Compensation Lawsuit Due to Medical Malpractice During Childbirth and Permanent Disability in Infant

What is medical malpractice during childbirth?

Medical malpractice during childbirth refers to harm to the mother or baby caused by a violation of medical standards during pregnancy monitoring, labor, decision-making regarding the mode of delivery, monitoring of the mother and baby, assessment of fetal heart rate, timely decision-making for a cesarean section, postpartum neonatal intervention, or management of complications.

The birthing process is one of the most sensitive areas of health law because it simultaneously protects the health of two people: the mother and the baby. Even a slight delay during childbirth can lead to oxygen deprivation, brain damage, cerebral palsy, epilepsy, developmental delay, or permanent physical or mental disability in the baby. For the mother, it can result in serious consequences such as bleeding, uterine rupture, infection, organ loss, the need for intensive care, or death.

The Ministry of Health's circular regarding the "Guidelines for the Management of Childbirth and Cesarean Sections" states that prenatal care, emergency obstetric care, childbirth, and postpartum care services are of undeniable importance in preventing maternal and infant deaths; it also states that the guidelines were prepared to ensure uniformity in childbirth services and to provide guidance in clinical practice.

Therefore, when adverse outcomes occur during childbirth, legal assessment is not solely based on the claim that "the baby was born disabled." The assessment also considers whether pregnancy monitoring was performed correctly, whether birth risks were identified beforehand, whether NST/CTG recordings were interpreted correctly, whether signs of fetal distress were observed, whether the decision for a cesarean section was delayed, whether the newborn received timely intervention after birth, and whether there is a causal link between the harm and medical malpractice.

Are all infant birth defects due to medical error?

No. A baby being born with a permanent disability doesn't always mean doctor or hospital error. In some babies, genetic diseases, congenital anomalies, infections in the womb, placental problems, premature birth, low birth weight, maternal illnesses during pregnancy, or neurological causes independent of birth can lead to permanent disability.

For example, cerebral palsy is not always due to oxygen deprivation during birth. The NICE guidelines explain that cerebral palsy can be associated with brain damage or developmental problems occurring during the baby's brain development, before, during, or shortly after birth; and that it can affect movement, balance, coordination, speech, swallowing, vision, hearing, and cognitive functions to varying degrees.

ACOG's report on neonatal encephalopathy and neurological outcomes also indicates that there are multiple causal pathways leading to cerebral palsy, and that a broader and more careful assessment is needed when establishing a link between intrapartum hypoxic events and cerebral palsy.

Therefore, in birth defect cases, the fundamental issue is not merely the existence of a disability in the baby, but whether this disability resulted from a preventable medical error or delay during the birthing process. If brain damage in the baby developed before birth and the delivery team acted in accordance with all standards, liability for compensation may not arise. However, liability arises if fetal distress was not detected during birth, the decision for a cesarean section was delayed, no intervention was made despite the baby being deprived of oxygen, or neonatal resuscitation was inadequately performed.

Most Common Types of Medical Errors During Childbirth

Medical errors during childbirth can occur at many different stages. The first stage is pregnancy monitoring. The mother's conditions such as high blood pressure, diabetes, preeclampsia, multiple pregnancy, fetal growth restriction, large baby, placental anomaly, breech presentation, previous cesarean section history, or risk of premature birth must be properly assessed. If a high-risk pregnancy is not properly monitored, serious problems can occur during childbirth.

The second stage is managing labor. The progress of labor, uterine contractions, cervical dilation, fetal descent, maternal vital signs, and fetal heart rate should be regularly monitored. If labor is not progressing, if the baby appears to be in distress, or if there is a risk to the mother or baby, the mode of delivery should be re-evaluated.

The third stage is making the decision for a cesarean section in a timely manner. If there is fetal distress, abnormal fetal heart rate, meconium-stained amniotic fluid, failure of labor to progress, cord prolapse, placental abruption, risk of uterine rupture, or life-threatening conditions for the mother, the decision for a cesarean section should not be delayed. The Ministry of Health's 2026 clinical guidelines for childbirth define fetal distress as signs of insufficient oxygenation in the fetus during pregnancy or labor; abnormalities in fetal heart rate, decreased fetal movement, and meconium-stained amniotic fluid are listed among the signs of fetal distress. The guidelines also clearly state that a cesarean section should be performed within 30 minutes of a pregnancy diagnosed with fetal distress.

The fourth stage is postnatal neonatal intervention. If the baby is not breathing at birth, has a low heart rate, is cyanotic, hypotonic, or requires resuscitation, rapid and appropriate neonatal resuscitation should be performed. Birth defects sometimes occur not before birth, but due to insufficient intervention in the first few minutes after birth.

Failure to Recognize Fetal Distress

Fetal distress is one of the most important concepts in birth defect cases. Failure to recognize signs that indicate the baby is not receiving enough oxygen in the womb can be critical in terms of permanent brain damage and disability.

In assessing fetal distress, NST/CTG recordings, fetal heart rate patterns, uterine contractions, meconium-stained fluid, maternal blood pressure, fever, bleeding, progress of labor, and clinical findings are all evaluated together. If there are recurrent decelerations in fetal heart rate, prolonged bradycardia, loss of variability, or other suspicious findings, the delivery team must act quickly.

The crucial point here is whether fetal distress was ignored despite being recorded. If the CTG recording is corrupted, the device is malfunctioning, no recording was made, the recorded data is missing from the file, or the recording was not interpreted, the hospital's liability for the records also comes into question. In maternity cases, CTG/NST records are often one of the most important pieces of evidence in the case file.

Compensation for Delayed Cesarean Section Decision

One of the most common allegations of medical malpractice during childbirth is a delayed decision for a cesarean section. A normal delivery may have been planned; however, the baby's or mother's condition may change during labor. In this case, the doctor needs to re-evaluate the delivery method.

According to the Ministry of Health's Mother-Friendly Hospital guide and the Management Guide for Childbirth and Cesarean Section, cesarean section indications are considered as maternal and fetal indications; fetal distress is listed among fetal indications. The same source states that the mode of delivery should be individualized according to the specifics of the case, taking into account the conditions of both the mother and the baby.

Therefore, the doctor's defense of "we expected a normal delivery" is not always sufficient. The decision for a normal delivery may be correct initially; however, if a cesarean section is not performed when labor is not progressing, the baby is in distress, or the mother is at risk, liability may arise.

In cases of alleged delayed cesarean section, the following questions are asked: When did the first risk factor emerge? When was the doctor informed? When was the decision for a cesarean section made? When was the operating room prepared? When was the baby delivered? Why was the time between the decision and delivery prolonged? What was the baby's Apgar score at birth? Was there acidosis in the cord blood gas analysis? Was the baby requiring neonatal intensive care? Was there any evidence of hypoxic-ischemic damage on the brain MRI?

The Importance of NST and CTG Recordings

NST and CTG recordings are essential evidence in assessing the baby's condition during labor. These recordings show the baby's heart rate and its relationship to uterine contractions. In birth defect cases, expert witnesses typically use these recordings to assess "the moment the baby was in distress" and "when intervention was necessary.".

If CTG records are not properly maintained, if records are missing during the critical hours of labor, if records cannot be provided by the hospital, or if there is suspicion of tampering with the records, this should not be interpreted against the patient. The Patient Rights Regulation stipulates that the patient has the right to directly review and obtain copies of files and records related to their health status, either directly or through their representative or legal guardian.

Therefore, families claiming birth defects should request not only the epicrisis report but also the birth monitoring form, partogram, NST/CTG outputs, nurse/midwife observation records, doctor's notes, surgical notes, newborn records, cord blood gas analysis, Apgar scores, and neonatal intensive care unit documents.

Oxygen Deprivation and Cerebral Palsy in Infants

Oxygen deprivation at birth can lead to hypoxic-ischemic encephalopathy due to insufficient oxygen reaching the baby's brain. In severe cases, this process can result in permanent neurological damage, cerebral palsy, epilepsy, developmental delay, feeding and swallowing problems, and vision or hearing problems.

However, not all cases of cerebral palsy are due to oxygen deprivation at birth. The NICE guidelines state that the causes of cerebral palsy can be multifactorial, with factors such as prenatal brain development problems, infection, difficult or premature birth playing a role. Furthermore, NICE recommendations explain that when evaluating cerebral palsy associated with perinatal hypoxic-ischemic injury, neonatal encephalopathy, MRI findings, and risk factors should be considered together.

Therefore, in a compensation lawsuit, the reason for the diagnosis is as important as the diagnosis itself. If the baby shows signs of hypoxic-ischemic encephalopathy, a low Apgar score, acidosis, abnormal cord blood gas analysis, early seizures, admission to the neonatal intensive care unit, a damage pattern consistent with birth on brain MRI, and fetal distress findings on CTG, the birth process should be examined in detail.

Shoulder Dysfunction, Brachial Plexus Injury, and Birth Trauma

Permanent disabilities at birth are not solely due to oxygen deprivation. Nerve damage, fractures, brain hemorrhage, or trauma can occur in the baby due to shoulder dystocia, difficult delivery, vacuum-forceps application, entrapment in the birth canal, or incorrect maneuvers.

The doctor should plan the delivery accordingly, especially if there are risk factors such as a large baby, maternal diabetes, a history of previous births, prolonged labor, difficult shoulder delivery, or failure of labor to progress. Failure to perform appropriate maneuvers during shoulder dystocia, excessive traction, or continuing with vaginal delivery when a cesarean section is indicated can cause brachial plexus damage.

In such files, birth weight estimation, ultrasound records, maternal diabetes monitoring, birth tracking form, birth notes, maneuvers performed during delivery, fetal arm movements after birth, orthopedic/neurological reports, and EMG results are important.

Birth Error at Private Hospital

If the birth takes place in a private hospital, the liability of the private hospital and the doctor is assessed within the framework of private law. A private hospital may be held liable not only for the obstetrician's mistakes but also for deficiencies in the midwife's, nurse's, anesthesia team's, neonatologist's, operating room, intensive care unit's, laboratory's, record-keeping system's, and organizational aspects.

A private hospital providing maternity services must have adequate staff, have the necessary specialists available for high-risk births, ensure access to an operating room for emergency cesarean sections, have a neonatal resuscitation team, and maintain complete records. If the baby requires neonatal intensive care after birth, the hospital must meet this need promptly or arrange for referral to an appropriate center.

In private hospitals, consumer law aspects may also come into play. However, cases involving serious harm such as permanent disability in the baby should not be treated solely as "defective service" or a refund of the delivery fee. In these cases, comprehensive damages such as lifelong care, rehabilitation, loss of earning capacity, education expenses, and compensation for non-pecuniary losses should be evaluated.

Birth Error at State Hospital

If the birth takes place in a state hospital, city hospital, training and research hospital, or public university hospital, the legal recourse is in most cases within the scope of administrative law. Maternity services provided in public hospitals are a public service. If this service is poorly performed, delayed, or not provided at all, the administration's fault in providing the service arises.

According to Article 13 of the Administrative Procedure Law No. 2577, individuals whose rights have been violated by administrative actions must apply to the relevant administration for the fulfillment of their rights within one year from the date they learned of the action, and in any case within five years from the date of the action, before filing a lawsuit; if the request is rejected or no response is given within thirty days, a lawsuit may be filed.

Therefore, if there is an allegation of birth defect at a public hospital, instead of directly filing a lawsuit in the judicial system, it is preferable to apply to the relevant administration and then pursue a full judicial review case in the administrative court. The application should clearly state the chronology of the event, the allegation of birth defect, the baby's disability, the requested records, and the compensation items.

What compensation can be claimed due to a birth defect?

If a baby suffers a permanent disability, the compensation categories are very extensive. This is because injury sustained at birth often affects the child's entire life. Therefore, not only birth expenses or initial treatment costs should be calculated, but also the child's lifelong care and support needs.

Compensation claims may include expenses for neonatal intensive care, surgery and treatment costs, physical therapy and rehabilitation expenses, special education expenses, medication and medical device expenses, orthopedic devices, wheelchairs, orthotics and prosthetics, speech therapy, occupational therapy, psychological support, caregiver expenses, transportation expenses, housing and vehicle modification costs, future treatment expenses, loss of earning capacity, and disruption of economic future.

According to the Turkish Code of Obligations, in cases of bodily harm, claims can be made for medical expenses, loss of earnings, losses arising from the reduction or loss of working capacity, and losses arising from the disruption of economic future. The same Code also stipulates that in cases of damage to bodily integrity, an appropriate amount of moral damages may be awarded.

In terms of moral damages, an assessment should be made from the perspective of both the child and the parents. For the child, permanent disability, lifelong dependence, limited mobility, pain, difficulty participating in social life, and violation of personal rights are important factors. For the parents, trauma experienced during childbirth, profound grief due to the child's permanent disability, the burden of care, and the radical change in family life may constitute grounds for moral damages.

Lifetime Child Care Expenses

The most significant difference in birth defect cases is that the damage extends over many years. If the baby has cerebral palsy, severe neurological damage, intellectual disability, epilepsy, or loss of movement, the child may require lifelong care. In this case, compensation cannot be calculated solely based on current expenses.

The court must assess the child's age, disability rate, care needs, treatment and rehabilitation requirements, life expectancy, special education needs, and future economic losses through an expert. Whether the child will be able to work in the future, whether they will require continuous assistance, and whether care will be provided by the family or a professional caregiver are important factors in calculating compensation.

Therefore, birth defect cases may require a combination of assessments from pediatric neurology, physical therapy, child development, special education, care, actuarial science, and forensic medicine.

How is a birth defect proven?

In birth defect cases, medical records form the basis of proof. If a family has any suspicions after birth, they should request all records promptly. The sooner the records are collected, the more accurate the case will be.

The required documents include: pregnancy records, ultrasound reports, NST/CTG records, birth monitoring form, partogram, doctor and midwife notes, maternal vital signs, fetal heart rate records, time of cesarean section decision, surgery notes, anesthesia form, time of birth, Apgar scores, cord blood gas, neonatal resuscitation records, neonatal intensive care unit discharge summary, brain MRI reports, EEG, pediatric neurology reports, physical therapy reports, and disability health board report.

The Patient Rights Regulation covers all public and private institutions providing healthcare services; the patient or their legal representative can review and obtain copies of their health file and records. Therefore, the hospital cannot say "we cannot provide records". Since the child is a minor, the parents or guardian can request these records.

The Importance of Expert Reports

In birth defect cases, expert reports determine the outcome of the case. A standard expert examination may not suffice in these cases. The expert panel should include a gynecologist, a perinatologist, a neonatologist, a pediatric neurologist, a radiologist, a forensic medicine specialist, and, depending on the nature of the case, a midwifery/nursing specialist.

The expert should answer the following questions: Was the pregnancy high-risk? Was the high-risk pregnancy monitored appropriately? Was the labor managed correctly? Were there signs of fetal distress on the NST/CTG recordings? When did these signs begin? When should the doctor have intervened? Was the decision for a cesarean section delayed? Did the baby show signs of hypoxic-ischemic damage at birth? Are the brain MRI findings consistent with oxygen deprivation during birth? Is there a causal link between the current disability and the error in the delivery process?

Objections should be raised to incomplete expert reports. In particular, general statements such as "cerebral palsy can have many causes" or "birth is a risky process" are insufficient. The report should evaluate concrete medical records, CTG timeline, cord blood gas analysis, Apgar scores, neonatal intensive care unit (ICU) process, and neurological findings together.

Can a criminal investigation be opened?

If a baby suffers severe permanent disability due to a birth defect, a criminal investigation may also be initiated. Depending on the nature of the incident, provisions regarding negligent injury or, if death occurs, negligent homicide will be discussed. Article 89 of the Turkish Penal Code regulates negligent injury, and as of 2025, the basic penalty range in the current text is imprisonment from four months to two years or a judicial fine.

However, special authorization processes must be considered in investigations into medical procedures and practices carried out by healthcare professionals. According to Annex 18 of the Basic Law on Health Services No. 3359, the Professional Responsibility Board's investigation authorization process applies to investigations into medical procedures and practices related to examination, diagnosis, and treatment carried out by physicians, dentists, and other healthcare professionals working in public or private healthcare institutions.

Criminal investigations and civil lawsuits are different. A criminal case investigates the criminal liability of healthcare personnel. A civil lawsuit, on the other hand, aims to compensate the child and family for their material and moral damages. The forensic medical report or expert report obtained in the criminal case can be important evidence in a civil lawsuit.

What should families do?

If a newborn baby shows signs of oxygen deprivation, requires intensive care, experiences seizures, cyanosis, has a low Apgar score, brain damage, developmental delay, or is suspected of having cerebral palsy, families should immediately gather all medical records. Verbal explanations alone should not suffice.

The first step is to request the complete medical records of both the mother and baby from the hospital where the birth took place. The second step is to document the child's current health status. Reports from pediatric neurology, physical therapy, child development, special education, and disability health boards should be obtained. The third step is to determine the correct legal course of action based on whether the birth was at a private or public hospital.

The fourth step is to prepare a complete list of damages. In such cases, claiming only moral damages is insufficient. Detailed calculations must be made for the child's lifelong care, rehabilitation, special education, equipment, treatment, caregiver costs, and loss of income.

Conclusion: Medical error during childbirth can affect a baby's entire life

Medical malpractice during childbirth is one of the most serious types of lawsuits in health law. This is because negligence during delivery can lead to permanent disability for the baby lasting a lifetime, disrupt the family's life, and result in very high care costs.

Not every infant disability is a birth defect. However, hospital and healthcare personnel liability may arise in cases of undetected fetal distress, incorrect interpretation of NST/CTG recordings, delayed decision for cesarean section, improper management of labor, incorrect intervention for shoulder dystocia, inadequate neonatal resuscitation, or delayed transfer to intensive care after birth.

A successful legal process in such cases is possible not only with the claim that "the baby was harmed during birth," but also through a minute-by-minute examination of the birth process, evaluation of NST/CTG recordings, cord blood gas analysis, Apgar scores, neonatal intensive care unit records, brain MRI findings, and a combined analysis of the child's current disability status.

If the baby suffers a permanent disability, the family can claim compensation for treatment costs, physical therapy and rehabilitation expenses, special education costs, caregiver expenses, medical devices, lifelong care needs, loss of earning capacity, disruption of economic future, and moral damages. In private hospitals, private law and consumer law should be considered; in state hospitals, administrative appeals and full judicial review should be pursued.