We applaud Gilbert et al for their effort to examine the effect of adverse birth events on the development of cerebral palsy (CP). CP is a condition associated with immense physical and psychological problems: lifetime disability for the child, significant demands on the wider family, risk of depression for parents, and enormous costs for each case of negligent care.
However, we do not agree that it is unclear whether the information from their study can help us reduce the incidence of birth-related CP. We believe that the adverse obstetric events associated with CP, whether relatively frequent such as fetal distress, or rare such as cord prolapse, in part remain a problem because care is suboptimal despite the best of intentions. Even in instances in which guidelines exist, they are often not implemented appropriately at the forefront of care. Embedded practical team training for all maternity staff on how to use evidence-based systems to support practice, and how to apply knowledge in the heat of emergencies, has been associated with fewer adverse events and better neonatal outcomes.
Further to training, prospective surveillance with appropriate tools may ensure that rates of adverse events remain low, by early identification of any deterioration, and instigation of targeted safety interventions.