How to End the Birth Litigation Crisis

 

Mission

 

The objective of this web site is to prevent neonatal cerebral palsy (CP) and to eliminate brain injury litigation from obstetrical practice.

 

Introduction

 

Neonatal Encephalopathy (NE) and subsequent Cerebral palsy (CP) are injuries that occur in managed childbirth; they will be prevented only when the mismanagement that produces them is understood, and avoided.  The elite mentors of the perinatal and legal professions have dogmatized hypoxia as the origin of these injuries. [1, 2] Hypoxia is seldom a causal factor in NE.

 

For 30 years, instant resuscitation and oxygenation (immediate cord clamping (ICC) and removal to resuscitation) of “hypoxic / depressed” neonates has not reduced the incidence of NE /CP, and may have increased it.  NE begins and progresses in well oxygenated neonates.  The origin of NE is NOT hypoxia.  The lesions seen on MRI scan of the oxygenated NE neonate are ischemia and infarction.  “There is no evidence that brain damage occurs before birth.” [3] The convenient term used for these NE babies is “Sick Neonates.” (We don’t know why they’re sick.)

 

The Cause

 

Sick neonates frequently need blood transfusion. [4] The MRI scan confirming NE indicates deficient brain blood flow.  “ICC causes hypotension and hypovolemia.” [5] Respiratory distress – retraction respiration, (RR) is a common dysfunction in NE – a sign of heart failure. [Primate Studies]  In NE, the brain blood vessels are not constricted; deficient brain perfusion is due to hypovolemic shock, low blood pressure and RR.  The origin of NE is massive blood loss into the placenta.

 

The clinical definition of NE [3] includes:

               

 

Cowan’s clinical definition of NE mimics the description of the ICC neonate!  However, ICC alone will seldom produce NE – a really “Sick neonate.”  Intra-partum hypovolemia [9, 10] combined with ICC are the usual causal factors in NE.  Late decelerations indicate hypoxia due to cord compression, but, as the oxygen supply is dissolved in blood, oxygen deficit is matched by blood volume deficit.  [The Cerebral Palsy Baby]

 

The Prevention

 

A child born with most of the above symptoms at the one minute Apgar score will be hypoxic and very severely hypovolemic, at high risk for NE.  However, if the cord has not been clamped, the child at one minute will be receiving a massive placental transfusion of oxygenated blood, and should be completely resuscitated within a few minutes with a five minute Apgar score near 10 – if the cord remains open.  The child will adjust itself to a normal state of hemo-dynamics and circulation.  It will not develop NE or any other birth brain injury. [Cord Clamp Injury]

 

The results of routinely clamping the cord after the placenta has delivered should soon persuade the birth attendant of the value of this practice – five-minute Apgar scores are routinely 10, even when one-minute Apgar scores are below 4.  Any resuscitation must be done with the placental circulation intact. [11] Discussions of conflicting situations are on the side-bars to this home page.  The physiology of the third stage of labor prevents cerebral palsy and litigation.