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Neurology and Health

Cerebral Palsy, fetal strokes

Keep Cerebral Palsy Out Of the Courts

By Dr. W. Gifford Jones

July 8, 2001

How can we best care for babies born with cerebral palsy? Are so©called "fetal strokes" an avoidable complication of labour? Possibly the fault of obstetricians failing to do Cesarean sections? Or is it time to end the myth about this disease and stop making lawyers rich? There is a way to protect children born with this disability.

I've always believed the greatest tragedy is the loss of a child. But it's also tragic to see a child enter this competitive world with cerebral palsy. A condition that will require constant care for the rest of its life.

Dr Alastair H. MacLennan, a researcher at Adelaide University in Australia, recently discussed this problem at the International Federation of Gynecology and Obstetrics meeting in Washington D.C.

Dr. MacLennan stressed that everyone must accept one immutable fact. That not a single strategy in modern obstetrics has had any effect on decreasing the number of cerebral palsy babies. In spite of all today's scientific advances one child in 400 is still born with this disability.

Obstetricians have tried several procedures to decrease this figure. But inducing labour prior to term has had no effect. Nor has the use of sophisticated electronic monitoring devices to observe every minute of the fetus during labour.

During birth a baby's head spends several hours forcing its way through a tight pelvic cavity. It is therefore reasonable to speculate that this constant trauma, associated with a lack of oxygen (asphyxia), causes fetal strokes.

But there's a problem. In 1945 the Cesarean section rate in Australia was four percent. Today it has escalated to 25 percent but the number of fetal strokes remains the same.

Dr. MacLennan claims that recent epidemiological, laboratory and clinical research has now slammed the door on the theory of asphyxia as the cause of cerebral palsy.

So what does cause it? MacLennan says "there's now considerable evidence that cerebral palsy occurs 'silently' during pregnancy. And that the majority of fetal strokes happen late in pregnancy during the development of the brain, between 20 and 36 weeks."

  Ô 0*0*0* Initially you're bound to be sceptical of this theory. After all, strokes occur in older people, not those who haven't even entered this world.

But Dr. Karen Nelson, a pediatric neurologist at the National Institute of Health in Bethesda, Maryland, has made a startling discovery. She found that 50 to 66 percent of babies suffering from fetal strokes show congenital clotting abnormalities.

She believes that in some cases the fetal clot may be triggered by intrauterine infection or chronic obstruction of the flow of blood. Or simply due to the clotting abnormality itself.

A silent fetal stroke may result in stillbirth. If this does not happen the first sign of fetal distress may be detected during labour. This gives the false impression that an acute event is taking place when it actually represents a chronic problem that was initiated weeks earlier.

Moreover, the diagnosis of fetal stroke may not become apparent to doctors and parents for a year or two until they become aware of the baby's abnormalities.

But whenever the diagnosis is confirmed a common reaction has always been, "If a Cesarean had been done, our baby would have been born normal."

Obstetricians have faced this criticism for years. And parents who take this view never have to look far to find a lawyer who agrees with them.

Dr. MacLennan suggests that in a court of law extreme opinions are presented. And it's the wrong place to discuss unproven scientific data. Particularly when there's no concrete evidence that medical malpractice has occurred.

In the end who reaps the rewards of a court settlement? Dr. Maclennan claims that 14 percent of compensation goes to the family, 84 percent to lawyers and the legal process. The compensation varies between 2 to 5 million!

This is an unjust way to treat babies inflicted with cerebral palsy. Surely they deserve the compensation, not the lawyers.

I wish this had been my idea. But my congratulations go to Dr. MacLennan for recommending a practical approach to these cases.

He claims that authorities should make fetal stroke a no©fault claim. After all, if no©fault insurance can apply to car accidents why not for these cases? This would save heartache and millions of dollars in legal hassles that go on for years. And it would provide these children with funds to adequately care for them. But I suspect hell will freeze over before lawyers surrender such lucrative cases.


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod