When a baby's oxygen supply is cut off for just a few minutes during childbirth, their entire life can change. Cerebral palsy, brain lesion disability, intellectual disability—when such outcomes occur, many parents give up, thinking "it was unavoidable." However, medical malpractice during delivery results in the largest damages awards among medical lawsuits, and recent court decisions have trended in favor of victims. When fetal heart rate monitoring is inadequate, when natural delivery is forced despite the mother's request for a cesarean section, or when oxytocin is overdosed—in all these situations, hospitals can be held liable. Damages can exceed 600 million to 1 billion KRW.

1. Why birth injury cases differ from other medical malpractice

Birth injury cases involve overwhelmingly larger damages than other medical malpractice cases. For children with severe cerebral palsy, lifetime medical, rehabilitation, and caregiving costs reach hundreds of millions to tens of billions of KRW, and these are reflected directly in damages awards.

(1) Scale of damages: Lifetime medical and caregiving costs are compensable

When calculating damages for severely disabled children with cerebral palsy, courts comprehensively consider (i) future medical expenses, (ii) rehabilitation costs, (iii) replacement costs for assistive devices, (iv) caregiver (custodial care) expenses, and (v) lost future income. When summed over the average lifespan, this amount reaches hundreds of millions to tens of billions of KRW. In May 2025, the Seoul Central District Court ordered damages of approximately 642.39 million KRW for a child with brain damage caused by negligent fetal heart monitoring (Case No. 2021Gahap578407, May 14, 2025).

(2) Criminal and civil proceedings often proceed simultaneously

When delivery malpractice is serious, criminal complaints for occupational negligent injury or homicide (업무상과실치상·치사) frequently accompany civil damages claims. Because criminal judgments help prove negligence in civil litigation, both procedures must be strategically designed together.

2. Legal standards you should know

(1) Duty of fetal well-being monitoring: NST and CTG are not optional

During delivery, medical personnel must continuously monitor fetal heart rate (FHR) using an electronic fetal monitoring device (CTG). When abnormal patterns appear in the fetal heart rate—minimal variability, persistent deceleration, late deceleration—immediate response is required. The court recognized medical negligence on the grounds that "the medical staff failed to recognize or properly evaluate a state where fetal well-being was not assured for more than one hour" (Seoul Central District Court, Case No. 2021Gahap578407, May 14, 2025).

(2) Delayed cesarean section decisions: refusing the mother's request is negligence

When medical staff force natural delivery despite the mother's request for a cesarean section and the fetus is injured as a result, hospital negligence is recognized. The Suwon High Court ordered damages of approximately 620.99 million KRW in a case where, during 11 hours of difficult labor, the mother twice requested a cesarean section but medical staff refused and forced natural delivery, with no NST records during the final 3 hours and 20 minutes of delivery (Suwon High Court, September 19, 2024).

(3) Oxytocin administration negligence: dosage, timing, and monitoring can all be at issue

Oxytocin, used for induced delivery, requires (i) proper indication confirmation, (ii) dosage control, and (iii) continuous monitoring of fetal status during administration. When abnormal fetal heart rate patterns appear during oxytocin administration but treatment continues or response is delayed, negligence is recognized.

(4) Causation inference: how to prove hypoxia caused brain damage

The causal relationship between delivery negligence and cerebral palsy is confirmed through medical expert opinions. The Apgar score immediately after birth, umbilical cord blood pH, and MRI findings serve as key evidence. When hypoxic findings exist at birth, brain lesions are subsequently confirmed, and delays in medical response during delivery are established, causation is inferred.

(5) Limitation of liability: even 30% can mean hundreds of millions in damages

Even when delivery negligence is recognized, courts often limit hospital liability to 30~60% considering (i) inherent risks of delivery, (ii) medical ambiguity of abnormal fetal heart rate patterns, and (iii) maternal factors. However, even when liability is limited to 30%, damages reach hundreds of millions of KRW. Raising the liability percentage is the core of litigation strategy.

3. Key evidence in birth injury cases

Two records determine the outcome of delivery malpractice litigation: fetal heart monitoring records (CTG charts) and delivery records.

(1) CTG (fetal heart rate records) and obstetric records

The CTG chart is the most direct evidence visually showing fetal status throughout the entire delivery process. The interval between when abnormal patterns appear on the CTG and when medical staff actually take action becomes key evidence of negligence. Delivery records contain oxytocin administration times and dosages, vaginal examination times, and NST frequency. If NST records show only three entries or have gaps in the latter stages, this is evidence of monitoring negligence.

(2) Neonatal initial care records

Records of Apgar scores (1-minute and 5-minute) immediately after birth, umbilical cord blood pH levels, and neonatal resuscitation timing are important. These are objective measurements showing whether oxygen supply was sufficient at birth.

(3) Imaging records and MRI

If brain MRI and brain ultrasound performed within days after birth show hypoxic-ischemic encephalopathy (HIE), this establishes a link to hypoxia during delivery.

4. When negligence is denied: inherent limits of childbirth

Courts do not recognize negligence in every birth injury case. The mere fact that "cerebral palsy occurred due to hypoxia after delivery" does not automatically establish negligence.

If the CTG before and after delivery was within normal range and records show that medical staff took appropriate action immediately upon discovering abnormal signs, negligence may be denied. Additionally, if medical expert opinion finds that the cerebral palsy resulted from pre-existing brain developmental abnormalities rather than intrapartum hypoxia, causation itself may be denied. For this reason, selection of medical experts and design of examination items are the most important stages of litigation.

5. Practical checkpoints

• If your child had a low Apgar score immediately after birth (below 7), received neonatal resuscitation, or was diagnosed with hypoxic-ischemic encephalopathy (HIE), you should consider a birth injury lawsuit.

• Whether you copied the CTG chart, delivery records, and neonatal care records immediately after delivery or as soon as possible (securing original records before the hospital modifies them is critical).

• Whether you checked for gaps in NST and CTG records during the latter stages of delivery (gaps of tens of minutes to several hours in the latter stages are strong evidence of monitoring negligence) (Suwon High Court, September 19, 2024).

• If the mother requested a cesarean section during delivery and medical staff refused, whether you immediately secured family member statements remembering the time and content (this fact itself is decisive evidence of negligence).

• If oxytocin was administered, whether you checked the administration times, dosages, and intervals, and analyzed the gap between when abnormal CTG patterns appeared during administration and when medical staff responded.

• Whether you strategically prepared the selection of medical experts and design of examination items (in birth injury cases, expert opinions determine almost every issue. Neglecting expert selection and item design can overturn the entire case with an unfavorable opinion).

• To lower the liability limitation percentage, whether you supported with medical literature the specific timing when medical staff should have recognized abnormal signs and the actions they should have taken at that time (the difference between 30% and 60% liability doubles the damages award).

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Birth injury is the most painful medical dispute for families. It is also the field with the greatest legal room to fight. A single CTG chart or a single line of delivery records can determine whether damages of hundreds of millions of KRW are awarded or denied.