The causes, consequences and legal options after a brain injury at birth

A brain injury at birth can have a profound and lasting impact on a child and their family. In some cases, the effects are clear very soon after delivery. In others, concerns may only become apparent as a child grows and misses developmental milestones.

Birth-related brain injury is a broad term used to describe damage to a baby’s brain that occurs before, during or shortly after labour and delivery. It may be caused by a number of different factors including reduced oxygen supply, infection, stroke, or trauma during birth.

Understanding the possible cause of a birth injury matters because it can help families access the right treatment and support and establish whether different care during pregnancy, labour, delivery or the neonatal period may have changed the outcome.

How does brain damage occur during birth?

There are several ways in which a baby may suffer brain damage around the time of birth. Not every case will involve negligence, but where warning signs are missed or treatment is delayed, parents may wish to investigate what happened.

What is Hypoxic Ischaemic Encephalopathy?

Hypoxic ischaemic encephalopathy, often referred to as HIE, is a type of brain injury caused by a lack of oxygen and blood flow to the brain.

HIE can occur where a baby experiences oxygen deprivation before, during or shortly after birth. Possible causes include placental abruption, umbilical cord complications, uterine rupture, prolonged labour or severe infection.

The severity of HIE can vary. Some babies recover well, while others may develop long-term disabilities. In the most severe cases, HIE can be life-threatening.

Treatment may include specialist neonatal care, breathing support, seizure management and therapeutic hypothermia, sometimes known as cooling treatment. Cooling treatment can reduce the severity of brain injury in some babies when started soon after birth.

Read an example of a case which involved a HIE.

Possible long-term effects of birth-related brain injury

The long-term effects of a birth-related brain injury depend on the type, location and severity of the injury. Some children have relatively mild difficulties, while others require lifelong care and support.

Possible consequences include:

• Learning disabilities
• Epilepsy or seizures
• Mobility difficulties
• Problems with fine motor skills
• Feeding or swallowing problems
• Bladder and/or bowel incontinence
• Speech and communication difficulties
• Visual or hearing impairment
• Behavioural or developmental challenges

Cerebral palsy is one of the conditions most commonly associated with brain injury around the time of birth. It can affect movement, posture, coordination and muscle tone. Some children may walk independently, while others may need mobility aids, therapy, equipment, adaptations and round-the-clock care.

For families, the practical and emotional impact can be significant. Parents may need to coordinate medical appointments, therapy, education support, benefits, housing adaptations and long-term care planning.

How are birth-related brain injuries diagnosed?

Diagnosis will usually involve a combination of clinical assessment, investigations and ongoing developmental monitoring.

Why some parents investigate the circumstances of birth

When a baby suffers a brain injury, parents are often left with difficult questions such as:

• Was the injury avoidable?
• Were warning signs recognised?
• Should delivery have happened sooner?
• Was infection treated quickly enough?
• Did the hospital follow the correct procedures?

The Maternity and Newborn Safety Investigations programme (MNSI) is part of a national strategy to improve maternity safety across the NHS in England. NHS trusts are required to refer certain patient safety incidents where a baby is born at term (37 weeks onwards), following labour, with a potential severe brain injury which is diagnosed within the first seven days of life.

There is currently no similar scheme in Wales and many serious incidents in England will not meet the criteria for a MNSI referral. Hospitals may carry out their own internal investigations which can provide some information about what happened. Parents can also complain directly to the local health board under the Putting Things Right scheme in Wales, or to the complaints team at the relevant hospital in England. However, families may feel that this still leaves unanswered questions.

Parents therefore may wish to instruct a specialist solicitor to obtain an independent expert review of the maternity records, neonatal records and scans. This can help establish whether the care provided was reasonable and whether any failings caused or contributed to the injury.

Legal enquiries are not just about compensation. For many families, they are also about understanding what happened and securing support for the future. Where clinical negligence is established, a claim can help fund therapies, specialist equipment, adapted accommodation, professional care, education support and case management.

When to seek legal advice

Parents may wish to seek specialist legal advice if they are concerned that mistakes were made during pregnancy, labour, delivery or neonatal care. This may include concerns about:

• Delayed delivery
• Failure to act on an abnormal CTG or signs of fetal distress
• Delayed diagnosis or treatment of infection
• Problems with assisted delivery
• Failure to escalate concerns to senior staff
• Poor communication or inadequate investigation after the birth

A specialist birth injury solicitor can review the records, obtain expert evidence and advise whether there may be grounds for a clinical negligence claim.

Time limits can apply to clinical negligence claims, so it is sensible to seek advice as early as possible if you have concerns. The rules can be different where a claim involves a child, or where someone lacks capacity to manage their own legal affairs, so specialist advice is important.

How we can help

Our clinical negligence team supports families whose children have suffered serious injuries at birth. We understand how distressing it can be to ask questions about your child’s care while also managing their day-to-day needs.

We can help you investigate what happened, obtain expert medical evidence and consider whether a claim can be brought. If negligence is established, we will work to secure compensation that reflects your child’s needs now and in the future.