How to End the
Birth Litigation Crisis
The objective of this web site is to prevent
neonatal cerebral palsy (CP) and to eliminate brain injury
litigation from obstetrical practice.
Neonatal Encephalopathy (NE) and subsequent
Cerebral palsy (CP) are injuries that occur in managed childbirth;
they will be prevented only when the mismanagement that produces
them is understood, and avoided. The elite mentors of the perinatal
and legal professions have dogmatized hypoxia as the origin of these
injuries. [1, 2] Hypoxia is seldom a causal factor in NE.
For 30 years, instant resuscitation and
oxygenation (immediate cord clamping (ICC) and removal to
resuscitation) of “hypoxic / depressed” neonates has not reduced the
incidence of NE /CP, and may have increased it. NE begins and
progresses in well oxygenated neonates. The origin of NE is NOT
hypoxia. The lesions seen on MRI scan of the
oxygenated NE neonate are ischemia and infarction.
“There is no evidence that brain damage occurs before birth.” 
The convenient term used for these NE babies is “Sick Neonates.” (We
don’t know why they’re sick.)
Sick neonates frequently need blood transfusion.
 The MRI scan confirming NE indicates deficient brain blood
flow. “ICC causes hypotension and hypovolemia.”  Respiratory
distress – retraction respiration, (RR) is a common dysfunction in
NE – a sign of heart failure.
In NE, the brain blood vessels are not constricted; deficient brain
perfusion is due to hypovolemic shock, low blood pressure and RR.
The origin of NE is massive blood loss into the placenta.
The clinical definition
of NE  includes:
Abnormal tone pattern
Weaker than it
ought to be 
Not vigorous – no suckling reflex
compression in utero
[The Cerebral Palsy Baby]
Not red, not responsive 
cord blood pH > 7.1
obtain blood 
>7 at 5 mins
shock  
definition of NE mimics the description of the ICC neonate!
However, ICC alone will seldom produce NE – a really “Sick
neonate.” Intra-partum hypovolemia [9, 10] combined with ICC are
the usual causal factors in NE. Late decelerations indicate hypoxia
due to cord compression, but, as the oxygen supply is dissolved in
blood, oxygen deficit is matched by blood volume deficit.
Cerebral Palsy Baby]
A child born with most of the above symptoms at
the one minute Apgar score will be hypoxic and very severely
hypovolemic, at high risk for NE. However, if the cord has not
been clamped, the child at one minute will be receiving a massive
placental transfusion of oxygenated blood, and should be completely
resuscitated within a few minutes with a five minute Apgar score
near 10 – if the cord remains open.
The child will adjust itself to a normal state of hemo-dynamics and
circulation. It will not develop NE or any other birth brain
The results of routinely clamping the cord
after the placenta has delivered should soon persuade the birth
attendant of the value of this practice – five-minute Apgar scores
are routinely 10, even when one-minute Apgar scores are below 4.
Any resuscitation must be done with the placental circulation
intact.  Discussions of conflicting situations are on the
side-bars to this home page. The physiology of the third stage of
labor prevents cerebral palsy and litigation.