Was your child hurt during labor or delivery? Some birth injuries are unavoidable. Others follow a missed fetal heart-rate pattern, a delayed cesarean, or a delivery that should have been managed differently. Maryland treats these as medical malpractice claims, with their own filing gateway, their own deadline and their own damages cap.
If your child was injured at birth, the deadline is almost certainly not what you think. Read the deadline section below before you decide it is too late.
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A birth injury is harm to the baby (or the mother) caused during labor, delivery or the hours around it. Not every one is anyone’s fault. The question is whether the care fell below the standard a competent obstetric team owed.
Four things, and all four have to be there: a doctor, midwife, nurse or hospital owed your family a duty of care; the care fell below the accepted standard; that failure caused the injury; and the injury produced real harm. Causation is where birth injury cases are won and lost, because a bad outcome and a negligent one look identical to a frightened parent at 3am. That is what the medical records, the fetal monitoring strips and the placental pathology are for.
Maryland requires that a qualified expert say so in writing before the case can go anywhere. See the deadlines and gateway section below.
Every figure below is from a named primary source. Where a national number is the only one that exists, we say so rather than dressing it up as a Maryland figure.
One thing worth knowing: the “significant birth injury” checkbox was removed from the national natality public use file, so there is no longer a clean national count of birth injuries drawn from birth certificates. Anyone quoting one should be asked where it came from. (NCHS, User Guide to the 2024 Natality Public Use File.)
HIE is brain injury caused by oxygen and blood-flow deprivation around birth. It is the most serious birth injury and the one most often misdescribed on law firm websites.
You will see “1 to 3 per 1,000” quoted everywhere. That range conflates two different things and the top of it is not HIE at all.
Two more recent US datasets bracket that figure. A study of 289,793 live births at 35 weeks or later across 15 Kaiser Permanente Northern California hospitals (2012–2019) found 1.7 per 1,000 with both acidosis and chart-confirmed encephalopathy — a deliberately conservative definition (Cornet et al., Pediatr Neurol 2023;149:145–150). A national analysis of 32,180,617 infants at 35 weeks or later (2010–2018) found the rate stable near 1 per 1,000 (Acun et al., AJOG 2022;227(5):751.e1–e10).
The same national analysis produced the odds ratios that do the causation work in an HIE case:
An abruption or a cord prolapse is a recognized obstetric emergency with a recognized response. When the response was slow, those odds ratios are the reason a jury can connect the delay to the injury.
A review of intrapartum hypoxia in non-anomalous term infants found umbilical arterial pH below 7.0 in about 3.7 per 1,000, HIE in about 2.5 per 1,000, and roughly 14.5% of cerebral palsy associated with intrapartum hypoxia-ischaemia (Graham et al., AJOG 2008;199(6):587–595). The authors’ own conclusion is that the large majority of cerebral palsy in these infants is not associated with intrapartum events. Any competent defense lawyer will quote that sentence to you. We would rather you hear it from us first.
Shoulder dystocia is an obstetric emergency: the baby’s shoulder lodges behind the mother’s pubic bone after the head delivers. How the team responds in the next 60 seconds can decide whether a child uses that arm normally for the rest of their life.
Adjusted odds ratio 56.9 in the 2025 US analysis (DeFrancesco); odds ratio 115.27 in the international meta-analysis (Van der Looven). Cesarean delivery is protective where the baby is macrosomic — adjusted odds ratio 0.581 (0.365–0.925).
ACOG states plainly that “slightly more than one half of all brachial plexus injuries are associated with uncomplicated vaginal deliveries”, and that severe brachial plexus palsy has been documented in the absence of any shoulder dystocia at all (Practice Bulletin 178, p. e128). A brachial plexus injury is therefore not proof of negligence. What matters is what the chart shows: whether the risk factors were recognized, whether the manoeuvres were performed and documented in order, and whether traction was applied when it should not have been.
Complete recovery is reported in about 80% of babies in some series and under 50% in others. At six months, complete recovery reached 64% for C5–C6 and C5–C6–C7 injuries but only 14% where the whole plexus (C5–T1) was involved. ACOG Practice Bulletin 178, p. e124. That 14% is the figure that separates a case worth thousands from one worth millions, and it is why the nerve level in your child’s records matters so much.
Most recorded birth trauma is not catastrophic. Saying so makes the serious cases easier to prove, not harder.
The injuries that change a life are the ones underneath that headline number: intracranial hemorrhage, skull fracture with depression, spinal cord injury, and the nerve injuries covered above. If your child had one of those, the fact that most birth trauma is minor is irrelevant to your case — and the AHRQ measure that produces the 4.67 figure counts them all together, so nobody should quote it at you as if it described your child.
The strongest published comparison of severe birth trauma by mode of delivery comes from an open-access study of Canadian births. The pattern is consistent with US clinical literature and it is the arithmetic behind every forceps and vacuum case.
| Mode of delivery | Severe birth trauma per 1,000 | Relative to spontaneous vaginal |
|---|---|---|
| Forceps | 25.48 | about 5.4× |
| Vacuum | 14.22 | about 3.0× |
| Cesarean with labor | 4.89 | about 1.0× |
| Spontaneous vaginal | 4.74 | — |
| Cesarean without labor | 2.48 | about 0.5× |
Source: Wen et al., BMJ Open 2018;8(3):e020578. Open access.
An instrumented delivery is not negligent because it is riskier — sometimes it is the safest option available in the moment. It becomes a claim when the indication was not there, when the operator kept pulling after the attempts should have stopped, when forceps and vacuum were used in sequence, or when a cesarean should have been called instead and was not.
Cerebral palsy is the injury families most associate with birth. The honest picture is more complicated than the advertising, and knowing it makes the cases that are intrapartum much easier to win.
2.4 per 1,000 children at age 8 (95% CI 2.2–2.7), from the CDC’s ADDM surveillance network for the 2022 surveillance year. The trend is downward: 3.5 per 1,000 in 2006, 2.9 in 2010, 2.4 in 2022. Patrick et al., Pediatrics Open Science 2026;2(2):1–9.
The ACOG/AAP task force deliberately declines to give one number, and gives a range instead: intrapartum events are estimated to account for 6% to 17% of spastic cerebral palsy overall, rising to 14% to 43% for spastic quadriplegic cerebral palsy — the most severe form, and the form most often at issue in litigation. ACOG/AAP, Neonatal Encephalopathy and Neurologic Outcome, 2nd ed. (2014), pp. 16–17.
So most cerebral palsy is not caused by anything that happened during delivery. But a meaningful minority of the severe cases is, and those are the cases where the fetal monitoring record, the cord gases and the placental pathology tell you what happened.
The only authoritative published figure is the CDC’s: an average lifetime cost of $921,000 per person with cerebral palsy, expressed in 2003 dollars for the year-2000 birth cohort. CDC, MMWR 2004;53(3):57–59.
Two things about that number. It is a societal cost estimate covering medical costs, lost productivity and special education — it is not a life care plan, and it is not what a claim is worth. And it is more than twenty years old; in current dollars it is far higher. When you see “birth injury cases are worth $5 million to $20 million” on a website, ask which study says so. There isn’t one. What a case is actually worth comes from a life care plan built for your child by an economist and a physiatrist, against the available insurance.
Malpractice carriers publish what their closed obstetric claims were about. It is the closest thing to a map of where obstetric care fails.
MedPro Group reports that delays in the treatment of fetal distress, improper performance of vaginal deliveries and improper management of pregnancy together account for 60% of obstetric case volume and 70% of total dollars paid. Delay in treating fetal distress alone is 27% of volume and 40% of dollars. Labor and delivery is the location in 74% of cases, and events occurred on the night shift in almost one third. MedPro Group, Obstetrics Claims Data Snapshot, 2025.
Failure to act on a non-reassuring fetal heart-rate tracing ranks first in every published obstetric closed-claims study. The Doctors Company put it at 22% of obstetric claims in its 2015 study and 31% in its 2026 study; MedPro reports 27%. Different books of business, different years — but the same finding.
In the 2015 study, patient assessment issues were a contributing factor in 32% of claims, the second most common factor after selection and management of therapy. And of the claims involving improper performance of a vaginal delivery, almost half involved brachial plexus injuries linked to shoulder dystocia. The Doctors Company, Obstetrics Closed Claims Study (2015).
In Coverys’ analysis of obstetric claims involving a fetal injury (n=432), neurological or brain injury was the most prevalent fetal injury, at 41%. Coverys, A Dose of Insight: Maternal/Fetal Risks (2018). Note the denominator: that is 41% of claims that already involved a fetal injury, not 41% of all obstetric claims.
The Joint Commission reviewed 47 self-reported sentinel events involving perinatal death or permanent disability. Communication issues topped the list of root causes at 72%, with 55% citing organizational culture as a barrier. Non-reassuring fetal status featured in 77% of the cases; staff competency was identified in 47% and inadequate fetal monitoring in 34%. Joint Commission, Sentinel Event Alert 30 (2004).
A note on a figure you may have read elsewhere: the “30-minute decision-to-incision” standard is often attributed to this Joint Commission alert. It appears nowhere in it. The 30-minute interval comes from the ACOG and AAP Guidelines for Perinatal Care. We checked, because a citation that does not survive checking is worse than no citation.
This is the most useful single study for a Maryland family, because it was done here and because it shows what changes when a labor and delivery unit takes shoulder dystocia seriously.
Obstetricians at Johns Hopkins ran a quality improvement program on shoulder dystocia management — standardised manoeuvres, simulation training and structured documentation. Comparing before and after, among vaginal deliveries of babies weighing at least 2,500 g complicated by shoulder dystocia:
Source: Gurewitsch Allen et al., “Improving Shoulder Dystocia Management and Outcomes with a Targeted Quality Assurance Program”, American Journal of Perinatology 2017;34(11):1088–1096. In fairness to the reader: the authors disclosed a patent interest in a shoulder dystocia simulator. We are telling you that rather than leaving you to find it.
Why this matters to a claim. When four out of five of these injuries disappear because a unit changed how it trains and documents, the injuries were not simply bad luck. That is the difference between an unavoidable complication and a preventable one — and it is the question a Maryland jury is asked to answer.
Four rules decide almost every Maryland birth injury case. The first one is the reason most families who think they are out of time are not.
A medical injury claim in Maryland runs under Cts. & Jud. Proc. § 5-109, Maryland’s statute of limitations for medical injury claims, not the general three-year rule. For an adult it is the earlier of five years from the date the injury was committed or three years from the date it was discovered.
For a child, that clock does not start at birth. In Piselli v. 75th Street Medical, 371 Md. 188 (2002), Maryland’s highest court held that under Article 19 of the Maryland Declaration of Rights, § 5-109’s periods do not begin to run against a minor’s claim until the child turns 18. Three years run from that eighteenth birthday, so the practical deadline for a birth injury is the child’s 21st birthday.
Two warnings, and please read both.
If the birth injury resulted in death, the claim is a wrongful death claim under § 3-904 — three years from the date of death — and Mummert v. Alizadeh, 435 Md. 207 (2013), holds that § 5-109 does not apply to it at all.
A Maryland medical malpractice claim above the District Court of Maryland’s jurisdictional limit must first be filed with the Health Care Alternative Dispute Resolution Office. In practice almost every case is then waived out of arbitration into circuit court — either by mutual waiver under § 3-2A-06A or unilaterally under § 3-2A-06B.
Within 90 days of the claim, you must file a certificate of a qualified expert attesting that the care departed from the standard and caused the injury (§ 3-2A-04(b)). The attesting expert may not devote more than 25% of their annual professional activities to testifying in personal injury claims (§ 3-2A-04(b)(4)(ii)). Miss the certificate and the case is dismissed, however strong the medicine.
Medical malpractice has a separate non-economic damages cap from every other injury claim in Maryland, and it steps up on 1 January rather than 1 October, by $15,000 a year from a $650,000 base.
| Cause of action arising in | Injury claim | Wrongful death, two or more beneficiaries |
|---|---|---|
| 2026 | $920,000 | $1,150,000 |
| 2027 (absent amendment) | $935,000 | $1,168,750 |
Cts. & Jud. Proc. § 3-2A-09. The wrongful death multiplier here is 125% — not the 150% that applies to non-medical claims under § 11-108. The two caps are mutually exclusive.
Economic damages are not capped. A lifetime of nursing care, therapy, equipment, home modification and lost earning capacity is recoverable in full and proved with a life care plan. In a severe birth injury that is the overwhelming majority of the claim.
Where a minor’s net recovery is $5,000 or more, Maryland does not hand it to a parent. It goes to a trustee under Estates & Trusts §§ 13-401 to 13-406, is preserved until the child turns 18, and can be reached earlier only by order of the circuit court — typically for the child’s own care, education or support. Parents sometimes worry about this. It is a protection, and it works.
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Longer than almost every website will tell you. A medical injury claim runs under Cts. & Jud. Proc. § 5-109, and in Piselli v. 75th Street Medical, 371 Md. 188 (2002), Maryland’s highest court held that the limitations periods do not begin to run against a child’s claim until the child turns 18. Three years run from there, so for an injury at birth the practical deadline is the child’s 21st birthday. Two cautions: the Code still prints an unenforceable “age 11” rule, so do not rely on what you read in the statute; and the parents’ own claim for medical expenses during the child’s minority is not tolled, so waiting still costs the family money. If the injury caused a death, it is a wrongful death claim — three years from the date of death.
You usually cannot know from the outside, and neither can we until we read the records. The answer lives in the fetal heart-rate tracings, the nursing notes with their timestamps, the cord blood gases, the placental pathology and the operative report. What we are looking for is a recognized warning sign that was not acted on, or an intervention performed when it should not have been. That review costs you nothing and we will tell you honestly if the records do not support a claim.
No, and any lawyer who tells you otherwise is setting you up. ACOG states that slightly more than half of all brachial plexus injuries follow uncomplicated vaginal deliveries, and severe cases have occurred with no shoulder dystocia at all. What makes it a claim is what the chart shows: whether the risk factors were recognized, whether the manoeuvres were performed in order and documented, and whether traction was applied when it should not have been. The nerve level matters enormously for value — complete recovery at six months runs about 64% for C5–C6 injuries but only 14% where the whole plexus is involved.
No. Most cerebral palsy is not. The ACOG/AAP task force estimates intrapartum events account for 6% to 17% of spastic cerebral palsy overall, rising to 14% to 43% for spastic quadriplegic cerebral palsy — the most severe form and the one most often litigated. So a diagnosis is not a case. But a meaningful minority of the severe cases does come from what happened during labor, and the monitoring record, the cord gases and the placental pathology are what separate the two.
It is a written statement from a qualified physician saying the care departed from the standard and caused the injury. Maryland requires it within 90 days of filing the claim (Cts. & Jud. Proc. § 3-2A-04(b)), and the expert may not devote more than 25% of their annual professional activity to testifying in personal injury cases. Without it the case is dismissed regardless of how strong the medicine is. It is also why a birth injury claim needs to start well before the deadline — finding and instructing the right expert takes months.
It depends on the life care plan and the available insurance, not on a formula. Economic damages — lifetime nursing care, therapy, equipment, home modification, lost earning capacity — are not capped in Maryland, and in a severe birth injury they are the overwhelming majority of the claim. Non-economic damages are capped separately for medical malpractice: $920,000 for a cause of action arising in 2026, or $1,150,000 in a wrongful death case with two or more beneficiaries. Be skeptical of any site quoting a “$5 million to $20 million average” — no published study supports it.
Whatever you already have, and do not worry about what you do not. Useful: the mother’s prenatal records, the labor and delivery record including the fetal monitoring strips, the delivery summary, the newborn records including cord blood gas results and Apgar scores, any NICU records, imaging (MRI or ultrasound of the head), and the placental pathology report if one was done. We can request all of it. What matters more is calling before the people who were in the room have moved on.
Nothing up front and nothing unless we recover for your child. We work on a contingency fee and we advance the case costs, which in a birth injury case are substantial — expert review alone runs into the thousands before a claim is filed. The initial case review is free and carries no obligation.
Maryland is one of a small number of states that still follows contributory negligence. In most states, being found partly at fault reduces what you recover. In Maryland it can bar your claim entirely, even if the other side was far more to blame. Maryland’s highest court reaffirmed the rule in Coleman v. Soccer Association of Columbia, 432 Md. 679 (2013), over a strong dissent, and said any change to it is for the General Assembly rather than the courts. That is why an insurance adjuster’s first move is so often to suggest you did something wrong. Being blamed is not the same as being at fault, whether the rule actually bars a claim depends on the specific facts, and it is the reason to be careful about what you say and to get advice early.
Three Maryland offices — Baltimore (Nottingham), Laurel and Bel Air — and we travel statewide to meet clients who cannot travel to us. Call (888) 844-5373 to schedule a visit.
We take birth injury and medical malpractice cases in all 24 Maryland jurisdictions — the 23 counties and Baltimore City.
We take cases anywhere in Maryland — all 23 counties and Baltimore City. Each name links to that jurisdiction's official local government website.
Source: MDOT Zero Deaths Maryland jurisdiction crash data summaries, 2023. Statewide totals: 577 fatal crashes and 621 traffic deaths.
Jason Plotkin was born and raised here, and he has lived in six Maryland jurisdictions — Baltimore City, Baltimore County, Montgomery County, Howard County, Allegany County and Worcester County. Mountains to shore. That is not a marketing line; it is where he has actually lived.
Marc Hassan, Tony Balasamo and Joshua Fannon were born and raised in Maryland too, and Christian Miele served in the Maryland House of Delegates. When you work with our firm, you are working with people who know this state — its roads, its courts and its neighbors.
Free case review, no fee unless we win. If you are not sure whether you still have time, call — for a child injured at birth you very likely do.
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