Medical Negligence During Childbirth

Avoidable birth injuries

South Africa is experiencing an unacceptably high perinatal mortality rate and high incidences of obstetric medical negligence. This is according to a joint submission to the United Nations Special Rapporteur on Violence Against Women.

The issue of oxygen deprivation in newborns is especially alarming.

The submission notes that “…almost half of the deaths that occur due to asphyxia – a complication that can cause cerebral palsy – were preventable…”

What is equally concerning is the sustained upward trajectory in the perinatal mortality rate.

The latest Stats SA report noted a 16.6% rise in early neonatal deaths between 1997 and 2020. Most deaths were due to respiratory and cardiovascular issues, and occurred within the first three days of life.

Cerebral palsy driving medical negligence claims  

In a 2025 Cape Times article, key contributors to the stubbornly high incidence of cerebral palsy in low- to mid-income countries, like South Africa, were identified as “perinatal complications, limited access to skilled obstetric care, and deep social and economic inequalities”.

As the growing number of medical negligence claims suggests, public hospitals, in particular, are struggling to provide the accepted level of care.  

According to The South African Society of Obstetricians and Gynaecologists, cerebral palsy and other birth-related injuries account for more than 40% of claims against state hospitals.

In the period between April 2024 and March 2025, the Department of Health paid out more than R1.1 billion in medico-legal claims. Of the total number of claims, 174 involved obstetric incidences leading to neonatal encephalopathy or cerebral palsy.

Avoidable maternal injuries and deaths

It’s not just babies who are at increased risk in South African hospitals. Mothers are too.

In state hospitals, reports of obstetric medical malpractice are widespread. They range from lack of monitoring and delayed medical response right through to verbal and physical abuse.

South Africa’s latest available maternal mortality ratio (MMR) was 109 deaths per 100,000 live births. Although this figure has decreased over the past decade, the COVID-19 pandemic pushed the 2019 ratio of 98 deaths per 100,000 live births up by almost 50% in 2021.

Even with the MMR returning to pre-pandemic levels, it’s still many times higher than the global average of 12 deaths per 100,000 live births in high-income countries.

What is medical negligence during childbirth?

If a medical practitioner fails to meet accepted standards of treatment and care expected in the specific situation and either acts or fails to act in a way that results in injury to the patient, it may constitute medical negligence.

Not all birth injuries are the result of medical negligence. However, it’s clear that in South Africa, a large number of birth-related injuries, to both mothers and their babies, could have been prevented through more diligent medical care.

Where a birth injury is a result of medical negligence, the responsible medical professional and/or hospital may be legally liable to pay compensation to the victim or their immediate family.

Avoidable medical errors leading to birth injuries

Among the most common, avoidable errors made by physicians and obstetricians during childbirth are:

• failure to monitor the birth process and anticipate birth complications, such as oxygen deprivation due to a tangled umbilical cord or difficulty in delivery due to the infant’s size
• failure to respond to signs of fetal distress
• failure to order a C-section when necessary
• incompetent use of forceps, a vacuum extractor or other tools
• incorrect use of medication such as oxytocin – a drug widely used in South Africa to induce labour or speed up delivery.

Common birth injuries due to negligence

Birth injuries range from minor to severe or fatal, and in some cases have life-long consequences for babies, mothers and their families.

Oxygen deprivation

Oxygen deprivation is a leading cause of birth injuries to South African babies.

It commonly occurs when the placenta separates prematurely, the umbilical cord becomes entangled around the baby’s neck or the baby doesn’t start breathing independently after delivery.

Oxygen deprivation can lead to significant brain damage, hearing impairment, partial or total blindness, learning disabilities, chronic seizures, developmental problems and even death.

It is also a prevalent cause of cerebral palsy, which is one of the most common injuries resulting from medical negligence during childbirth.

Brachial palsy, Erb’s palsy and Klumpke’s palsy

These injuries occur when the nerve bundle responsible for movement in the arms and hands (the brachial plexus) is damaged. See our articles on Erb’s Palsy and Brachial Plexus injury claims for more information.

The most common cause is shoulder dystocia, a condition that occurs when the infant’s shoulders become trapped behind the mother’s pelvic bone during delivery.

This may result from a medical practitioner pulling too hard, or pulling incorrectly, during delivery.

Facial paralysis

If too much pressure is put on the infant’s face during birth, nerve damage may occur, causing facial paralysis. This most often occurs when a physician uses forceps or vacuum extraction to deliver the baby.

Fractures

Bone fractures can occur during delivery, particularly fractures to the clavicle. While these may be unavoidable, they can occur when the physician fails to spot complications and perform a C-section, or pulls the infant too hard.

Injuries to the mother due to medical malpractice during childbirth

Serious injuries and maternal deaths most often occur as a result of C-sections.

Medical negligence or incompetence during C-sections can lead to mothers dying from blood loss. They may also cause injury to organs such as the intestines and bladder and result in blood clots, uterine rupture and post-partum haemorrhage.

If incorrect suturing is performed after an episiotomy or a C-section, this may result in tears, long-term discomfort and other complications.

Other common birth injuries suffered by mothers are vaginal tearing, obstetric anal sphincter injury (OASI) and forceps injuries to the urethra, bladder, genital tract and perineum.

Long-term impact of maternal and birth injuries

The immediate trauma and longer-term impacts for victims and their families cannot be overstated.

Beyond suffering chronic pain, mothers have to deal with the severe emotional and psychological distress associated with a difficult birth and/or injured baby.

Long-term physical complications can include incontinence, pelvic floor dysfunction and painful intercourse.

Babies may suffer lifelong physical and/or mental disabilities requiring costly rehabilitation and treatment, and ongoing specialised care. Many may never have the capacity to hold down a job or earn an income.

Public vs. private healthcare claims for birth injuries

Birth injury claims in South Africa differ depending on where the incident occurred – whether at a private or public healthcare facility.

In public hospitals, the relevant provincial health department is liable for acts or omissions by healthcare workers acting in their official capacity.

Claims are subject to strict statutory requirements and time limits.

In private facilities, individual doctors or nurses, or the facility itself, can be held liable for damages. Payouts are made through the hospital’s, or individual’s, indemnity insurance.  

Click here to learn more about requirements specific to claims against state institutions.

How long do you have to claim?

Barring a few exceptions, medical negligence claims must be lodged within 3 years of the date of the incident.

What to do if you have a claim for medical negligence during childbirth

Medical malpractice claims are complex and require specialist expertise to prosecute successfully.

If you or your baby has sustained a serious injury during labour and/or the delivery process as a result of medical malpractice, contact us at DSC Attorneys for the best possible legal assistance.