Potentially Actionable Birth Injuries and Obstetric Care
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The general concept
A serious injury during pregnancy, labor, delivery, or shortly after birth may justify investigation, but the injury or an unexpected outcome does not by itself establish malpractice. The central questions are whether a provider departed from the applicable standard of care, whether that departure proximately caused an injury, and what damages followed. These questions often require review by obstetric, maternal-fetal medicine, neonatology, nursing, radiology, or other experts. Separate claims may belong to the child and to a parent, and deadlines can differ.
Erb’s palsy and brachial plexus injury
Erb’s palsy is a form of brachial plexus injury that can cause weakness or loss of movement in an infant’s shoulder, arm, or hand. The investigation may examine shoulder dystocia, the baby’s position, the maneuvers used, traction applied, and whether the injury occurred before, during, or after delivery. Some brachial plexus injuries occur despite appropriate care; the diagnosis alone does not prove excessive force or negligence.
Fetal distress and fetal heart-rate monitoring
“Fetal distress” is often used informally to describe concerning fetal status. A claim may involve whether the fetal heart-rate pattern was interpreted in context, whether appropriate measures were taken, whether the obstetrician was notified, and whether delivery was expedited when indicated. The full tracing, timestamps, maternal condition, response to interventions, decision-to-delivery interval, cord gases, newborn records, and expert analysis may be important. A single abnormal tracing or an adverse outcome does not answer whether the response met the standard.
Neck traction and shoulder dystocia
When a baby’s shoulder becomes lodged after the head delivers, clinicians use recognized maneuvers to complete delivery. A claim may focus on whether the team recognized the emergency, called for help, used appropriate maneuvers in sequence, avoided inappropriate force or fundal pressure, and documented what occurred. Traction on the head or neck may be relevant to a brachial plexus injury, but the mechanics and causation are disputed medical questions; the existence of an injury does not establish that traction was excessive.
Macrosomia and a large baby
A large estimated fetal weight can affect counseling and delivery planning, particularly when combined with diabetes, prior shoulder dystocia, or other risk factors. Ultrasound estimates are imprecise, and actual birth weight is not the same as the weight reasonably knowable before delivery. ACOG guidance says planned cesarean may be beneficial to consider at estimated fetal weights of at least 5,000 grams without diabetes or 4,500 grams with diabetes; those figures are counseling thresholds, not an automatic rule that every patient must have a cesarean. The record should be assessed using information available at the time, not hindsight.
Cesarean delivery: delay, failure, or choice of route
A claim may ask whether the team should have recommended or performed a cesarean earlier—for example, in response to persistent concerning fetal status, labor arrest, suspected obstruction, or a combination of maternal and fetal risks. The opposite question can also arise when an unnecessary procedure allegedly caused injury. The standard depends on the clinical circumstances, available alternatives, patient preferences and consent, and the evidence available when the decision was made. The fact that a cesarean occurred, did not occur, or was followed by injury is not enough by itself.
Placental abruption
Placental abruption is premature separation of the placenta and may threaten both the pregnant patient and fetus. Bleeding may be visible or concealed. Relevant issues can include recognition of pain, bleeding, contractions, or other warning signs; assessment and monitoring; communication; stabilization; and the timing and method of delivery. A delayed diagnosis is actionable only if expert evidence connects a departure from the standard of care to avoidable harm.
Prenatal care and missed risks
Prenatal-care claims may concern failure to obtain or follow up on indicated testing, recognize maternal illness or pregnancy complications, communicate abnormal results, arrange appropriate surveillance, or refer a higher-risk patient for specialist care. The visit schedule and tests depend on the patient’s history, symptoms, risk factors, and preferences. A gap in visits or an adverse birth outcome does not alone establish negligence; the question is what care was indicated and whether a missed step changed the outcome.
Genetic testing and informed decisions
Potential issues include whether screening and diagnostic options were appropriately discussed, whether a result was accurately interpreted and communicated, whether follow-up testing or counseling was indicated, and whether the patient had a meaningful opportunity to make an informed decision. Screening is not the same as diagnostic testing, and a negative screening result does not rule out every condition. Maryland recognizes a limited parental wrongful-birth theory in appropriate circumstances, while Kassama v. Magat rejects a child’s claim that life with a disability is itself a legally compensable injury. The claim, claimant, causation, and recoverable damages must be analyzed carefully; a child’s disability is not proof that a provider caused it.
Prematurity and neonatal injury
Prematurity can result from many causes and is not itself proof of malpractice. Potential issues may include recognition and management of preterm labor or ruptured membranes, infection or bleeding, counseling about risks, appropriate maternal treatment, transfer to a facility equipped for the expected gestational age, and coordination with neonatal specialists. Whether an intervention was indicated depends on gestational age, maternal and fetal condition, timing, and the guidance in effect at the time. Experts must connect any missed or delayed care to the particular injury.
Evidence, deadlines, and Maryland procedure
Useful records may include the complete prenatal chart, ultrasound and laboratory results, fetal-monitoring strips in their original format, labor and delivery records, medication and nursing records, operative and anesthesia notes, placental pathology, cord gases, neonatal intensive-care records, and later developmental or therapy records. Preserve complete originals and metadata where available. Maryland medical-malpractice claims generally must first be filed with the Director of the Health Care Alternative Dispute Resolution Office. Unless the sole issue is lack of informed consent, a claimant generally must file a certificate of a qualified expert, with the expert’s report, within 90 days after the complaint; statutory extensions and exceptions may apply. The child’s medical-malpractice limitations period is governed by Courts and Judicial Proceedings § 5-109 as interpreted in Piselli, while a parent’s separate claim and any wrongful-birth claim must each be evaluated on their own facts and deadlines. Do not assume one claimant’s deadline governs all claims.
Related Maryland Cases and Authorities
Md. Code, Cts. & Jud. Proc. §§ 3-2A-01 through 3-2A-09, 5-109; Piselli v. 75th Street Medical, 371 Md. 188, 808 A.2d 508 (2002); Reed v. Campagnolo, 332 Md. 226, 630 A.2d 1145 (1993); Kassama v. Magat, 368 Md. 113, 792 A.2d 1102 (2002); ACOG Practice Bulletin No. 178, Shoulder Dystocia; ACOG Practice Bulletin No. 216, Macrosomia; ACOG Clinical Practice Guideline No. 10, Intrapartum Fetal Heart Rate Monitoring (2025); ACOG Clinical Practice Guideline No. 8, First and Second Stage Labor Management (2024); ACOG Practice Bulletin, Prenatal Diagnostic Testing for Genetic Disorders; ACOG/SMFM Obstetric Care Consensus No. 6, Periviable Birth.