What Evidence Is Needed to Prove Medical Malpractice in a Birth Injury Case?

When a birth injury occurs, families are often left wondering what went wrong and whether it could have been prevented. Proving medical malpractice in these cases depends on the evidence, including detailed records, timelines, and data that reveal how labor and delivery unfolded. 

Knowing what evidence is needed to prove a medical malpractice birth injury case can help you better understand the legal process so you can take informed steps to protect your child’s rights and secure the resources they’ll need for the future.

Let’s look at the key points every parent should know about gathering and preserving birth injury evidence.

Key Takeaways About Medical Malpractice Evidence

• To prove medical malpractice in a birth injury case, attorneys need evidence showing what the standard of care required, how the providers deviated from it, and how that deviation caused harm to your child.
  
• Core evidence includes complete medical records (including electronic audit logs), fetal monitoring strips, medication and staffing records, cord blood gases, placental pathology, imaging, and neonatal ICU documentation.
  
• Prompt action matters. A preservation letter sent to medical providers can stop records from being lost or overwritten.
• ABC Law Centers can gather, secure, and analyze the evidence needed to support your case so you can focus on your child’s care.

Why Necessary “Evidence” Is Different In Birth Injury Cases

Birth injury claims are medical malpractice claims, but the facts are often complex and highly technical. You’re not just proving that something went wrong during labor, delivery, or newborn care; you’ll need to prove:

1. What careful providers should have done (the accepted standard of care)
2. What actually happened
   
3. How the departure from the standard of care caused your child’s injury
   

That proof comes from evidence in the form of records, data, and testimony. The earlier those materials are secured, the stronger the case can be.

---

“The best thing [to do after a birth injury] is to notify an attorney immediately. And one of the things we can do is send a letter out quickly to preserve all evidence. It’s called a preservation letter.” — Attorney Jesse Reiter, Founding Partner, ABC Law Centers

---

The Three Building Blocks of a Medical Malpractice Case: Duty, Breach, And Causation

Every medical malpractice case rests on three legal pillars:

1) Standard of care (duty)

All medical providers must act as a reasonably careful provider would have acted under similar circumstances. In birth injury cases, this often involves recognizing and responding to fetal distress, managing shoulder dystocia, timely moving to a C-section, properly dosing medications like Pitocin, and following neonatal resuscitation protocols.

2) Breach (negligence)

Negligent care can be described as specific acts or omissions that fall below the standard of care. For example, ignoring non-reassuring fetal heart rate tracings or delaying a needed C-section can be forms of negligence.

3) Causation and damages

You will need proof that the breach of duty more likely than not caused the injury (such as hypoxic-ischemic encephalopathy leading to cerebral palsy), along with the resulting losses, which may include the costs for medical care, therapies, equipment, and life-care needs.

Evidence is what ties these three requirements together. Whether your child was diagnosed with HIE, cerebral palsy, or another form of birth injury, our birth injury attorneys will promptly gather all the necessary evidence to support your case.

What Evidence is Needed to Support a Birth Injury Case?

The following types of evidence are typically used as the foundation of a birth injury lawsuit. Don’t worry if you don’t have these; our team at ABC Law Centers will request and organize them for you.

Labor and delivery records

• Complete EMR chart for parent and baby, including prenatal care, admission notes, labor progress notes, orders, nursing notes, and delivery records.
  
• Electronic fetal monitoring (EFM) strips and monitor calibration data.
  
• Vital sign logs, contraction patterns, and oxytocin (Pitocin) titration sheets.
  
• Medication administration records (MAR), including timing, dosage, and response notes.
  
• Anesthesia records for epidural/spinal procedures, blood pressure readings, and interventions.
  
• Decision-to-incision timeline for emergency C-section, including paging logs and anesthesia availability.
  
• Operative reports and delivery summaries.
  
• Staffing and assignment sheets showing who was in the room and when.
  

Newborn and NICU records

• Apgar scores with underlying descriptors (not just the totals).
  
• Cord blood gases (arterial and venous) and early arterial/venous blood gases.
  
• Neurologic exams, EEG, MRI/cranial ultrasound, and consult notes.
  
• Cooling therapy documentation (if therapeutic hypothermia was used), such as initiation time and criteria.
  
• Neonatal resuscitation records (NRP sheets), including oxygen and intubation details.
  
• Metabolic, infectious, and genetic workups relevant to the differential diagnosis.
  

Pathology and physical evidence

• Placental pathology report and slides/blocks (to assess infection, inflammation, abruption, infarcts, and timing).
  
• Umbilical cord and membranes documentation.
  
• Imaging studies (parent and newborn), retained foreign bodies, or device logs (vacuum/forceps usage data).
  

Hospital systems and metadata

• Audit trails/EMR metadata (who accessed or edited what and when).
  
• Incident/occurrence reports (where available by law).
  
• Policies and protocols for labor management, escalation, oxytocin, EFM interpretation, shoulder dystocia, and NRP.
  
• Equipment maintenance logs for fetal monitors, infusion pumps, and monitors.
  
• Security video or nurse call logs (time-sensitive and often overwritten quickly).
  

Communications

• Paging/phone records, internal messaging, and code alerts.
  
• Discharge summaries and follow-up recommendations.
• Prenatal referrals/consults and any deferred recommendations.

How A Preservation Letter Protects Your Child’s Case

Hospitals routinely overwrite electronic data and video on rolling schedules. A preservation letter tells the providers and facility to keep specified materials (including audit logs and videos). Sending this letter quickly:

• Stops routine deletion and alteration
  
• Defines the scope of evidence covered (records, devices, videos, metadata)
  
• Sets up consequences for spoliation (destruction of evidence)
  

ABC Law Centers can issue tailored preservation letters early, which can make the difference between an incomplete and a compelling record.

Proving The Standard Of Care 

To show what should have happened, cases often rely on:

• Clinical guidelines and protocols applicable at the time
  
• Testimony from experienced clinicians in obstetrics, nursing, neonatology, anesthesia, and related fields
  
• Hospital policies that the team was expected to follow
  
• Training records and credentialing files (where discoverable)
  

This evidence paints a picture of what safe care should have looked like in your situation. Then we compare it to what actually happened.

Showing Breach: Reading The Timeline

Many birth injury cases turn on timing. To create the strongest foundation for your case, we build a minute-by-minute timeline using:

• EFM tracings alongside nursing notes
  
• Medication start/stop times
  
• Decision-to-incision intervals for C-section
• Paging logs and room entries
• Neonatal resuscitation timestamps
  

When the timeline shows delays in recognizing distress or escalating care, it can demonstrate a breach of duty.

Proving Causation: Connecting The Dots

It’s not enough to show that the standard of care fell short. We also need to show that the injury happened because of that shortfall. In birth injury cases, causation may be supported by:

• Cord blood gases and early blood gases showing acidosis
  
• EFM patterns consistent with hypoxia and lack of timely response
  
• Neuroimaging (MRI) that aligns with the timing of oxygen deprivation
  
• Placental pathology indicating acute events near delivery
  
• Excluding other causes (like congenital anomalies or infections) through testing
  

When the clinical picture, labs, imaging, and timeline all line up, causation becomes clearer to the judge or jury.

Damages: Documenting Your Child’s Needs, Now And In The Future

An attorney will present evidence of the specific damages your family incurred as well as the cost of a lifetime of care to help quantify what your child and family will need over a lifetime. Proof of your damages may include:

• Medical records and therapist evaluations
  
• Assistive technology and home modifications estimates
  
• Life-care plans projecting future care needs (therapies, equipment, medications)
  
• Economic analyses of lost earning capacity and attendant care

What If The Hospital Says, “We Did Nothing Wrong”?

That’s common. Providers may argue the injury was unavoidable or caused by factors outside their control. Meticulous evidence can combat those claims by showing:

• The baby’s distress was apparent (or should have been) on the strips
  
• Action was delayed despite warning signs
  
• Hospital policies required faster action
  
• Alternative causes don’t fit the medical data

How ABC Law Centers Secures And Analyzes Evidence

When you partner with our experienced birth injury team at ABC Law Centers, we help build a strong case by gathering and organizing necessary evidence. Some of the steps we’ll take include:

• Immediate preservation: We notify all facilities and providers to keep records, devices, and digital data.
  
• Comprehensive record requests: Not just PDFs — we ask for native formats, metadata, and audit trails.
  
• Placental pathology retrieval: We locate and preserve slides/blocks for independent review.
  
• Independent medical review: We work with qualified medical professionals on our team and leading medical specialists across the country to interpret the records and imaging. Our medical experts give sworn testimony, which is used to support your case.
  
• Clear timelines and visuals: We make complex medicine understandable to families, adjusters, mediators, and juries.
  
• Charging no upfront fees: We cover all costs and are paid only if we recover compensation for you.
  

Frequently Asked Questions About Medical Malpractice Evidence

Do I need all the records before I call a lawyer?

No. Call us first. Time matters, and we can quickly send preservation letters and request complete records so nothing critical is lost.

What if I only have paper printouts?

That’s okay. Paper can be a helpful roadmap, but we’ll request the native electronic data, which often contains timestamps and edits that don’t show up on printouts.

Are fetal monitor strips really that important?

Yes. EFM strips, combined with nurse/physician notes and medication records, help show what was happening with the baby and how the team responded.

Will we need testimony from medical professionals?

Often, yes. Birth injury cases typically rely on testimony from clinicians with relevant training and experience who can explain the standard of care, breach, and causation.

How long do we have to file?

Filing deadlines, known as statutes of limitations, vary by state and situation (and can be shorter for cases against government-run hospitals). Because rules differ, and some states have special rules for children, it’s important to talk with a lawyer as soon as you can to protect your rights.

Take the Next Steps With ABC Law Centers

You don’t need to organize binders or learn medical jargon overnight. If you suspect something went wrong during labor, delivery, or newborn care, a conversation can help you understand your options and protect critical evidence.

Successful birth injury cases require a legal team with extensive knowledge about the law and medicine involved in these situations. As a firm that focuses exclusively on birth injury lawsuits, the ABC Law Centers lawyers know what it takes to build, present, settle, or litigate your birth injury case. Our track record of multi-million dollar settlements speaks for itself.

Reach out today for a free, no-obligation consultation where you can learn more about how we can prepare your case and have all your questions answered. You won’t pay a penny throughout the legal process unless we recover compensation for you and your child.