What Is a Birth Injury? How to Know If Your Baby Was Harmed by Medical Negligence

The hours surrounding childbirth are among the most medically intense moments in a person’s life. Labor and delivery involve a compressed window of time during which the condition of both mother and baby can change quickly, often requiring immediate and precise decisions from an entire team of healthcare providers. Most births result in a healthy baby and a recovering mother. But when medical errors occur during that window, the consequences can be permanent.

Birth injuries are a specific and serious category of harm that occurs during pregnancy, labor, delivery, or the immediate newborn period. Unlike congenital conditions, which result from genetic factors or events that occurred during fetal development and are not attributable to medical care, birth injuries are caused by things that happen during the medical care process itself. Some are unavoidable. Many are not.

This article explains what birth injuries are, which types occur most frequently, what causes them, how to distinguish a birth injury from a congenital condition, and how to recognize whether medical negligence may have played a role in what happened to your child.

Defining a Birth Injury

A birth injury, in the medical and legal sense, refers to physical harm or damage sustained by a newborn during labor, delivery, or the immediate postdelivery period. The term can also encompass harm caused by failures in prenatal care, where a physician’s negligence during pregnancy created conditions that led to injury at or around the time of birth.

Birth injuries exist on a broad spectrum. At the minor end, they include things like a broken clavicle from a difficult delivery, bruising from the use of delivery instruments, or temporary facial nerve compression. These conditions typically resolve within days or weeks and do not produce lasting effects. At the severe end, birth injuries include devastating conditions such as cerebral palsy, hypoxic-ischemic encephalopathy (HIE), permanent brachial plexus injuries resulting in arm paralysis, and spinal cord injuries. These conditions require lifelong care, produce permanent disability, and carry profound financial and emotional consequences for the affected child and their family.

It is worth being precise about one important distinction. A congenital condition is one that originates before birth, typically as a result of genetics, chromosomal abnormalities, or exposures that occurred early in pregnancy. Conditions such as Down syndrome, cystic fibrosis, and many heart defects are congenital. They are not birth injuries and are not the result of medical negligence. A birth injury, by contrast, results from something that happens during the delivery process or from failures in medical care that affect the baby at or near the time of birth.

How Common Are Birth Injuries?

Birth injuries are more common than many families realize. According to data drawn from the Centers for Disease Control and Prevention and published research in the National Library of Medicine, approximately 6.6 to 7 out of every 1,000 live births in the United States result in a birth injury. That translates to roughly 28,000 to 30,000 affected babies every year, or approximately three births per hour across the country.

Not all of these injuries are the result of medical negligence. Some occur despite entirely appropriate care. However, research estimates that approximately 80 percent of serious birth injuries were preventable with proper medical management. That figure comes from the Cerebral Palsy Guide and is consistent with findings from insurance industry claims analysis, which has found that in roughly 40 percent of birth injury liability claims, the harm was linked to poor management of labor and delivery.

Obstetrics and gynecology is one of the highest-risk specialties for malpractice claims in the United States. A study of medical malpractice claims paid between 2009 and 2014 found that approximately 25 percent of all paid malpractice claims were related to obstetrics and gynecology. The average loss for birth injury cases has been estimated at $2.5 million, higher than almost any other category of medical malpractice.

The Most Common Types of Birth Injuries

Understanding the specific types of birth injuries that occur most frequently helps families recognize what may have happened to their child and whether it warrants further investigation.

Brain Injuries: HIE, Cerebral Palsy, and Oxygen Deprivation

Brain injuries are the most common serious birth injury category. According to internal research from birth injury legal databases, brain damage accounts for approximately 25 percent of all birth injuries, and it is the most legally and medically significant category because of its permanence and the severity of its consequences.

The brain’s dependence on a continuous supply of oxygenated blood makes it extremely vulnerable during labor and delivery. When that supply is interrupted, even briefly, brain cells begin to die. Brain damage can begin within approximately four minutes of oxygen deprivation. The longer the deprivation continues, the more extensive and permanent the damage.

Hypoxic-Ischemic Encephalopathy, or HIE, is the medical term for brain injury caused by reduced oxygen and blood flow to a newborn’s brain during or around the time of birth. HIE exists on a spectrum. Mild cases may produce temporary symptoms or modest developmental delays, and some infants with mild HIE recover completely. Moderate to severe HIE, however, frequently results in cerebral palsy, intellectual disability, epilepsy, and other permanent neurological conditions.

Cerebral palsy is the most common physical disability in childhood and is often, though not always, linked to birth injury. The CDC has documented rates of cerebral palsy in the United States at approximately 1.5 to 4 children per 1,000 live births, with recent data suggesting a rate of roughly 3 per 1,000 births. Approximately 8,000 to 10,000 babies are diagnosed with cerebral palsy each year in the United States. The estimated lifetime costs of care for a child with cerebral palsy exceed $1.6 million, and for children who also have an intellectual disability, the CDC reports that medical care costs run 26 times higher than for children without these conditions.

Approximately 20 percent of cerebral palsy cases are attributed to HIE, making HIE one of the most significant and potentially preventable causes of this condition. Because HIE can result from failures in fetal monitoring, delayed decision-making about emergency delivery, or mismanagement of labor complications, it is a condition that often prompts medical malpractice investigation.

Brachial Plexus Injuries: Erb’s Palsy and Klumpke’s Palsy

The brachial plexus is the network of nerves that runs from the spinal cord through the neck and into the shoulder, arm, and hand. These nerves can be stretched, compressed, or torn during a difficult delivery, particularly in cases involving shoulder dystocia, a complication where the baby’s shoulders become lodged behind the mother’s pelvic bone after the head has been delivered.

Erb’s palsy, the most common form of brachial plexus birth injury, affects the nerves controlling the shoulder and upper arm and results in weakness or paralysis of the affected arm. Erb’s palsy is reported to occur in approximately 1 to 2.6 per 1,000 live births, with about 12,000 cases diagnosed each year in the United States. Erb’s palsy constitutes roughly 50 to 60 percent of all brachial plexus birth injuries.

The good news is that many cases of Erb’s palsy resolve with physical therapy, and complete recovery occurs in roughly 70 to 80 percent of cases within the first year of life when appropriate treatment is begun early. However, a significant proportion of children with brachial plexus injuries experience permanent weakness, reduced range of motion, or paralysis of the affected arm.

From a malpractice standpoint, brachial plexus injuries are frequently scrutinized because they often occur in the context of shoulder dystocia, a complication that trained obstetric providers are expected to recognize and manage with specific clinical maneuvers. Excessive traction applied to the baby’s head or neck during a shoulder dystocia, rather than approved delivery maneuvers, is a recognized departure from the standard of care.

Skull Fractures and Intracranial Hemorrhage

Difficult deliveries, particularly those involving the use of forceps or vacuum extractors, can cause physical trauma to the infant’s head. This trauma can result in cephalohematoma, a collection of blood beneath the periosteum of the skull bone, which occurs in approximately 2.5 percent of vaginal deliveries and up to 10 percent of deliveries involving forceps or vacuum extraction. More seriously, birth trauma can cause intracranial hemorrhage, or bleeding inside the skull, which can damage brain tissue and produce neurological consequences.

Skull fractures in newborns are relatively uncommon but do occur, particularly in assisted deliveries. Most skull fractures in newborns are linear and heal without intervention. Depressed skull fractures, which involve the bone being pushed inward toward the brain, are more serious and may require treatment.

Spinal Cord Injuries

Spinal cord injuries at birth are rare but catastrophic. They typically occur when excessive force is applied to the infant’s head or neck during delivery, causing overstretching of the spinal cord. Spinal cord injuries at birth can result in permanent paralysis, loss of sensation below the level of the injury, and respiratory complications requiring mechanical ventilation. These injuries are among the most devastating outcomes of a negligent delivery.

Bone Fractures

The most commonly fractured bone during childbirth is the clavicle, or collarbone. Clavicle fractures can occur during vertex deliveries when the shoulder becomes impacted, or during breech deliveries. They are also associated with shoulder dystocia management. In most cases, a broken clavicle heals without intervention and does not produce permanent consequences. However, the circumstances surrounding a clavicle fracture may indicate that excessive force was applied during delivery, which can be clinically relevant if other injuries also occurred.

Oxygen Deprivation from Umbilical Cord Complications

The umbilical cord is the baby’s lifeline during labor, delivering oxygenated blood from the placenta. Complications involving the cord, including cord prolapse, where the cord drops through the cervix ahead of the baby, nuchal cord, where the cord wraps around the baby’s neck, or true knots in the cord, can interrupt oxygen delivery. Some cord complications are genuinely unforeseeable and unpreventable. Others, particularly cord prolapse, require immediate recognition and emergency response, and a delay in that response can result in preventable brain injury.

What Causes Preventable Birth Injuries

Understanding which clinical failures most commonly lead to preventable birth injuries helps parents and families evaluate whether what happened to their child might have been avoidable.

Failure to Monitor Fetal Heart Rate

Electronic fetal monitoring during labor is the primary tool providers use to assess the baby’s well-being in real time. Abnormalities in the fetal heart rate tracing, including persistent late decelerations, variable decelerations, or prolonged bradycardia, are warning signs that the baby may not be receiving adequate oxygen. Failure to recognize these signs, failure to respond to them appropriately, or failure to escalate to emergency delivery when the tracing becomes non-reassuring are common bases for malpractice claims in birth injury cases.

Delayed or Inappropriate Decision to Perform a C-Section

In situations where vaginal delivery poses a significant risk to the baby or mother, the standard of care may require prompt performance of a cesarean section. Delays in decision-making about emergency C-section, whether caused by failure to recognize the urgency, failure to assemble the surgical team promptly, or any other lapse in the system, can allow a baby to sustain brain injury that could have been prevented by timely delivery.

Misuse of Forceps or Vacuum Extractors

Forceps and vacuum extractors are legitimate tools that, when used correctly by skilled practitioners, can assist in a difficult delivery. However, both instruments carry risks when misapplied. Excessive traction, incorrect placement, or use of these instruments in situations where they are contraindicated can cause skull fractures, intracranial hemorrhage, brachial plexus injuries, and other serious harm. Misuse of these instruments is a recognized category of birth injury malpractice.

Failure to Identify or Respond to Shoulder Dystocia

Shoulder dystocia is a delivery emergency in which the baby’s anterior shoulder becomes lodged behind the mother’s pubic symphysis after the head has been delivered. Clinicians are trained to recognize this complication and to apply a series of specific maneuvers to resolve it, including the McRoberts maneuver, suprapubic pressure, and rotational maneuvers. Failure to recognize the complication, panic or inappropriate maneuvers in response to it, or application of excessive downward traction on the baby’s head are recognized causes of brachial plexus injury and can constitute malpractice.

Failure to Manage High-Risk Conditions During Pregnancy

Some birth injuries have their roots in failures that occurred during prenatal care rather than during delivery itself. Preeclampsia, a pregnancy complication characterized by high blood pressure and signs of organ damage, requires careful monitoring and timely intervention. Untreated or under-treated preeclampsia can lead to seizures, called eclampsia, stroke, and severe complications for both mother and baby. Similarly, gestational diabetes requires close management because it affects fetal growth and delivery planning. Failure to appropriately manage these known high-risk conditions can lead to preventable harm.

Medication Errors During Labor

Medications used to induce or augment labor, particularly Pitocin (oxytocin), must be carefully dosed and monitored. Excessive Pitocin stimulation can produce hyperstimulation of the uterus, resulting in contractions that are too frequent and too prolonged, which can deprive the baby of oxygen between contractions. Dosing errors with Pitocin are a recognized source of birth injury malpractice claims.

Failure to Diagnose and Treat Newborn Conditions Promptly

Some birth injuries occur or worsen in the period immediately after birth because a condition is not promptly recognized and treated. Neonatal jaundice, caused by elevated bilirubin levels, is one of the most common newborn conditions. When it is severe and untreated, bilirubin can accumulate in the brain and cause kernicterus, a form of permanent brain damage. Prompt monitoring of bilirubin levels and appropriate treatment with phototherapy are expected components of newborn care, and the failure to identify and treat severe jaundice is a basis for malpractice claims.

Birth Injury vs. Congenital Condition: A Critical Distinction

Parents who receive a devastating diagnosis for their newborn naturally want to understand what caused it. One of the first questions a malpractice attorney will ask is whether the child’s condition is congenital or the result of a birth injury, because the answer determines whether there is a viable legal claim.

Congenital conditions develop before the birth process begins and typically result from genetic factors, chromosomal abnormalities, or environmental exposures during early pregnancy. They are not caused by what happens during labor and delivery, and they are not the result of medical negligence. Examples include genetic syndromes, chromosomal conditions, and some structural heart defects.

A birth injury, by contrast, results from something that happens during labor, delivery, or the newborn period, and may be caused by medical negligence. Cerebral palsy that results from oxygen deprivation during labor is not congenital; it is a birth injury. A brachial plexus injury caused by excessive traction during delivery is not congenital; it is a birth injury.

In practice, distinguishing between congenital conditions and birth injuries requires careful medical record review and expert analysis. Certain findings in the medical record, including abnormal fetal heart rate tracings, evidence of fetal acidosis on cord blood gas testing, low Apgar scores, and MRI imaging taken shortly after birth, can help establish whether a brain injury occurred at or around the time of birth. An experienced medical expert, particularly one with specialized knowledge in obstetrics and neonatal medicine, is essential to this analysis.

Warning Signs That a Birth Injury May Have Occurred

In the days, weeks, and sometimes months after birth, families may begin to notice signs that their child may have sustained a birth injury. Some of these signs are apparent immediately; others emerge as the child fails to meet expected developmental milestones. Common warning signs include:

• Low Apgar scores at one minute and five minutes after birth. Apgar scores assess the newborn’s heart rate, respiratory effort, muscle tone, reflex response, and skin color. Scores of seven or above indicate a baby in good health. Scores below seven, particularly at the five-minute mark, warrant further evaluation.
• Seizures in the newborn period, which can indicate brain injury.
• Difficulty feeding, poor sucking reflex, or hypotonia (abnormally low muscle tone) in the newborn.
• Unusual body posture, asymmetric limb movement, or one arm that appears floppy or non-functional.
• Delayed developmental milestones in the first year or two of life, including delayed head control, delayed rolling, delayed sitting, or delayed walking.
• Diagnosis of cerebral palsy, Erb’s palsy, or other neurological conditions in the first months or years after birth.
• Significant breathing difficulties in a full-term newborn that require ventilator support.
• Persistent jaundice in the newborn period that is not being adequately treated.

Warning Signs in the Medical Record

When families suspect a birth injury, the medical record from labor and delivery is often the most important source of evidence. Certain findings in those records may indicate that the standard of care was not met:

• Prolonged or concerning fetal heart rate tracings that were not acted upon promptly.
• Documentation of a prolonged second stage of labor without escalation to operative delivery.
• Evidence of shoulder dystocia or other delivery complications, combined with documentation of potentially improper maneuvers.
• Low cord blood gas pH or elevated base deficit, indicating fetal acidosis and oxygen deprivation.
• Apgar scores below seven at five minutes without clear documentation of the cause and appropriate response.
• Documentation of Pitocin administration without adequate monitoring notations.
• Gaps, inconsistencies, or apparent alterations in the medical record.

Medical records related to labor and delivery are dense, technical documents. Interpreting them accurately requires clinical expertise, and families should not attempt to evaluate them in isolation.

The Financial Reality of a Birth Injury

Families who have a child with a serious birth injury face financial challenges that most people cannot fully anticipate. A child with moderate to severe cerebral palsy, for example, may require decades of physical therapy, occupational therapy, and speech therapy. They may need specialized medical equipment, home modifications, specialized educational programs, and personal care assistance. The CDC has estimated that the lifetime healthcare costs for a person with cerebral palsy exceed $1 million. Adjusted for inflation, more recent estimates put the lifetime cost at over $1.6 million, and that figure does not include the indirect costs borne by families who may need to reduce or eliminate employment to provide care.

When a birth injury results from medical negligence, the responsible parties can be held legally accountable for these costs. Compensation in a successful birth injury case can include past and future medical expenses, the cost of long-term care and therapy, adaptive equipment and home modification costs, lost future earning capacity of the child, and compensation for pain and suffering. Given the magnitude of these potential damages, birth injury malpractice cases frequently produce some of the largest jury verdicts and settlements in all of personal injury law. In 2023 alone, a jury in Pennsylvania returned a verdict of $182.7 million in a birth injury case, and a Michigan jury returned $120 million in 2024.

What to Do If You Believe Your Baby Was Harmed by Medical Negligence

If you believe that your baby sustained a birth injury as a result of medical negligence, the most important step you can take is to consult with an experienced birth injury attorney as early as possible. These cases require prompt investigation to preserve evidence, and the statute of limitations, even with the extensions that apply to minor plaintiffs, creates real constraints on how long families have to act.

Before or during that consultation, there are practical steps you can take. Request copies of all medical records from the delivery, including the full labor and delivery record, fetal monitoring strips, nursing notes, and any neonatal records. Keep all records of your child’s subsequent medical care, evaluations, and treatments. Document the developmental challenges your child is experiencing and when you first observed them. Write down what you remember about the delivery, including any conversations with providers, any moments of confusion or concern, and any statements made by medical staff.

Do not sign any settlement agreement or release of claims before speaking with a birth injury attorney. Hospitals and their insurers occasionally reach out to families of seriously injured newborns in the period after delivery. Any release you sign may permanently extinguish your child’s right to seek compensation.

Perhaps most importantly, understand that you do not need to know whether malpractice occurred before consulting with an attorney. That is precisely what the attorney’s investigation is designed to determine. If the records and circumstances suggest a potential claim, a qualified attorney will connect you with the medical experts necessary to evaluate it. If the evidence does not support a claim, a good attorney will tell you that too.