 This post is the fourth in a series of articles that explain what Texas law requires you to prove in different types of birth injury cases, who can actually be sued, and how much time you have to act. This particular post explains what cerebral palsy is, what the research says about its causes, and what evidence separates a genuinely preventable injury from one that was not.
A child is diagnosed with cerebral palsy, and it is natural for a family to assume something must have gone wrong during delivery. However, the research does not support that assumption in most cases. Decades of epidemiological study have consistently found that the large majority of cerebral palsy cases trace back to factors already present before labor even began, not to anything that happened in the delivery room. That does not mean a birth injury never causes cerebral palsy. It means the question deserves a careful, evidence-based answer rather than an assumption in either direction. What Is Cerebral Palsy, and What Actually Causes It? Cerebral palsy is a group of permanent disorders affecting movement and posture, caused by a disturbance in the developing brain. It is not a single condition with a single cause. It is a description of an outcome that can result from many different underlying events, occurring at many different points before, during, or after birth. A template for defining a causal relation between acute intrapartum events and cerebral palsy is an international consensus statement developed by task forces including obstetric and pediatric specialists. It found that in roughly 90 percent of cases, intrapartum hypoxia could not be identified as the cause of the child's cerebral palsy. Other large epidemiological reviews have reached similar conclusions, generally finding that 70 to 80 percent of cerebral palsy cases are associated with factors present before labor, including prematurity, intrauterine growth restriction, intrauterine infection, genetic and chromosomal conditions, and placental abnormalities that developed over the course of the pregnancy. Birth asphyxia, meaning inadequate oxygen during labor and delivery, is estimated to account for well under 10 percent of cases. These are not numbers a family should have to take on faith. They come from decades of peer-reviewed research, and they mean that a cerebral palsy diagnosis, standing alone, is not evidence that the delivery was mismanaged. If Most Cerebral Palsy Is Not Caused by Delivery, When Can It Still Be Malpractice? Malpractice becomes a real question in the minority of cases where the medical record shows specific, identifiable evidence of an acute intrapartum hypoxic-ischemic event, evidence that goes well beyond a cerebral palsy diagnosis alone. Texas law and the underlying medicine both require that specificity before a case can be evaluated seriously. The same international consensus framework used to evaluate hypoxic-ischemic encephalopathy applies here, since many, though not all, intrapartum-caused cerebral palsy cases begin with a hypoxic-ischemic injury at birth. The framework looks for a sentinel hypoxic event, such as
When a child's medical record shows this specific pattern, the case for an intrapartum cause is meaningfully stronger. When it does not, a cerebral palsy diagnosis by itself typically will not support a health care liability claim. What Role Do Therapeutic Hypothermia and Early Treatment Play? When a newborn does show signs of an acute hypoxic-ischemic injury at birth, a separate and time-sensitive standard of care applies to how quickly that injury is treated, independent of whatever caused it in the first place. For babies born at 36 weeks' gestation or later with moderate-to-severe hypoxic-ischemic encephalopathy, therapeutic hypothermia, also called cooling therapy, has been the standard of care since 2010 and remains the only treatment shown to reduce the risk of death or long-term disability, including cerebral palsy. A 2026 clinical report from the American Academy of Pediatrics (“AAP”) confirms that cooling must generally begin within 6 hours of birth and continue for 72 hours to be effective. A hospital that fails to recognize a newborn's eligibility for this treatment, or that delays transferring the baby to a facility equipped to provide it, can bear responsibility for a worse outcome than the underlying injury alone would have caused, even if the original hypoxic event itself was not preventable. What Medical Evidence Helps Distinguish an Intrapartum Injury From a Pre-Existing One? Several categories of evidence typically drive this analysis, and a qualified medical expert usually needs to review all of them together rather than relying on any single record in isolation. These categories of evidence include
No single piece of evidence is conclusive by itself, which is exactly why a cerebral palsy case requires this kind of comprehensive review rather than a conclusion drawn from the diagnosis alone. What Should a Family Do If Their Child Was Diagnosed With Cerebral Palsy? First, request the complete labor, delivery, and neonatal record as early as possible, along with the placental pathology report if one was performed. Because most cerebral palsy has nothing to do with the delivery, a careful record review before deciding whether to pursue a claim protects your family from pursuing a case the evidence will not support, just as much as it protects your right to pursue one the evidence does support. Texas Health & Safety Code §241.154 requires a hospital to provide these records to the patient within 15 days of a written request. Texas Civil Practice and Remedies Code §74.351 requires a Claimant asserting a health care liability claim to serve a preliminary expert report on each Defendant within 120 days of the date on which that Defendant filed their Answer to a lawsuit. This preliminary expert report is required to explain the standard of care, how it was breached, and how the breach caused the injury based on the information then available. Given how heavily a cerebral palsy case depends on ruling out non-intrapartum causes, that expert report typically requires input from more than one type of specialist. Texas's statute of limitations for these claims generally requires action within two years, with a specific, more complicated rule for young children, so it is worth having the records reviewed sooner rather than later. We Can Help At The Borah Law Firm, PLLC, we only handle medical malpractice cases in Texas, nothing else. As part of our practice, we represent patients and families in cases just like the one discussed in this blog. If you believe a loved one received substandard birth injury care, whether in a nursing home, assisted living facility, or hospital, we can help you understand whether a case exists and what your options are. Contact us today so you can tell us your story. Frequently Asked Questions Is cerebral palsy always caused by something that happened during birth? No. Research consistently finds that 70 to 80 percent of cerebral palsy cases are associated with factors present before labor began, and that birth asphyxia accounts for well under 10 percent of cases. A cerebral palsy diagnosis alone is not evidence that the delivery was mismanaged. What evidence can show whether cerebral palsy was caused by a birth injury? Evidence typically includes fetal heart rate monitoring strips showing a sudden change from a previously normal pattern, umbilical cord blood gas results showing significant acidemia, newborn brain imaging, and placental pathology findings. A qualified medical expert usually needs to review these together to reach a conclusion. How long do I have to file a cerebral palsy malpractice claim in Texas? Texas generally requires a health care liability claim to be filed within two years, though claimants younger than 12 at the time of the injury may have longer under Texas Civil Practice and Remedies Code §74.251. The rules are complicated enough that a family should not calculate the deadline on their own. About the Author: J.T. Borah is a Texas-licensed medical malpractice attorney and Texas Super Lawyer at The Borah Law Firm, PLLC in Austin, Texas. He has testified before both the Texas House and Senate on patient safety issues and focuses exclusively on medical malpractice cases statewide. About this article: AI writing tools assisted Mr. Borah in drafting this article. All legal analysis reflects his independent professional judgment. This article is for general informational purposes only. It is not legal advice and does not create an attorney-client relationship. Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC1116849/ Comments are closed.
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