Today we are talking to you about another topic that people don’t want to bring up and can’t face very well: cerebral palsy.
The harsh reality
Cerebral palsy is a chronic, damaging disorder of the central nervous system that appears early in life and is characterized primarily by an inability to control its movements and posture, and is not the result of a progressive deterioration of a neurological disorder. The natural incidence of cerebral palsy is 1-2/1000 in the population and there is no good way to predict cerebral palsy and no good way to treat it.
The most common causes of cerebral palsy are: developmental abnormalities, genetic disorders (including inherited metabolic disorders), autoimmune disorders, disorders of coagulation mechanisms, infections, trauma or a combination of other factors, of which the percentage of cerebral palsy that is actually associated with adverse events during delivery is not as high as we might think, less than 1/4.
The results of the relevant cerebral palsy studies suggest that spastic tetraplegia, especially those accompanied by motor dysfunction, is the only type of cerebral palsy associated with ischemic and hypoxic events during pregnancy, especially during delivery. Simple motor disorders or ataxic cerebral palsy, especially when combined with cognitive impairment, are usually genetically related and not due to asphyxia during delivery or the perinatal period. Similarly, neurological manifestations without signs of cerebral palsy, such as epilepsy, neurodevelopmental delay, attention deficit, and hyperactivity disorder, are not caused by perinatal asphyxia.
To link acute intrapartum abnormalities to cerebral palsy, strict diagnostic criteria must be met, as proposed by the International Working Committee on Cerebral Palsy, which are as follows.
Required criteria (all four must be met)
1. evidence of metabolic acidosis (pH <7 and BD "12 mmol/L) in the fetal umbilical artery blood at the time of delivery.
2, early-onset moderate or severe neonatal encephalopathy in newborns 4 weeks and older for gestational age
3. spastic tetraplegia or dyskinetic cerebral palsy.
4. exclusion of other identifiable diseases, such as trauma, coagulation disorders, infections or genetic disorders.
The wronged obstetrician
The current helpless status quo is that whenever cerebral palsy occurs, it is customary to assume that the obstetrician is at fault. This is a presumption of guilt, but doctors often have a hard time defending themselves due to the lack of good evidence to support them.
Despite the lack of objective, scientific clinical evidence, four nonspecific clinical signs (meconium-contaminated amniotic fluid, disconcerting fetal heart monitoring graphics, low Apgar scores, and neonatal encephalopathy) are commonly cited as evidence of birth asphyxia and hypoxic-ischemic neonatal encephalopathy, when in fact these factors do not cause neurological damage and are not specific causes of cerebral palsy. The best evidence from many clinical epidemics confirms that the vast majority of cerebral palsy does not result from asphyxia and organ damage caused by hypoxia alone during delivery.
Although these perinatal nonspecific signs give the first impression to the health care provider and the patient’s parents that the fetus may be in distress, most of them are still the developmental outcome of a disease that was already present in the pregnant woman herself prior to delivery. Please note that this is often the outcome, not the cause.
With advances in science and technology, studies from morphology to molecular biology have revealed that the vast majority of neonatal encephalopathies and cerebral palsy do not originate from the delivery process. It is more commonly believed that the cause of most neonatal encephalopathies and cerebral palsy is developmental, genetic, metabolic, autoimmune, infectious, traumatic, or a combination of other factors.
A difficult journey of the heart
It is not easy for obstetricians, but it is even harder for parents of children with cerebral palsy, especially the mothers. After learning that the child has cerebral palsy, the mother’s emotions often go through ups and downs: first, despair, as if she had fallen into a bottomless abyss; then, anger, asking why, why did the child have cerebral palsy? Why did it happen to my child? Next is self-blame or other blame, blaming themselves for not doing systematic checkups during pregnancy, not listening to doctors’ advice, not paying attention to eating habits and healthy lifestyle, blaming doctors for not reminding themselves, blaming doctors for not handling the delivery process well; after going through the above process, after understanding that there is nothing they can do to change the fact of cerebral palsy, they slowly learn to accept the reality, enter into seeking doctors’ help, and start the rehabilitation of the child. The new normal of treatment.
For parents of children with cerebral palsy, they need not only medical support, but also psychological counseling, support from social resources, and support from mutual aid organizations for parents of children with cerebral palsy.
The road to life is difficult and requires mutual understanding and support from family members;
Life is fragile and needs to be taken care of carefully;
Life is not perfect, so we need to face and accept it openly, and we need to give more care and love to these imperfect lives.