How do medical experts determine if cerebral palsy was caused by medical negligence?

Cerebral palsy and birth injury claims are extremely complex and require careful handling by experienced medical negligence solicitors. Boyes Turner is independently recognised as a leading law firm and a specialist in cerebral palsy and birth injury claims. For more than 30 years, our expert cerebral palsy solicitors have successfully supported families affected by maternity and neonatal negligence, securing substantial compensation for those involved. You can read more about our recent settlements.

Cerebral palsy is not always caused by mistakes in medical care, but often a diagnosis of cerebral palsy can leave parents wondering if it was caused by poor care provided during pregnancy, labour, birth or shortly after delivery. One of the first steps taken in an investigation is to appoint a set of highly regarded medical experts, as they will be the key to working out what happened and why. More information about this process is set out below.

Understanding cerebral palsy and possible causes

Cerebral palsy is a permanent condition affecting movement and co‑ordination, caused by an injury to the developing brain. It can arise before birth (for example from problems with brain development, infection or stroke), during labour and delivery (often linked to lack of oxygen or blood flow), or in the neonatal period (for example from severe jaundice, infection or a further brain injury).

One important potential cause is hypoxic‑ischaemic encephalopathy (HIE) – a type of brain injury caused by a shortage of oxygen and/or blood flow to the baby’s brain, usually around the time of birth. However, HIE is only one of several possible mechanisms, and even where a hypoxic event has occurred, it is does not necessarily mean there has been negligent care.

Because the medical issues are very complex, Courts in England and Wales rely on independent medical experts to help explain what the likely cause of a child’s cerebral palsy is and whether there were any failings in the care provided which probably caused or materially contributed to the cerebral palsy.

The expert team in cerebral palsy/ birth injury claims

In serious birth injury and cerebral palsy claims, the specialist solicitor will usually instruct a team of experts, each focusing on different areas of medicine. Typically, these include the following medical experts:

• Obstetrician:  a consultant specialising in pregnancy and childbirth, who reviews antenatal and intrapartum care
• Midwife:  considers whether midwifery care, including monitoring in labour and escalation to doctors, met appropriate standards
• Neonatologist: a consultant who cares for newborn babies, particularly those who are unwell or premature
• Paediatric neurologist: a specialist in children’s brain and nervous system conditions, who assesses the type and pattern of cerebral palsy and its likely cause
• Paediatric neuroradiologist: a radiologist with particular expertise in interpreting brain scans (e.g. MRI) in babies and children, including patterns that help to time and explain the brain injury

Other experts may be needed, for example in genetics or paediatric neuropsychology, depending on the issues that emerge.

Step one: Reconstructing what happened around the birth

The starting point usually involves putting together a detailed chronology of what happened around the time of birth. Family members may be asked what they can recall from around this time and the medical experts will consider their recollections alongside the medical records, including:  

• Antenatal records, scans and blood tests
• Notes of attendances in late pregnancy
• Labour and delivery records, including cardiotocograph (CTG) fetal heart monitoring, midwifery and obstetric notes
• Theatre records if there was an instrumental delivery or caesarean section
• Neonatal notes from the delivery room, special care baby unit or neonatal intensive care, including Apgar scores, cord blood gases, need for resuscitation, cooling therapy and any early seizures

The midwife and obstetric experts focus on whether labour and birth were managed in line with accepted UK practice at the time. They look closely at:

• Whether risk factors (for example pre‑eclampsia, infection, diabetes, reduced fetal movements, growth concerns) were properly recognised and acted upon
• How CTG and other fetal monitoring were interpreted, and whether concerning features were escalated promptly to an obstetrician
• The timing of any decision to induce labour, perform an instrumental delivery or proceed to caesarean
• The management of obstetric emergencies such as placental abruption, uterine rupture, cord prolapse or shoulder dystocia

The neonatologist examines the baby’s condition immediately after birth and in the following hours and days. They consider whether there is evidence of neonatal encephalopathy (abnormal neurological function in the newborn), how severe it was, and whether the care in the neonatal period was appropriate, including resuscitation, treatment of infection or jaundice, and the use of therapeutic cooling for HIE.

This stage helps establish if and when a significant brain insult is likely to have occurred, and whether it was related to events in labour, earlier in pregnancy, or after birth.

Step two: Interpreting the brain scans

 In almost all cerebral palsy claims, a paediatric neuroradiologist plays a central role. MRI has transformed our ability to identify the timing and pattern of neonatal brain injury. On MRI scans of babies or young children with hypoxic‑ischaemic injury, neuroradiologists commonly describe patterns of damage which can be associated with an acute, severe hypoxic event around the time of birth. By comparing the imaging with a child’s clinical picture and the neonatal course, the paediatric neuroradiologist and paediatric neurologist together help answer crucial questions, including:

• Does the pattern of brain injury fit with an acute event in labour?
• Is it more consistent with an earlier problem in pregnancy, or a later neonatal insult?
• Are there signs suggesting a non‑hypoxic cause, such as infection, stroke or a structural brain malformation?

Step three: The paediatric neurologist’s assessment

A paediatric neurologist assesses the child in person (or occasionally via detailed records and video). They will:

• Confirm the diagnosis and type of cerebral palsy (e.g. spastic quadriplegia, dyskinetic)
• Review the timing of developmental milestones
• Consider associated difficulties such as epilepsy, learning difficulties, sensory impairments or behavioural issues
• Integrate their findings with the neuroradiologist’s report and neonatal history

Their role is to give an overall opinion on the most likely cause and timing of your child’s brain injury, and whether the pattern is consistent with an intrapartum hypoxic event (such as HIE) or more likely to have a non‑negligent origin.

From medical findings to legal negligence

Once the likely cause and timing of the injury are agreed, the legal question is:

Did the care fall below the standard of a reasonably competent midwife, obstetrician or neonatologist, and did that failing probably cause or significantly contribute to the brain injury? For example, obstetric and midwifery experts might conclude that:

• CTG traces were abnormally concerning and should have led to expedited delivery; or
• A clear obstetric emergency was not recognised or acted upon quickly; or
• There was a failure to follow national or local guidelines on intrapartum fetal monitoring

The neonatology, paediatric neurology and neuroradiology evidence may then show that, had appropriate steps been taken, the baby would probably have been delivered earlier or managed differently, avoiding or significantly reducing the brain injury.

Even where mistakes are identified, not all errors amount to legal negligence, and not all negligence can be shown to have caused the child’s cerebral palsy. Establishing that “but for” the negligent act or omission the injury would probably not have occurred, or would have been materially less severe, is often the most challenging part of cerebral palsy claims.

What this means for you and your family

For families, this process can understandably be draining and technical.  It involves many different experts, detailed analysis of records and imaging, and careful application of complex legal tests. It also takes time. However, a thorough expert investigation is crucial to cerebral palsy claims as it provides an explanation of what happened and why. Where negligence is established then a claim can be put forward and compensation secured, which can fund much needed care, therapy, adapted accommodation and specialist equipment/transport. 

Boyes Turner’s specialist solicitor’s role is to:

• Listen to your concerns with compassion
• Obtain and analyse maternity and neonatal records
• Instruct the right combination of highly regarded medical experts, to investigate fully.
• Advise you realistically about the strength of any potential claim and your options, including funding arrangements

Boyes Turner’s cerebral palsy solicitors have helped secure compensation for many families and you can read about our recent birth injury settlements.

If you are worried that your child’s cerebral palsy may have been caused by mistakes in their care, our specialist team is here to guide you expertly through the process. Contact us now to talk to a solicitor free and confidentially for advice.