Cerebral palsy is a condition that affects movement and muscle control. It can arise for many different reasons, and a diagnosis does not automatically mean that something went wrong during medical care. However, where there were concerns during pregnancy, labour, delivery or neonatal care, the medical records may warrant careful review by legal and medical experts. Michael Boylan Litigation has extensive experience in investigating and advising on cerebral palsy and birth injury matters across Ireland, and can help families understand whether the circumstances of their child's birth raise issues that should be explored further.
Cerebral Palsy May Be Linked to Birth Injury or Medical Negligence
Cerebral palsy is a disorder of motor function caused by damage to the developing brain. It usually presents as abnormal muscle tone, contraction and strength. In some cases, the injury to motor function is combined with cognitive disability, particularly where the insult to the brain was prolonged or severe.
It is important to understand that many cases of cerebral palsy occur without any failure in medical care. The developing brain can be injured by different causes at different stages, and only a proportion of children with cerebral palsy will have the condition as a result of how their mother's pregnancy, delivery or the baby's neonatal care was managed.
That said, cerebral palsy and other forms of neurological injury often result from hypoxia, which is effectively the starvation of oxygen or oxygenated blood to the brain. Over the past two decades, there has been a growing body of scientific research suggesting that hypoxia is not an all-or-nothing event. There can be a spectrum of disability. More modest hypoxic insults may cause subtler forms of neurological difficulty, such as learning or behavioural problems, without obvious signs of motor impairment.
The legal investigation in these cases typically centres on whether earlier recognition, escalation or delivery would likely have avoided or reduced the injury. Where the evidence suggests that competent medical treatment could have prevented brain damage, or significantly limited its severity, there may be grounds for a claim. This is a factual and medical question, not an assumption, and it requires thorough expert analysis.
Medical Issues Commonly Reviewed in Cerebral Palsy Birth Injury Cases
Various complications can arise during pregnancy, labour or the neonatal period. When these are not managed competently, the consequences for the baby can be severe. The following are among the most commonly reviewed issues in birth injury litigation.
Failure to identify or respond to foetal distress
A CTG trace (cardiotocograph) records the baby's heart rate alongside the mother's contractions. It is one of the principal tools used to monitor the baby's wellbeing during labour. In some cases, an abnormal foetal heart rate pattern may indicate that the baby is in distress and that urgent action is needed. Where there is a failure to correctly interpret the CTG, or a delay in escalating concerns to senior obstetric staff, the opportunity to intervene in time may be lost.
Delay in performing a caesarean section
Where the clinical picture calls for urgent delivery, the timing of a caesarean section can be central to the outcome. A delay of even a short period may, depending on the circumstances, result in a significant worsening of oxygen deprivation to the baby. Why the delay occurred and whether it was clinically justified are often among the most important questions in a birth injury investigation.
Misuse or poor management of Syntocinon or induced labour
Syntocinon (a synthetic form of oxytocin) is commonly used to induce or accelerate labour. If not carefully managed, it can cause excessive or prolonged contractions, which reduce the oxygen supply reaching the baby. Proper monitoring of the baby's response to Syntocinon and timely intervention when concerns arise are essential parts of safe obstetric care.
Instrumental delivery concerns
Forceps and vacuum (ventouse) deliveries carry their own risks. Issues may arise where there is trauma to the baby, a delay in moving to caesarean section after a failed instrumental attempt, or where the decision to proceed with instrumental delivery was not appropriate in the circumstances.
Placental abruption, uterine rupture and pre-eclampsia
These are high-risk obstetric emergencies that require rapid recognition and response. Placental abruption involves the placenta separating from the uterine wall. Uterine rupture is a tear in the wall of the uterus. Pre-eclampsia is a condition involving high blood pressure that can become dangerous for both mother and baby. In each case, the central question is whether the medical team identified the complication promptly and acted appropriately.
Neonatal failures after birth
The care a baby receives immediately after delivery can be just as important as the care during labour. Issues that may arise include failures in resuscitation, ventilation, the management of seizures, infection, hypoglycaemia (low blood sugar), jaundice and the timely initiation of therapeutic cooling (a treatment used to limit brain damage in certain cases). A failure to refer a baby to a neonatal intensive care unit when clinically indicated may also be relevant.
Understanding the Timing of the Injury
One of the most complex aspects of a cerebral palsy investigation is establishing when the brain injury occurred. The timing has significant implications for both medical causation and legal liability.
Injury before birth
Brain injury may occur during the antenatal period as a result of complications such as maternal health conditions, placental insufficiency or reduced foetal movements that were not properly investigated. In some cases, earlier intervention during pregnancy could have prevented or limited the injury.
Injury during labour and delivery
This is the period most commonly examined in birth injury claims. A hypoxic ischaemic injury (brain damage caused by a lack of oxygen and blood flow) may occur during prolonged or poorly managed labour. Evidence from CTG recordings, cord blood gas results and Apgar scores (a scoring system used to assess a baby's condition at birth) can help indicate whether the baby was deprived of oxygen around the time of delivery.
Injury in the neonatal period
In the hours and days after birth, certain warning signs may indicate that the baby has sustained a brain injury or is at risk of further harm. These include respiratory distress, feeding difficulties, seizures, abnormal muscle tone and abnormal blood results. The neonatal records are often central to understanding what happened after delivery and whether appropriate care was provided.
What Evidence Is Reviewed in a Cerebral Palsy Birth Injury Investigation?
Birth injury cases are document-intensive. The strength of any claim depends on the quality and completeness of the medical records and the expert analysis of those records.
Maternity and labour records
These include:
- Antenatal notes: The record of care during pregnancy, including any identified risks.
- Labour ward notes: Documentation of events during labour, including clinical observations and decisions.
- Partogram: A graphical record of the progress of labour.
- CTG traces: The continuous monitoring record of the baby's heart rate and the mother's contractions.
- Medication records: Details of drugs administered, including Syntocinon.
- Escalation notes: Records of when and whether concerns were raised with senior staff.
Neonatal and paediatric records
These include:
- Resuscitation records: What was done immediately after birth if the baby required assistance.
- Apgar scores: The baby's condition at one and five minutes after delivery.
- Cord blood gas results: A measure of the baby's oxygen and acid levels at birth.
- Blood glucose and bilirubin levels: Relevant to hypoglycaemia and jaundice.
- Infection markers: Blood tests indicating possible infection.
- NICU notes: Records from the neonatal intensive care unit, where applicable.
MRI scans and expert medical evidence
Brain imaging, particularly MRI, can help identify the pattern and likely timing of a brain injury. This is often a critical piece of the puzzle in determining when and how the damage occurred. Independent expert evidence in cerebral palsy cases may be required from specialists in obstetrics, midwifery, neonatology, paediatric neurology, neuroradiology and long-term care planning, among others.
What Must Be Proven in an Irish Cerebral Palsy Birth Injury Case?
To succeed in a clinical negligence claim, three elements must be established.
Breach of duty
The first question is whether the medical care fell below the standard that would reasonably be expected. This is assessed by reference to what a competent practitioner in the relevant field would have done in the same circumstances.
Causation
Even where a failure in care is identified, it must be shown that the failure caused or materially contributed to the child's injury. This is often the most complex and contested part of a birth injury case. The medical and legal analysis must demonstrate that, on the balance of probabilities, the outcome would have been different had competent care been provided.
Assessment of future needs
Where both breach of duty and causation are established, the claim must also address the child's lifelong needs. This typically involves assessment of:
- Medical care and therapies: Ongoing treatment, physiotherapy, occupational therapy, speech and language therapy.
- Equipment: Wheelchairs, communication aids, orthotics and other assistive devices.
- Educational support: Special needs assistance, school placement and learning resources.
- Housing adaptation: Modifications to the family home or provision of suitable accommodation.
- Transport: Adapted vehicles and travel support.
- Assisted care: Day-to-day personal care, overnight care and respite.
- Long-term financial planning: Ensuring that the child's needs are met throughout their lifetime.
The Legal Process for Cerebral Palsy Birth Injury Claims in Ireland
The process begins with a detailed review of the medical records, followed by independent expert assessment of the care provided. If the evidence supports a claim, a formal letter of claim is sent to the relevant hospital or healthcare provider. In most clinical negligence cases, a claim must be lodged with the Injuries Resolution Board (formerly the Personal Injuries Assessment Board) before court proceedings can be issued. Given the complexity of birth injury cases, they are typically heard in the High Court. The process involves exchange of expert reports, possible mediation, and, where necessary, a full hearing. Each case follows its own course depending on the issues in dispute.
Time Limits in Cerebral Palsy and Birth Injury Cases
In Ireland, there are statutory time limits for bringing a clinical negligence claim. Different rules apply where the injured person is a minor (under 18 years of age). In general terms, the limitation period may not begin to run until the child reaches adulthood, but the specific rules depend on the circumstances of each case. A parent or guardian may choose to seek legal advice earlier on the child's behalf, and there are good reasons for doing so. Earlier review can help preserve important evidence, including medical records, CTG traces and witness recollections, and can clarify the issues at an early stage. Families should be aware that obtaining early advice does not commit them to any particular course of action.
Cases of Note
Michael Boylan Litigation has acted in a significant number of reported and publicly noted birth injury cases, including:
- Interim settlement of €5.8 million for birth injury.
- Settlement of €16.3 million on a full and final basis for a young girl with cerebral palsy, achieved using video conference technology.
- €3 million High Court settlement for a girl with cerebral palsy.
- First ever award of damages by way of annual payment for life for an injured child.
- €6 million settlement for a seven-year-old girl with cerebral palsy.
- €15 million award for a boy with cerebral palsy over injuries at birth.
- €6.7 million settlement for a boy left brain damaged after an operation.
- €15.6 million total award for a severely disabled girl over care at birth.
- €2.6 million interim damages for a girl with brain injury at birth.
- Settlement for a teenage girl with cerebral palsy over alleged negligence in her birth at Mayo General Hospital.
- Medico-Legal Issues in Obstetric and Neonatal Care, 9 October 2014, Radisson Blu.
- Michael Boylan wins major trial for baby brain injured at birth as a result of inadequate resuscitation.
- Statement regarding Eoin Dunne v Coombe.
- Michael Boylan achieved interim settlement of €1.9 million for a girl with cerebral palsy and apology.
- Michael Boylan wins €4.75 million damages for a ten-year-old girl who suffered brain damage from undiagnosed hydrocephalus.
Questions Parents Commonly Have After a Cerebral Palsy Diagnosis
Does a cerebral palsy diagnosis mean there was negligence?
No. Many children with cerebral palsy have the condition for reasons entirely unrelated to the care they received. A diagnosis alone does not indicate that something went wrong. The relevant question is whether the medical records and expert evidence show that an avoidable injury occurred as a result of substandard care.
What if the birth was difficult but no one explained what happened?
This is a common concern. A review of the medical records can help clarify the sequence of events, including how labour was monitored, what delivery decisions were made and what neonatal care was provided. Many families find that a records review answers questions they have carried for years.
What is the relevance of a CTG trace?
A CTG trace records the baby's heart rate alongside the mother's contractions during labour. In some cases, the trace may show patterns that should have prompted escalation to senior staff or urgent delivery. Whether the CTG was properly interpreted and acted upon is frequently a central issue in birth injury cases.
Why are cord blood gases and Apgar scores important?
Cord blood gases measure the baby's oxygen and acid levels at the time of birth. Apgar scores assess the baby's condition at one and five minutes after delivery. Together, they can help indicate whether the baby experienced oxygen deprivation around the time of birth and how severe that deprivation may have been.
Can neonatal care after delivery be relevant?
Yes. The care provided in the hours and days after birth can be just as significant as the care during labour. Issues such as resuscitation, ventilation, seizure management, infection, jaundice, hypoglycaemia and therapeutic cooling may all be relevant depending on the facts of the case.
Who brings a case where the injured person is a child?
Where the injured person is a child, a parent or legal guardian usually acts on the child's behalf in bringing a claim. This is subject to legal advice and the procedures of the court. The child's interests are the primary consideration throughout the process.
Will the case definitely go to trial?
Not necessarily. The outcome depends on many factors, including the strength of the evidence on liability and causation, the expert medical opinion and whether the parties are able to reach a resolution without a full court hearing. Some cases settle during the litigation process, while others proceed to trial. Each case is different, and no guarantees can be given at the outset.
Get in Touch
If your child has been diagnosed with cerebral palsy and you have concerns about the care provided during pregnancy, labour, delivery or after birth, Michael Boylan Litigation can carry out a confidential review of the medical records. Contact the firm to discuss your child's case.
*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.
