Fetal Monitoring Errors: Preventing Infant Brain Damage

The birth of a child should be a time of celebration, but for many families, that joy is cut short by a devastating diagnosis of permanent brain damage. In many cases, these injuries are not the result of unpreventable “nature,” but are instead the direct result of medical professionals failing to correctly interpret the baby’s “voice” during labor—the fetal heart rate.

When a baby is in the womb, their heart rate provides a real-time window into their well-being. When healthcare providers misinterpret or ignore non-reassuring fetal heart rate patterns, they lose the critical window of opportunity to intervene. This failure to meet the standard of care can lead to Hypoxic-Ischemic Encephalopathy (HIE), cerebral palsy, and lifelong neurological disabilities.

The medical team has a legal and ethical obligation to maintain vigilant observation of these monitors. When a “non-reassuring” pattern emerges, it indicates that the baby is no longer compensating for the stress of labor and is beginning to suffer from oxygen deprivation during labor. If your child suffered a birth injury due to monitoring errors, pursuing a birth injury malpractice lawsuit may be the only way to secure the resources they need for their future.

What Is Electronic Fetal Monitoring (EFM)?

Electronic Fetal Monitoring (EFM) is the standard method used in hospitals to track a baby’s heart rate and the mother’s contractions during labor. The monitor produces a continuous “strip” of data—a digital and paper record of how the baby’s heart reacts to the mechanical stress of contractions. This technology was designed specifically to detect early signs of oxygen deprivation so that doctors could intervene before preventable infant brain damage occurs.

Under normal conditions, a healthy, or “reassuring,” fetal heart rate typically ranges between 110 and 160 beats per minute (bpm). It should also demonstrate “variability,” which refers to the small, healthy fluctuations in the heart rate from beat to beat. This variability is a sign that the baby’s autonomic nervous system is intact and actively regulating the heart in response to the environment. When these patterns change—becoming too fast, too slow, or excessively smooth—it is a primary indicator that the baby is struggling to maintain adequate oxygen levels in the blood and brain.

Understanding “Non-Reassuring” Patterns

The term “non-reassuring fetal heart rate” (often referred to as fetal distress) is used when the monitoring strip indicates the baby may not be tolerating the stress of labor. These patterns serve as an early warning system for hypoxia (low oxygen) or asphyxia (a total lack of oxygen). If left unaddressed, these conditions are the leading HIE (Hypoxic-Ischemic Encephalopathy) causes, resulting in the death of brain cells and permanent neurological impairment.

Key Warning Signs on a Fetal Monitor:

Late Decelerations on Fetal Monitor: These are dips in the heart rate that occur after the peak of a contraction and return to baseline only after the contraction has ended. These are particularly dangerous because they often signal uteroplacental insufficiency symptoms—meaning the placenta is no longer providing enough oxygen to the baby.
Absent or Minimal Variability: Healthy babies have a jagged heart rate line; a smooth or flat line (absent variability) indicates the baby’s brain is becoming too exhausted or damaged to regulate the heart. This is often viewed by experts as a “silent” emergency.
Bradycardia: A baseline heart rate below 110 bpm is considered below the normal range. Clinically significant bradycardia—typically defined as a heart rate below 80 bpm sustained for three minutes or longer—is a medical emergency that can indicate severe oxygen deprivation. If the heart rate drops to these critical levels and stays low, the baby is in immediate danger of cardiac arrest and permanent brain damage.
Tachycardia: A baseline heart rate above 160 bpm (some guidelines use 150 bpm as the threshold). While tachycardia can be caused by maternal fever or medication, it can also be an early sign of hypoxia as the baby’s heart works overtime to compensate for low oxygen levels.
Prolonged Decelerations: A drop in heart rate lasting more than two minutes but less than ten. These are often caused by umbilical cord compression or placental abruption and require immediate clinical action.

The Cascade of Injury: How Errors Lead to Brain Damage

The fetal brain is incredibly sensitive to oxygen levels. During a contraction, blood flow to the placenta is naturally restricted, briefly reducing the oxygen supply. A healthy baby has enough “reserve” to handle this brief dip without issue. However, if the baby is already compromised—due to a tangled cord, placental issues, or the over-use of labor-inducing drugs—each subsequent contraction further depletes their oxygen reserves, leading to a state of metabolic acidosis.

Brain damage can occur in three primary ways due to fetal heart rate monitoring errors:

Failure to Recognize Distress: Clinical negligence often begins with a simple failure of observation. A nurse or doctor may misread the strip, dismissing a dangerous “late” deceleration as a benign “early” deceleration, or failing to notice that the baby’s variability has shifted from moderate to minimal over several hours.
Delayed Intervention: Even when distress is recognized and documented, medical teams may wait too long to perform an emergency C-section. A delayed emergency C-section malpractice claim often arises when teams attempt “conservative” measures for too long while the baby’s brain continues to starve for oxygen. Brain cells begin to die within minutes of severe oxygen deprivation, and delays in intervention—even relatively brief ones—can mean the difference between a healthy child and one with permanent neurological damage. The extent of injury depends on both the severity and duration of oxygen deprivation.

Misidentifying Maternal Heart Rate: This is a catastrophic but preventable error where the monitor accidentally picks up the mother’s pulse (usually 70-80 bpm) instead of the baby’s. If a doctor mistakes the mother’s healthy heart rate for the baby’s, they may believe the baby is fine while the infant is actually experiencing profound bradycardia or even death in the womb.

The Role of Pitocin and Uterine Tachysystole

Pitocin is a synthetic hormone used to induce or strengthen labor contractions. While it is one of the most common drugs used in delivery rooms, it carries significant risks that require constant monitoring. If Pitocin causes contractions to be too frequent, too strong, or too long—a condition called uterine tachysystole—the placenta does not have enough time to “recharge” with oxygen-rich blood between contractions.

Medical malpractice often occurs when hospital staff continue to increase Pitocin levels, or fail to turn the medication off, despite a non-reassuring fetal heart rate. This effectively “strangles” the baby’s oxygen supply by forcing the uterus to stay in a state of near-constant contraction. In these instances, the medical team is actively contributing to the baby’s distress rather than alleviating it.

Malpractice and the Standard of Care

Medical negligence during labor and delivery occurs when a healthcare provider deviates from the standard of care for fetal monitoring—the level of care that a reasonably competent professional would have provided under similar circumstances. The law requires that monitors are not only used but are also interpreted correctly and acted upon within a medically appropriate timeframe. Failure to meet these standards may also form the basis of a vacuum extractor injury lawsuit if delivery tools were misused in response to unaddressed distress.

In fetal monitoring cases, malpractice often involves:

Inadequate Training: Staff failing to understand the difference between Category I (normal), Category II (intermediate), and Category III (abnormal) tracings.
Failure to Communicate: A nurse failing to notify the attending obstetrician or “chain of command” when a heart rate strip becomes non-reassuring.
“Alarm Fatigue”: A systemic issue where staff become desensitized to monitor alarms or fail to watch the monitor continuously during high-risk labors.

Symptoms of Fetal Distress-Related Injury

If a monitoring error occurred, the baby may show immediate signs of injury at birth. These physical markers are often the first clues that a lack of oxygen occurred during the labor process. Families should look for the following:

Low Apgar Scores: Specifically at the 5-minute and 10-minute marks, which suggest the baby had difficulty transitioning to life outside the womb.
Need for Resuscitation: The baby is born “blue” or “limp” and requires a breathing tube, oxygen, or chest compressions immediately after birth.
Neonatal Seizures: Abnormal electrical activity in the brain occurring within the first 24 to 48 hours of life is one of the most significant indicators of HIE.
Hypotonia: A “floppy” muscle tone or a weak sucking reflex, indicating that the neurological pathways governing muscle control have been damaged.
Organ Dysfunction: Signs that the kidneys, liver, or heart were also affected by the lack of oxygen, as the body tried to shunt blood only to the most vital organs during the period of distress.

Proving a Fetal Monitoring Malpractice Claim

A diagnosis of HIE or cerebral palsy from birth negligence is not enough to prove malpractice on its own. To hold a hospital or doctor accountable, your legal team must prove two things: first, that the monitoring strip showed clear signs of distress that required action, and second, that a timely intervention would have prevented the brain damage from occurring.

This requires a meticulous review of the electronic fetal monitoring data by medical experts. It is also important to understand the difference between birth defects and birth injuries when determining if medical negligence played a role. These strips provide an objective, minute-by-minute record of the baby’s condition. If you are considering suing a hospital for HIE, these records are the foundation of your case.

Seek an Expert Medical and Legal Review

If your child has been diagnosed with a brain injury and you suspect that “non-reassuring” heart rates were ignored during labor, it is vital to consult a specialized HIE attorney as soon as possible. Hospitals are only required to keep certain records for a limited time, and the statute of limitations for filing a claim varies by state.

Legal action provides more than just accountability; it provides the means to care for your child. Holding negligent providers accountable ensures your child has the financial support for lifelong therapies, specialized equipment, and the around-the-clock medical care they may require.

The Powless Law Firm is an Indiana law firm that represents victims and families statewide in serious cases involving birth injury, medical negligence, personal injury, nursing home neglect, and wrongful death. If you have concerns about nursing home negligence, please contact us at (877) 469-2864. Together, we can make a difference.

The Powless Law Firm represents families across Indiana—from Indianapolis to Fort Wayne and Evansville—in cases involving birth trauma lawsuits, medical malpractice birth injury claims, and cerebral palsy lawsuits. As experienced medical malpractice attorneys in Indiana, we are here to listen to your story and help you find the way forward.

Call (877) 469-2864 now for a free, confidential consultation. There is no fee unless we win your case.