There have been radical changes in our understanding of
aetiological factors over the past 20 years. In 1862, Little
reported that abnormal birth was a possible factor in
spastic cerebral palsy. Although he was aware of other
causes, his writings were interpreted to mean that abnormal
birth was the primary cause of spastic cerebral palsy. There
was no recognition of Freud’s converse view that
intrauterine developmental abnormality was responsible. For over 100 years, most
cases of cerebral palsy were thought to be caused by
asphyxia during either labour or the perinatal period. Prevalence rates of
cerebral palsy were used as outcome measures of obstetric
practice and neonatal care and it was expected that
improvement in these areas would result in lower rates of
cerebral palsy .
As a result, there was increased use of interventions such as
electronic foetal monitoring and caesarean section.
However, the role of perinatal asphyxia in the aetiology of
cerebral palsy was challenged when the stillbirth and
neonatal death rates declined but the cerebral palsy rate
remained constant .