CEREBRAL PALSY FROM THE BIRTHING PROCESS

There are no specific events that, if they occur during pregnancy, delivery, or infancy, will always occurring at birth or right after birth). This is apparently why the incidence of CP in undeveloped and poverty stricken areas of the world, where infant mortality is very high, is the same as in northern Europe, where infant mortality is the lowest. It also explains why modern obstetrical care, including monitoring and a high rate of Cesarian section, has lowered infant mortality rates but not the incidence of cerebral palsy. One large study, for example, has shown that more than 60 percent of all pregnancies have at least one complication, and that most of these complications cause no problems. For instance, 25 percent of all newborns have the umbilical cord wrapped around their neck, and 16 percent passed meconium (had the first bowel movement) at the time of birth. These "birth events" and the development of CP have only a small correlation. In other words, the chances of a child developing CP were nearly the same whether the child was born with a cord wrapped around her neck or not. On the other hand, newborns in this study who had very low Apgar scores (less than 3 at 20 minutes) had a risk 250 times greater than infants with normal Apgar scores of developing cerebral palsy. An Apgar score at this level suggests that the infant suffered severe asphyxia (lack of sufficient oxygen to the brain) during birth. Half of the infants who suffered severe asphyxia during birth did not develop cerebral palsy, however. When CP is diagnosed in childhood, it is often discovered that the child suffered asphyxia at birth, but the asphyxia is usually considered the symptom of an otherwise sick baby with a neurological problem, and not the primary cause of CP. In two different large studies, only about 9 percent of children with CP were thought to have CP directly and exclusively related to asphyxia at delivery. Ninety-one percent of the babies had other inherent causes which led to prematurity or perinatal or neonatal problems (problems In the nineteenth century, Dr. William John Little described cerebral palsy and stated that the condition was due to birth injury in most cases. Cerebral palsy is also known as Little's disease and static encephalopathy, but the term cerebral palsy is most widely used. Dr. Sigmund Freud (who was a prominent neurologist before he founded the field of psychiatry) also investigated the causes of cerebral palsy. Freud thought that the condition was due to something which occurred before the child's birth. He argued that the problems seen at birth were often due to an abnormality present in the baby before birth, rather than being caused by the birthing process. This view of Freud's was greatly ignored in the first half of this century, but recent research has lent support to the idea that cerebral palsy is more often a result of a congenital abnormality than to an injury sustained at birth. Nevertheless, the birthing process can be traumatic for the infant, and injuries occurring during birth do sometimes cause cerebral palsy. Modern prenatal care and improved obstetric care have significantly reduced the incidence of birth injury, but it is unlikely that it will ever be completely eliminated.