You usually can’t tell from the diagnosis alone. The only reliable way to know is through an independent review of your complete labor, delivery, and newborn records by qualified medical experts.
That review asks questions like. Did the oxygen deprivation happen around labor and delivery? Were there warning signs the care team should have recognized? Would acting sooner have prevented or reduced the brain injury?
Many parents sense something went wrong in the delivery room, only to be told nothing could have been done. When our team investigates hypoxic-ischemic encephalopathy (HIE) and oxygen deprivation injuries, separating unavoidable injuries from preventable ones is always the first job.
Why an HIE diagnosis doesn’t automatically mean malpractice
HIE describes a type of brain injury, not how it happened.
Some causes of newborn brain injury can’t be prevented even with excellent care. These include certain infections, placental problems that develop weeks before labor, and rare genetic or metabolic conditions. Some of these conditions can even look like HIE at first. One case report published through the National Library of Medicine describes a newborn first diagnosed with HIE who was later found to have a chromosomal abnormality.
That’s why an honest malpractice review never starts by assuming someone was at fault. It starts by finding out when and why the injury occurred.
What are the warning signs that your baby’s HIE may have been preventable?
No single sign proves negligence, but families who later learn their child’s HIE was preventable often remember several of these moments:
- Nurses repeatedly changing the mother’s position, giving oxygen, or stopping Pitocin
- Monitor alarms or staff saying the baby’s heart rate was “dropping”
- Long gaps before a doctor came to the bedside
- A decision to do a C-section, followed by a long wait before delivery
- Repeated or prolonged vacuum or forceps attempts
- A baby born pale, limp, or not breathing who needed resuscitation
- Low Apgar scores at 5 and 10 minutes
- Seizures in the first day of life
- Cooling therapy or a transfer to another hospital’s NICU for cooling
The first few items often mean staff were reacting to a worrying fetal heart rate. The key question is whether they reacted quickly and forcefully enough.
Be careful with vague explanations like “the cord was around the neck.” Umbilical cord complications are exactly the situations where the speed of the team’s response matters most.
How do medical experts determine when the brain injury happened?
Timing is a central medical question in most HIE cases. If the injury happened during labor, there may have been a window when a faster delivery would have protected your baby. If it happened days or weeks earlier, the delivery team may not be responsible.
Experts rely on several markers, many drawn from criteria published by the American College of Obstetricians and Gynecologists (ACOG):
- Umbilical cord blood gases: An umbilical artery pH below 7.0, or a base deficit of 12 mmol/L or more, points to significant oxygen deprivation close to delivery.
- Apgar scores: Scores below 5 at both 5 and 10 minutes after birth support an acute event.
- Injury to other organs: Oxygen loss around birth often also affects the kidneys, liver, heart, or blood clotting, which shows up in early lab results.
- The brain MRI pattern: Damage to the deep brain (basal ganglia and thalamus) often follows sudden, severe oxygen loss. “Watershed” injury can stem from partial, prolonged oxygen deprivation.
- A sentinel event: An emergency such as cord prolapse, placental abruption, or uterine rupture can result in further complications.
- The fetal heart rate tracing over time: A tracing that starts normal and worsens during labor is strong evidence your baby was healthy on arrival and was injured during labor.
That last point is often the most powerful. It shows the injury developed on the care team’s watch.
What “preventable” means in a malpractice case
In legal terms, “preventable” has two parts. First, the care fell below the standard of care, or what a reasonably careful provider would have done in the same situation.
Second, there must be causation. Acting correctly would, more likely than not, have avoided the injury or made it less severe.
For example, suppose the fetal monitor showed worsening distress for two hours, and a timely C-section would have delivered your baby before the injury window. Both parts may be met. In fact, delayed C-sections, missed monitor patterns, and Pitocin misuse are among the specific labor and delivery errors that may lead to HIE.
What if the hospital told you nothing went wrong?
This is very common, and it doesn’t settle the question. Hospital explanations come from the institution that could be responsible, and they rarely include an independent analysis of the fetal monitoring strips.
Many families only learn what really happened after an outside review. Feeling unsure or dismissed is not a sign you’re wrong to ask.
Questions worth asking your care team
You have every right to ask about your own care and your baby’s care. It helps to write down their answers, or bring these questions to a lawyer:
- Was continuous fetal heart rate monitoring used, and what did it show before delivery?
- When was the decision to deliver made, and when was your baby actually born?
- What were the umbilical cord blood gas results?
- What did the placenta pathology report find?
- When was HIE suspected, and when did cooling start?
- What did the brain MRI show, and when was it done?
Write down your own memories while they’re fresh, including times, names, what staff said, and who was in the room.
How the Killino Firm team finds out what happened
You don’t have to sort through medical jargon alone. Our review starts with a conversation about your pregnancy, labor, and how your child is doing today.
If the facts suggest a possible claim, we get your complete records, including the actual fetal monitoring strips and MRI images, not just summaries. Specialists in obstetrics, labor and delivery nursing, neonatology, and pediatric neuroradiology then review them. These records become the core of the evidence needed to prove an HIE case.
This entire review costs you nothing. We cover the cost of records and expert reviews upfront, and we’re paid only if we secure a recovery for your child.
You deserve real answers about your baby’s HIE
Attorney Jeffrey Killino and our team take on complex birth injury cases that other firms turn away. As a retired Board Member of the United Cerebral Palsy Association, Jeff understands the lifelong impact a preventable brain injury has on a child and family.
We have represented families nationwide and have offices in Philadelphia, Los Angeles, New York, Miami, and San Francisco. Whether your baby was just discharged from the NICU or is already in therapy, our HIE lawyers can help you understand what happened.
Get your free, confidential case evaluation. Call 24/7 at 878-788-7718 or reach our team online.
No upfront fees; client pays no legal fees unless a recovery is achieved.
The information provided on this site is not formal legal advice. Prior results do not guarantee a similar outcome. Confidential consultation is required.
