traumatic injury: Injury to the brain or skull may occur during the passage of the baby’s head through the birth canal, or the spine or spinal cord may become injured due to improper positioning of the baby by the physician.  Furthermore, attempts to position the baby can damage internal organs, or the brain may bleed, which causes oxygen deprivation.  The head may also get caught in the birth canal, and this can cause intracranial bleeding.  All of these conditions can cause cerebral palsy.
  • Forceps injury: Sometimes forceps are used to assist in delivery of the baby’s head.  There are many injuries associated with this delivery instrument, which resembles a pair of salad tongs.  Improper placement of the forceps can cause compression of the head, spinal cord injury, tearing of the vasculature in the brain, and brain bleeds and hemorrhages.  The brain can swell, which can lead to seizures and ischemia.  All of these conditions can deprive the brain of oxygen and cause cerebral palsy.

Cerebral palsy is a very serious brain injury, and most of the complications associated with a breech birth can deprive the baby’s brain of oxygen-rich blood , thereby causing the condition.  Children with cerebral palsy usually require lifelong care and therapy, as the condition can severely limit a child’s movement, posture and sight-based perception.  Children with cerebral palsy can have difficulty communicating and may have developmental delays and learning disabilities.

Medical Malpractice and Breech Birth

It is imperative for physicians to properly evaluate a mother and baby in order to be aware of a breech position.  Continuous monitoring is essential so that physicians know when a baby is in distress.  Standards of care for delivery must be followed, and the hospital and physician must be prepared for a delivery by emergency C-section in order to avoid oxygen deprivation and resultant cerebral palsy.

Legal Help for Birth Injuries Caused by Mismanaged Breech Delivery

Jesse Reiter & Rebecca Walsh, Medical Malpractice Attorneys for BabiesIf your baby was in the breech position and was later diagnosed with a permanent and serious injury such as cerebral palsy, negligence may have occurred. Your physician may have failed to recognize the breech position, may have failed to try rotating maneuvers, may have mistakenly proceeded with a vaginal breech delivery, or may have failed to timely order or perform a necessary C-section.  If negligence results in injury to the baby, it is medical malpractive.

Listed below are a few areas that can constitute negligence:

  • Failure to closely monitor the mother and baby when risk factors for breech presentation are present, or when breech presentation is known
  • Failure to obtain adequate informed consent, which includes advising the mother of the risks and alternatives of delivery methods, such as vaginal birth versus C-section and expectant management
  • Failure to obtain adequate informed consent, which includes advising the mother of the risks and alternatives of the use of delivery instruments, such as forceps
  • Failure to properly and timely deliver the baby and follow standards of care when performing rotating maneuvers, a C-section or vaginal delivery, and when utilizing delivery instruments

The nationally recognized attorneys at Reiter & Walsh ABC Law Centers have been helping clients with breech birth injuries and cerebral palsy for many years.  We will evaluate your case for free to determine if your newborn suffered injuries due to the negligence of the physician.  Call us at 888-419-2229.

Video: Breech Birth