Delivered a baby with cerebral palsy?

[DrBuzzLightYear]

Has any one here ever delivered a baby with cerebral palsy? How did you deal with it? I'm not talking about lawsuits, I'm wondering about how did you deal with it personally.

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[IdiotBoxen]

I'm learning to deal with the loss of babies or babies that aren't quite right. I just tend to get really teary, blame myself and go home.

I know I won't be popular for saying this, but one thing that makes me feel alot better is having sex. It's probably not healthy, but I don't care that much really.

My attending keeps saying the same things to me. It's not your fault. You did all you could. It happens. Etc... It's ****ing impossible to think those things when you're wrapping a baby up in a blanket, then giving it to the parents waiting for their baby to die in their arms.

I hope I deal with it better later in my career.

 

[DrBuzzLightYear]

Hmm... that response was both odd and touching at the same time... So how far are you along in your career? And for that matter, how often do OB's deliver babies that are close to death, deformed, or brain damaged? Thanks

 

[IdiotBoxen]

Depends. The hospital where I work at, we do specialise in managing the higher risk pregnancies, and we do very well at it. However, there are some babies you just can't save. So, I guess we see it alot more than most, but thankfully, most of the babies here are healthy.

Honestly, I can remember every baby that has died. I can't remember virtually any of the healthy ones. So I guess I think alot more about them, even though they are infrequent.

I remember another message I wrote on this board. I got really angry at myself when I looked back through the message I had referred to the deceased as "it".

Doing obs/gyn rotation now (extended selective), 2nd year out.

 

[tom_jones]

Has any one here ever delivered a baby with cerebral palsy? How did you deal with it? I'm not talking about lawsuits, I'm wondering about how did you deal with it personally.

Hide the baby from jon edwards

 

[MichiMO]

Hide the baby from jon edwards

So sick of hearing comments like this!

1. There are many more important things to consider when choosing a president/vp: foreign policy, economic policy, what type of judges they will appoint...just to name a few.
2. Whether of not it is personally good for doctors, there is a need for trial lawyers....what if your child was harmed due to an incompetent OB and required a lifetime of care which your insurance would not completely cover...are you not entitled to compensation or should your compensation be capped at an amount that may not be adequate to cover your needs?

This is not to say there is not a malpractice problem. However, it is a very complex issue and cannot be solved with simplistic "burn the lawyer" type thinking.

Sorry for the rant. Just sick of reading comments like this on these boards.

 

[starayamoskva]

I'm learning to deal with the loss of babies or babies that aren't quite right. I just tend to get really teary, blame myself and go home.
My attending keeps saying the same things to me. It's not your fault. You did all you could. It happens.

Why would you think it is your fault?
Why would anyone think that it would be the fault of the person giving care?
Particularly if it is an infant with CP (which research has proven occurs earlier in pregnancy and rarely in the peripartum period).

 

[DrBuzzLightYear]

Really?? I've never heard any debate about CP not being caused by anoxic injury during delivery... If CP's been proven to not be caused by damage during delivery, then why are OB's loosing malpractice suits??

 

[IdiotBoxen]

Why would you think it is your fault?
Why would anyone think that it would be the fault of the person giving care?
Particularly if it is an infant with CP (which research has proven occurs earlier in pregnancy and rarely in the peripartum period).

Because I always blame myself when something goes wrong. I know I shouldn't, and i'm getting better at it, but it still happens to me. What's worse is when the family invites me to go to a funeral for the infant. The coffin is the size of a big hat box.

But, there's nothing i'd rather do than this.

 

[neilc]

Really?? I've never heard any debate about CP not being caused by anoxic injury during delivery... If CP's been proven to not be caused by damage during delivery, then why are OB's loosing malpractice suits??

do a medline search on "cerebral palsy etiology" and see what you come up with. the consensus is that a small percentage of CP is due to anoxic injury at time of delivery...

now, the question of why OB's are losing malpractice cases? well, put a baby with CP on the stand, in front of a jury, and what are they likely to do? if the lawyer can generate sympathy and distract from the reality of the causes of CP, or convince the jury that this case is one of the 10% of CP that are anoxic injury, there you have it....

there are legit cases out there. what really gets me is that many, many innocent doctors were hung out to dry without good evidence.

rant off...here is the text of an editorial that sums up the current literature.

BMJ 1999;319:1016-1017 ( 16 October )

Editorials
Only a minor part of cerebral palsy cases begin in labour
But still room for controversial childbirth issues in court

Education and debate p 1054


Cerebral palsy develops in 2-3 out of 1000 live births during the first years of life. Its association with complications during childbirth has led to much controversyand much litigation. This issue of the BMJ contains an international consensus statement on what is known about the causal relation between acute intrapartum events and cerebral palsy (p 1054).1 The statement has been produced by an international task force representing a wide range of sciences, clinical specialties, and professional associations. The document is based on a thorough multidisciplinary literature review with the intention of benefiting research into the causation and prevention of cerebral palsy and helping those who counsel in this field or who offer expert opinion in court.

The common assumption is that perinatal asphyxia is the usual cause of cerebral palsy in term babies.2 A few years ago a consensus statement from the Australian and New Zealand perinatal societies concluded, "There is no evidence that current obstetric practices can reduce the risk of cerebral palsy. The origins of many cases of cerebral palsy are likely to be antenatal."3 Important Australian studies have shown that intrapartum hypoxia alone accounts for only a small proportion of cases of newborn encephalopathy and later cerebral palsy. 4 5 A realistic estimate may be that around 10% of cases of cerebral palsy stem from adverse intrapartum events.2 The consensus statement published in this issue underlines this new insight into the origin of cerebral palsy. It points to events before labour or the newborn period as the main cause of cerebral palsy. This message is important because of the common opinion among the public, and also among some physicians, that cerebral palsy stems from intrapartum events.

The report presents three essential criteria that have to be met for a case of cerebral palsy to be causally linked to an acute intrapartum hypoxic event. The cerebral palsy should be of the spastic quadriplegic or dyskinetic type. There should be early onset of severe or moderate neonatal encephalopathy in a baby born at 34 weeks or later. And there should be evidence of metabolic acidosis in intrapartum fetal, umbilical arterial cord, or very early neonatal blood samples (pH <7.00 and base deficit 12 nmol/l). These are strict criteria. In particular, providing evidence of metabolic acidosis will create difficulties as pH and base deficit measurements will not be available at smaller hospitals and certainly not at home deliveries.

In addition to these essential criteria, the report presents five other criteria that together suggest an intrapartum timing but which by themselves are non-specific. Some of these criteriafor example "early imaging evidence of acute cerebral abnormality," can be ascertained only when the delivery takes place at a technically advanced hospital. This means that meeting the criteria to define an acute intrapartum hypoxic event and thereby assume a causal relation with cerebral palsy will depend on the place of delivery. Unexpected adverse events in smaller hospitals or outside hospital will have to be judged based mainly on clinical observations as before. Nevertheless, the criteria and the accompanying comments in the consensus document represent important support for expert opinions in court, although some of the controversial issues will still persist.6

Research on the causation of cerebral palsy needs to focus more on antenatal events. Evaluation of the condition of the fetus in utero is likely to be greatly facilitated by new technology.2 There is also a need for detailed follow up of newborn babies and their later development. Medical registries of births and their immediate outcomes have long existed in some countries. Thus, fetal age, birth weight, and health status at childbirth have been well documented over the past three decades in Denmark, Norway, and Sweden. In none of these countries, however, are there any systematic nationwide follow up data on the children. This is necessary to enable appropriate surveillance of long term outcomes such as cerebral palsy. Such surveillance, however, has been established in Western Australia, based on a systematic follow up of births recorded in the state's medical birth registry. 7 8 The follow up data provide the opportunity for public health surveillance in an important health sector. But they have also been of great importance in perinatal research, particularly into cerebral palsy.7-10

Over the past decades smaller and smaller babies have survived a preterm delivery. The association between preterm birth below 34 weeks of gestation and cerebral palsy, however, is not dealt with in any detail in the consensus document.

Future generations might criticise the medical and public health authorities in the latter part of the 20th century for not having established proper surveillance of perinatal care and its consequences, along with the consequences of the tremendous development of medical technology surrounding pregnancy, childbirth, and the neonatal period. In the near future, however, regardless of proper surveillance and new insights, in most cases of cerebral palsy there will be nothing or nobody to blame. Focus should therefore be on the provision of optimal care for infants with cerebral palsy and their families.

Leiv S Bakketeig, professor of clinical epidemiology.

Institute of Public Health, Odense University, DK-5000 Odense C, Denmark ([email protected])

 

[MechE]

2. Whether of not it is personally good for doctors, there is a need for trial lawyers....what if your child was harmed due to an incompetent OB and required a lifetime of care which your insurance would not completely cover...are you not entitled to compensation or should your compensation be capped at an amount that may not be adequate to cover your needs?

Things like this would be economic damages which are not capped. What they're trying to cap is non-economic damages, like pain and suffering. That's what is usually behind those multi-million dollar settlements.

 

[DrBuzzLightYear]

I'm not sure is MechE is right... the one case I read about (theres a link to the article somewhere on the OB/GYN forum) the jury just calculated the cost for life-time 24/7 in home care. That alone was the vast majority of the $26 million dollar settlement.

 

[MechE]

I'm not sure is MechE is right... the one case I read about (theres a link to the article somewhere on the OB/GYN forum) the jury just calculated the cost for life-time 24/7 in home care. That alone was the vast majority of the $26 million dollar settlement.

Usually, not always.

 

[starayamoskva]

what if your child was harmed due to an incompetent OB and required a lifetime of care which your insurance would not completely cover.

I am quite curious as to what harm you would attribute to the "incompetent" OB. We have already established in this thread that it is rare for CP to be associated with hypoxia in the peripartum period.

A big problem seems to be that everyone expects a perfect pregnancy, a perfect delivery and a perfect baby with an IQ greater than 160 yet they don't want to follow simple recommendations by their physician.
There are no guarantees and maybe we should do a better job of relaying that fact to patients. As long as the expectation remains that every pregnancy should have an ideal outcome we will never get past the problems with trial lawyers.
Is it the OB's fault that a woman goes into preterm labor and delivers an infant at 24 weeks that has all the problems associated with early delivery?
Is it the OB's fault that the diabetic mother who doesn't control her sugars has a baby with a heart defect?
Is it the OB's fault that a woman has pre-eclampsia and has to be delivered early or has poor placentation and has a fetus with IUGR, hypoxia or preterm delivery?

Are we incompetent because of an unexpected shoulder dystocia? Are we incompetent because we don't rush to c-section with the first little dip in the fetal heart rate?

Finally, since when did society at large become responsible for the care of these children? Yes, it is expensive and physically and emotionally draining to care for a disabled child (I know from personal experience) but that child is the responsibility of its parents (who chose to procreate in the first place) The disabled child is not a ticket to being a millionaire via the "lawsuit lottery"

 

[DrBuzzLightYear]

medicine has gotten good enough that a negative outcome is now inconceivable to most patients/juries. so when nature takes its course and a patient doesn't end up the way they hoped, the doctors get lynched for malpractice.