Pregnancy and delivery are never perfectly predictable. Even with careful prenatal management and skilled providers at the bedside, labor can change quickly. But when a baby suffers a serious birth injury, families are often left with a second trauma: not knowing whether the outcome was unavoidable or whether missed warning signs, delayed intervention, or improper delivery techniques played a role.
At Decof, Mega & Quinn, P.C., our team has litigated complex medical malpractice and birth injury cases for decades. In our experience, the most important question is rarely “Was there a complication?” It’s whether the complication was anticipated, recognized, and managed appropriately, and whether reasonable steps could have prevented the injury.
Traumatic Birth Injuries: What the Term Usually Means
“Traumatic birth injury” typically refers to physical harm that occurs during labor and delivery. Some injuries relate to the mechanics of delivery, such as force, positioning, and difficult passage through the birth canal. Others arise from physiologic events during labor, such as oxygen deprivation. Families will often see these injuries discussed together because they can originate in the same high-risk moments.
Common examples include:
- Brachial plexus injuries (including Erb’s palsy)
- Fractures (often the clavicle)
- Facial nerve injuries
- Cephalohematoma / subgaleal hemorrhage
- Intracranial bleeding
- Hypoxic-ischemic encephalopathy (HIE) related to impaired oxygen delivery around the time of birth
A serious outcome does not automatically mean malpractice. The legal question is whether providers met the standard of care, and whether a breach of that standard caused or contributed to the injury.
Clinical Risk Factors That Should Shape the Delivery Plan
Certain maternal, pregnancy, and fetal factors can increase the likelihood of complications during delivery. Many of these risks are identifiable before labor begins and should influence planning, communication, monitoring, and readiness to intervene.
- Maternal health factors can include diabetes (including gestational diabetes), high blood pressure or preeclampsia, obesity, thyroid disease, and other conditions that complicate pregnancy management. These issues do not imply wrongdoing, but they frequently change what prudent obstetric care looks like, especially in how closely the pregnancy is monitored and how a delivery plan is developed.
- Pregnancy history and structural considerations can also raise risk. Prior C-section or uterine surgery, a history of shoulder dystocia, and multiple gestation can all affect how a delivery is managed and when a team should be prepared to move rapidly to operative delivery.
- Pregnancy and placental conditions may increase urgency during labor. Abnormal amniotic fluid levels can heighten the risk of cord compression or distress. Placental problems such as placenta previa, placental abruption, or placental insufficiency can create time-sensitive scenarios in which delays have real consequences.
- Fetal size and position are also major drivers of delivery risk. Suspected macrosomia (a larger baby) may increase the chances of shoulder dystocia or difficult operative delivery. Malpresentation, such as breech presentation, face/brow presentation, or persistent occiput posterior positioning, can prolong labor and increase the likelihood of interventions.
These factors often appear in the chart well before delivery. In a case review, they are evaluated because they affect what a reasonably careful team should anticipate, how they monitor, and when they escalate.
Labor-and-Delivery Flashpoints Where Preventable Errors Can Occur
Many traumatic birth injury claims turn on what happened during labor: whether warning signs were recognized, how providers responded, and whether intervention occurred in time.
- Prolonged or Dysfunctional Labor. When labor stalls, fails to progress, or becomes prolonged, particularly in the presence of concerning fetal monitoring, providers typically need to reassess the plan. The key question is whether the labor course remained acceptable or whether continued labor created foreseeable risk that should have prompted earlier operative delivery.
- Fetal Distress and Delayed Delivery. Abnormal fetal heart rate patterns can indicate that a baby is not tolerating labor. When concerning patterns persist, clinical standards typically require timely corrective measures and escalation when distress does not resolve. In litigation, a common focus is the timeline: what the monitor showed, what interventions were attempted, and how long it took to deliver after distress became apparent.
- Induction/Augmentation and Pitocin Management. Pitocin (oxytocin) can be appropriate and widely used, but it must be managed carefully. Excessive uterine activity—contractions that are too strong or too frequent—can reduce oxygen delivery to the baby. When this occurs, providers are expected to respond appropriately (often by adjusting medications and taking corrective steps). When the record reflects ongoing distress without adequate adjustment or escalation, it may raise questions about whether the standard of care was met.
- Shoulder Dystocia. Shoulder dystocia is a true obstetric emergency in which the baby’s shoulder becomes lodged after the head is delivered. It requires trained maneuvers and coordinated care. When excessive traction is applied to the baby’s head and neck, the risk of brachial plexus injury increases. In evaluating potential malpractice, the issue is not simply that shoulder dystocia occurred, but how it was managed and whether technique, force, or delay contributed to avoidable injury.
- Vacuum/Forceps Delivery. Operative vaginal delivery can be lifesaving in the right circumstances, but it carries risk, especially if performed under poor conditions or continued despite indicators it is not working. Risk increases when the baby is not in an appropriate position, the head is too high, placement is improper, multiple unsuccessful attempts occur, or the tool is used with excessive force. Case evaluation often centers on selection of method, appropriateness of continued attempts, and whether a timely C-section should have occurred instead.
- Missed or Delayed Need for C-Section. A recurring theme in birth injury litigation is avoidable delay in moving to C-section when clinically indicated. In some cases, the “decision-to-incision” timing becomes central: when fetal distress or failure to progress emerged, when the decision was made, and whether delays were preventable.
System Breakdowns That Can Turn Risk into Harm
Not every birth injury is about a single bad decision. Sometimes the underlying issue is systemic: the right response was not coordinated, not timely, or not executed in a controlled way.
Breakdowns that can elevate preventable risk include:
- Inadequate fetal monitoring or failure to respond appropriately to abnormal patterns
- Poor communication and handoffs between nurses and physicians
- Delays in calling the obstetrician, anesthesia team, or neonatal specialists
- Failure to follow established protocols for fetal distress, hemorrhage, infection, or shoulder dystocia
- Understaffing or lack of readiness for emergent operative delivery
- Documentation that reflects confusion, gaps in escalation, or inconsistent clinical reasoning
In many serious cases, the record tells a story not just of what happened clinically, but of whether the process was controlled and responsive when urgency increased.
When a Birth Injury May Be Actionable
Families often hear that birth is unpredictable. That can be true. But unpredictability is not a substitute for appropriate care. In a legal review, the focus is usually on three linked questions:
- Standard of care: Did the providers act as reasonably careful providers would have acted under similar circumstances?
- Causation: Did a departure from the standard of care cause or materially contribute to the injury?
- Damages: What are the short- and long-term needs and losses associated with the injury?
In practical terms, potentially actionable cases often involve one or more of the following patterns:
- Concerning fetal monitoring that was not addressed promptly or escalated appropriately
- A prolonged period of fetal distress before delivery
- Delay in moving to C-section despite persistent warning signs
- Misuse of vacuum/forceps or continued attempts after failure became apparent
- Improper management of Pitocin or uterine hyperstimulation
- Poorly managed shoulder dystocia, especially where records reflect excessive traction or delayed maneuvers
- Failures in communication, staffing, or protocol that contributed to delayed intervention
A case does not require a “perfect storm” of errors. In many situations, the dispute centers on a narrower point: whether a reasonable intervention should have happened earlier, and whether that timing would likely have changed the outcome.
The Records That Often Answer the Question
Families are rarely given a complete explanation in real time. A thorough evaluation typically depends on objective documentation, such as fetal monitoring strips, prenatal and labor-and-delivery records, operative reports, NICU records, imaging, and consult notes.
In some cases, additional data (such as cord gas results) can provide important context. Medical experts then assess whether the documented course was consistent with appropriate care.
How Decof, Mega & Quinn, P.C. Helps Rhode Island Families Get Answers
When your child is injured at birth, you deserve clarity grounded in the medical record and the realities of obstetric decision-making.
Decof, Mega & Quinn, P.C. has represented Rhode Islanders in catastrophic injury and medical malpractice cases since 1975, with a legacy that includes more record-setting verdicts than any other firm in the state and the largest medical malpractice verdict in Rhode Island history ($62 million).
If you are questioning whether your child’s birth injury was preventable, the first step is a careful, informed review of what happened and why. To speak with a member of our team, call (401) 200-4059 or contact us online.