Electronic Fetal Monitoring Errors in New York
Understanding EFM mistakes, medical standards, and your legal rights when monitoring failures cause birth injuries
Electronic fetal monitoring (EFM) is one of the most widely used medical technologies during labor and delivery in New York hospitals. Healthcare providers rely on EFM to track a baby’s heart rate and detect signs of distress during birth. When used correctly and interpreted properly, EFM can identify problems early and help prevent serious birth injuries.
However, EFM errors remain a leading cause of preventable birth injuries in New York. Despite decades of use, studies show EFM has a false positive rate of approximately 99% in predicting cerebral palsy, meaning most concerning readings turn out to be false alarms [Source: Nature Women’s Health, 2024]. Yet healthcare providers continue to make critical mistakes in monitoring, interpreting, and responding to EFM data—errors that can result in permanent brain damage, cerebral palsy, and even stillbirth.
If your child suffered a birth injury due to fetal monitoring errors in New York, understanding what went wrong and your legal options is essential. This guide explains how EFM works, common monitoring errors, medical standards of care, and the legal requirements for pursuing a medical malpractice claim in New York State.
What is Electronic Fetal Monitoring?
Electronic fetal monitoring (EFM), also called cardiotocography, is a medical technology that simultaneously tracks two critical variables during labor: fetal heart rate (FHR) and uterine contractions. The underlying principle is that changes in the fetal heart rate pattern correlate with the baby’s oxygenation status [Source: NCBI StatPearls, 2024].
Healthcare providers use EFM to monitor the baby’s well-being throughout labor and identify potential signs of fetal distress that may require intervention.
How EFM Technology Works
EFM systems use transducers to record fetal heart rate and uterine activity. The data appears on a continuous paper strip or digital display that healthcare providers monitor throughout labor.
External Monitoring (Most Common)
- Two transducers placed on maternal abdomen
- One records fetal heart rate over the baby’s heart
- One records contractions over the uterine fundus
- Non-invasive method used in most deliveries
- Can be affected by maternal movement and obesity
Internal Monitoring (High-Risk Cases)
- Fetal scalp electrode for direct heart rate recording
- Intrauterine pressure catheter for precise contraction measurement
- Used when external monitoring is unreliable
- Requires ruptured membranes and cervical dilation
- Provides more accurate data but is invasive
When EFM is Used in New York Hospitals
The American College of Obstetricians and Gynecologists (ACOG) recommends continuous EFM specifically for high-risk pregnancies, though many New York hospitals use it routinely for all deliveries. High-risk situations where continuous monitoring is essential include:
- Previous cesarean delivery or uterine surgery
- Preeclampsia or gestational hypertension
- Diabetes or other maternal medical conditions
- Induced or augmented labor (Pitocin administration)
- Multiple gestation (twins, triplets)
- Suspected intrauterine growth restriction
- Post-term pregnancy (beyond 40-41 weeks)
- Any signs of fetal distress or abnormal heart rate
Did You Know? For low-risk pregnancies, ACOG states that intermittent auscultation (listening to the fetal heartbeat periodically with a handheld device) is equivalent to continuous EFM when performed with a 1:1 nursing ratio [Source: AAFP, 1999]. However, most U.S. hospitals adopted continuous EFM as standard practice before research could verify its effectiveness.
Understanding EFM Patterns: What Healthcare Providers Should Monitor
Proper interpretation of EFM strips is critical for identifying fetal distress and preventing birth injuries. The National Institute of Child Health and Human Development (NICHD) established standardized terminology for electronic fetal monitoring in 2008 to ensure consistent interpretation across healthcare providers.
Key Components Healthcare Providers Must Assess
Medical professionals use a systematic approach to evaluate EFM tracings. The DR C BRAVADO mnemonic helps ensure comprehensive assessment:
| Component | What It Means | Clinical Significance |
|---|---|---|
| DR – Determine Risk | Maternal and fetal risk factors | Identifies high-risk situations requiring closer monitoring |
| C – Contractions | Frequency, duration, intensity of contractions | Excessive contractions (tachysystole) can reduce oxygen to baby |
| BRA – Baseline Rate | Average fetal heart rate between contractions | Normal: 110-160 bpm; abnormal rates suggest problems |
| V – Variability | Beat-to-beat fluctuations in heart rate | Moderate variability indicates healthy baby; absent variability is concerning |
| A – Accelerations | Temporary increases in heart rate | Presence indicates baby is well-oxygenated |
| D – Decelerations | Temporary decreases in heart rate | Type and timing determine if intervention needed |
| O – Overall Assessment | Categorize pattern as Category I, II, or III | Determines clinical management plan |
Normal vs. Abnormal Baseline Heart Rate
The baseline fetal heart rate is calculated as the mean FHR rounded to increments of 5 beats per minute (bpm). To establish a baseline, there must be at least 2 minutes of identifiable baseline segments in any 10-minute window [Source: AAFP, 1999].
Normal Baseline
110-160 bpm
Indicates adequate oxygenation and normal fetal condition
Bradycardia
Below 110 bpm
May indicate fetal distress, umbilical cord compression, or maternal hypotension
Tachycardia
Above 160 bpm
May indicate fetal hypoxia, maternal fever, infection, or medication effects
Understanding Variability: The Most Important Indicator
Fetal heart rate variability refers to the beat-to-beat fluctuations in the baseline heart rate. Moderate variability and the presence of accelerations are the two most reliable indicators that a baby is not experiencing metabolic acidemia at the time of observation [Source: AAFP, 1999].
| Variability Type | Range | Clinical Interpretation |
|---|---|---|
| Absent | Undetectable | Concerning – may indicate fetal sleep, medication, or hypoxia |
| Minimal | ≤5 bpm | Reduced variability – requires close monitoring |
| Moderate | 6-25 bpm | Normal – indicates healthy fetal nervous system |
| Marked | >25 bpm | Saltatory pattern – may indicate acute hypoxia or cord compression |
Critical Medical Standard: The combination of decreased variability with late or variable decelerations indicates an increased risk of fetal acidosis and signifies the infant may be depressed at birth. This pattern requires immediate intervention [Source: AAFP, 1999].
Types of Decelerations: Recognizing Danger Signs
Decelerations are temporary decreases in fetal heart rate. The type, timing, and depth of decelerations help healthcare providers determine whether the baby is experiencing distress.
Early Decelerations (Benign)
Timing: Mirror image with contractions
Cause: Fetal head compression during contractions
Clinical Significance: Benign finding, not associated with fetal hypoxia or acidosis [Source: AAFP, 1999]
Action Required: Continue monitoring; no intervention needed
Variable Decelerations (Common)
Timing: Variable relationship to contractions
Cause: Umbilical cord compression
Appearance: Abrupt decreases resembling U, V, or W shape
Action Required: Monitor closely; intervene if severe, recurrent, or with lost variability
Late Decelerations (Ominous)
Timing: Begin at or after peak contraction, return to baseline after contraction ends
Cause: Uteroplacental insufficiency – inadequate oxygen delivery to baby
Clinical Significance: All late decelerations are considered potentially ominous, regardless of depth [Source: AAFP, 1999]
Action Required: Immediate intervention to improve oxygenation
Prolonged Decelerations (Concerning)
Definition: Decrease ≥15 bpm lasting ≥2 minutes but less than 10 minutes
Cause: Multiple potential causes including cord compression, maternal hypotension, uterine rupture
Action Required: Urgent assessment and intervention; may require emergency delivery
The Three-Tiered Classification System
ACOG recommends using a three-tiered system to categorize fetal heart rate patterns and guide clinical decision-making [Source: AAFP, 2009].
| Category | Characteristics | Interpretation | Management |
|---|---|---|---|
| Category I (Normal) |
• Baseline 110-160 bpm • Moderate variability • Accelerations present • No late or variable decelerations | Strongly predictive of normal fetal acid-base status | Continue routine monitoring |
| Category II (Indeterminate) |
• Patterns not classified as Category I or III • May show tachycardia, minimal variability, or occasional concerning decelerations | Not predictive of abnormal fetal acid-base status but requires evaluation | Continued surveillance and reevaluation; may require interventions to improve pattern |
| Category III (Abnormal) |
• Absent variability with bradycardia, OR • Absent variability with recurrent late/variable decelerations, OR • Sinusoidal pattern | Associated with abnormal fetal acid-base status; high risk of current or impending fetal acidemia | Prompt evaluation and intervention required; may necessitate expedited delivery |
Common Electronic Fetal Monitoring Errors
Review of birth injury malpractice cases in New York reveals that EFM-related errors typically fall into three main categories: ignoring warnings, misinterpretation of patterns, and failure to use or improper setup of monitoring equipment.
1. Failure to Monitor Adequately
Medical malpractice can occur when healthcare providers implement EFM but fail to check the monitoring strips frequently enough to ensure the baby is tolerating labor. The required frequency of EFM review depends on the clinical situation:
| Clinical Situation | Required Monitoring Frequency |
|---|---|
| Low-risk patient, first stage of labor | Every 30 minutes |
| Low-risk patient, second stage of labor (pushing) | Every 15 minutes |
| High-risk patient, first stage of labor | Every 15 minutes |
| High-risk patient, second stage of labor | Every 5 minutes |
| Patient receiving Pitocin (labor induction/augmentation) | Continuous monitoring required |
Common Error: Nurses leaving monitoring room for extended periods, failing to check strips during shift changes, or being assigned to too many laboring patients simultaneously, making adequate monitoring impossible.
2. Misinterpretation of EFM Patterns
Even when healthcare providers review EFM strips regularly, errors in interpretation can lead to missed opportunities to prevent birth injuries. Common misinterpretation errors include:
- Confusing maternal and fetal heart rates – External monitors can sometimes pick up the mother’s heart rate instead of the baby’s, particularly if the baby is very active or if the transducer is poorly positioned
- Misclassifying deceleration types – Failing to recognize late decelerations as ominous, or dismissing concerning variable decelerations as benign
- Ignoring loss of variability – Not recognizing that absent or minimal variability combined with decelerations is a critical warning sign
- Failing to recognize Category III patterns – Not identifying tracings that require immediate intervention
- Incorrectly attributing concerning patterns to benign causes – Assuming tachycardia is only due to maternal fever when fetal hypoxia may be present
Research Finding: Studies have identified that inadequate knowledge, fear of conflict among healthcare team members, and poor communication are common system errors contributing to misinterpretation of EFM [Source: AHRQ Patient Safety, 2024].
3. Failure to Respond Appropriately
Perhaps the most critical error occurs when healthcare providers accurately interpret concerning EFM patterns but fail to take appropriate action. This category of error includes:
Delayed Response
- Waiting too long to notify the attending physician of Category II or III patterns
- Failing to implement intrauterine resuscitation measures promptly
- Delaying decision for cesarean delivery despite Category III tracing
- Continuing Pitocin despite non-reassuring patterns
Inadequate Intervention
- Not changing maternal position when variable decelerations occur
- Failing to provide supplemental oxygen for Category II patterns
- Not administering IV fluids for maternal hypotension
- Continuing oxytocin despite uterine tachysystole
Standard Interventions for Non-Reassuring Patterns
When EFM patterns become concerning, healthcare providers should implement the following interventions immediately [Source: AAFP, 1999]:
| Intervention | Purpose | When Applied |
|---|---|---|
| Change maternal position (lateral or knee-chest) | Relieve umbilical cord compression or improve placental blood flow | Variable or late decelerations |
| Administer oxygen via tight-fitting face mask | Increase maternal oxygen saturation to improve fetal oxygenation | Any Category II or III pattern |
| IV fluid bolus (lactated Ringer’s solution) | Correct maternal hypotension and improve placental perfusion | Late decelerations, maternal hypotension |
| Discontinue oxytocin (Pitocin) | Reduce uterine contraction frequency to improve placental blood flow | Late decelerations, uterine tachysystole |
| Perform vaginal examination | Check for umbilical cord prolapse or rapid cervical change | Sudden prolonged deceleration |
| Fetal scalp stimulation | Elicit acceleration to confirm adequate fetal pH | Category II patterns with minimal variability |
| Amnioinfusion (fluid instillation into uterus) | Cushion umbilical cord to reduce variable decelerations | Recurrent severe variable decelerations |
| Expedited delivery (cesarean or operative vaginal) | Deliver baby before irreversible injury occurs | Category III patterns not responding to interventions |
4. Equipment Setup and Technical Errors
Technical failures and equipment misuse can render EFM ineffective or produce misleading data:
- Improper transducer placement – External monitors positioned incorrectly, failing to capture fetal heart rate accurately
- Inadequate signal quality – Not troubleshooting poor signal or switching to internal monitoring when external is inadequate
- Equipment malfunction – Not recognizing or responding to equipment failure or artifact on the tracing
- Recording maternal heart rate instead of fetal – Failing to verify the source of the recorded heart rate
- Paper running out or digital system malfunction – Loss of monitoring data due to preventable technical issues
Birth Injuries Caused by EFM Errors
When healthcare providers fail to properly monitor, interpret, or respond to electronic fetal monitoring, babies can suffer from oxygen deprivation (hypoxia) during labor and delivery. The severity and duration of oxygen deprivation determines the type and extent of injury.
Common Birth Injuries from Monitoring Failures
Hypoxic-Ischemic Encephalopathy (HIE)
Brain injury caused by lack of oxygen and blood flow during birth. HIE can range from mild (full recovery) to severe (permanent disability or death).
Signs: Low Apgar scores, seizures in first 24 hours, need for resuscitation, difficulty feeding, abnormal muscle tone
Cerebral Palsy
Permanent movement disorder caused by brain damage before, during, or shortly after birth. While many cases have other causes, birth asphyxia from monitoring failures can result in cerebral palsy.
Note: EFM has a 99% false positive rate in predicting cerebral palsy [Source: Nature, 2024], but true positive cases represent preventable tragedies.
Seizure Disorders
Oxygen deprivation can cause permanent brain damage resulting in epilepsy and recurrent seizures throughout the child’s life.
Cognitive and Developmental Delays
Brain injury from birth asphyxia can result in intellectual disabilities, learning difficulties, speech delays, and behavioral problems.
Organ Damage
Severe oxygen deprivation affects multiple organs beyond the brain, potentially damaging kidneys, liver, heart, and lungs.
Stillbirth or Neonatal Death
In the most tragic cases, failure to respond to EFM warnings of fetal distress results in stillbirth or death shortly after birth.
Time is Critical: Brain cells begin to die within minutes of oxygen deprivation. The difference between a healthy baby and permanent brain damage can be as little as 10-15 minutes of delayed response to Category III EFM patterns.
Medical Malpractice Standards for EFM in New York
Not every birth injury results from medical malpractice. To establish liability for a birth injury caused by EFM errors in New York, you must prove four elements:
1. Duty of Care
The healthcare provider (physician, nurse, hospital) owed a professional duty of care to you and your baby. This duty is established when a doctor-patient relationship exists—when the provider accepts responsibility for your prenatal care and delivery.
2. Breach of the Standard of Care
The healthcare provider violated the accepted medical standard of care. In New York, the standard of care is determined by asking: What would other competent healthcare providers in the same specialty and geographic area do under similar circumstances?
For EFM-related cases, breach of the standard of care might include:
- Failing to implement continuous monitoring when medically indicated (high-risk pregnancy, Pitocin administration)
- Not checking EFM strips at the required frequency based on risk level
- Misinterpreting obvious Category III patterns as reassuring
- Failing to notify the attending physician of non-reassuring patterns
- Not implementing standard intrauterine resuscitation measures
- Delaying cesarean delivery despite persistent Category III tracing unresponsive to interventions
- Continuing Pitocin despite late decelerations indicating uteroplacental insufficiency
Expert Testimony Required: New York law requires testimony from a qualified medical expert to establish what the standard of care was and how the defendant breached it. This typically means an obstetrician or maternal-fetal medicine specialist with experience in EFM interpretation.
3. Causation
The breach of the standard of care directly caused the birth injury. You must prove that if the healthcare provider had acted properly (monitored correctly, interpreted accurately, responded appropriately), your baby’s injury would not have occurred or would have been less severe.
Establishing causation in EFM cases requires demonstrating:
- The EFM strip showed clear warning signs of fetal distress
- The healthcare provider’s error (failure to recognize, failure to act) occurred during a critical window
- The injury pattern is consistent with oxygen deprivation during the specific time period when proper intervention could have prevented harm
- The delay in recognition or intervention was long enough to cause permanent injury
Challenge in Causation: Defense attorneys often argue that the baby’s injury was caused by prenatal factors rather than labor management errors. Medical records, timing of injury, and expert analysis of EFM strips are critical evidence in proving causation.
4. Damages
You must demonstrate that actual harm resulted from the breach. In birth injury cases, damages may include:
- Past and future medical expenses – NICU care, surgeries, therapies, medications, medical equipment
- Cost of lifelong care – For severe injuries like cerebral palsy, lifetime care costs can exceed $1-3 million
- Lost earning capacity – Compensation for the child’s inability to work in the future
- Pain and suffering – For the child’s physical pain, emotional distress, and reduced quality of life
- Parental loss of services – Compensation for the loss of a normal parent-child relationship
The Controversy Surrounding EFM Effectiveness
While EFM is used in approximately 85% of births in the United States, the medical evidence supporting its widespread use is surprisingly weak. This creates a complicated situation: EFM is the standard of care (failing to use it properly is malpractice), yet research shows it may not improve outcomes for low-risk pregnancies.
Research Findings on EFM Effectiveness
Key Research Insight: American hospitals adopted continuous EFM for routine use before medical research could test its effectiveness. After EFM became widespread, studies revealed that intermittent auscultation (listening to the fetal heartbeat every 10-15 minutes during active labor) is equally effective for identifying fetal distress in low-risk pregnancies [Source: ScienceDirect, 2022].
A Cochrane systematic review found that continuous EFM:
- Does not significantly reduce poor outcomes in newborn infants
- Results in increased cesarean sections and operative vaginal deliveries
- Has a false positive rate of approximately 99% in predicting cerebral palsy [Source: Nature Women’s Health, 2024]
- Leads to more medical interventions without clear benefit in low-risk births
Why EFM Remains Standard Despite Mixed Evidence
Despite questions about its effectiveness, EFM remains entrenched as the standard of care in New York and across the United States for several reasons:
- Medicolegal concerns – Obstetricians use continuous EFM defensively to protect against malpractice claims
- Hospital workflow – EFM allows remote monitoring of multiple patients, requiring less intensive nursing care than intermittent auscultation
- Documentation – Continuous paper strips provide permanent records of fetal status during labor
- Established practice – Changing established protocols requires significant institutional effort
- Patient expectations – Many families expect and want continuous monitoring
Important Legal Distinction: While research may question EFM’s overall effectiveness, this does not absolve healthcare providers of the duty to use it properly and respond appropriately when it shows clear signs of fetal distress. If EFM is being used, it must be used correctly.
New York Statute of Limitations for Birth Injury Cases
If you believe your child suffered a birth injury due to EFM errors in New York, you must understand the strict time limits for filing a medical malpractice lawsuit.
Standard Medical Malpractice Statute of Limitations
New York law (CPLR § 214-a) requires medical malpractice lawsuits to be filed within two years and six months (30 months) after the medical error occurred or was discovered [Source: NY Courts, 2024].
Special Rules for Birth Injuries (Infancy Toll)
New York provides extended time limits for children, recognizing that birth injuries may not be fully understood or diagnosed for years. Under CPLR § 208 (the “infancy toll”), minors receive additional time to file lawsuits.
The 10-Year Rule
For birth injuries occurring during labor and delivery, the statute of limitations is the earlier of:
- 10 years after the injury, OR
- 30 months after the child turns 18
Practical effect: Most families must file before the child’s 10th birthday [Source: Rheingold Law, 2024].
Delayed Discovery Exception
If the birth injury is not discovered until after birth (some injuries may not become apparent until the child is 1-3 years old), you have until the child turns 10, or within 2.5 years of discovery, whichever comes first.
Example: Cerebral palsy diagnosed at age 3 = must file by age 10, not age 13.
Critical Deadline: The 10-year cap is absolute. Even if the injury wasn’t discovered until age 9, you only have until age 10 to file, not 2.5 years from discovery. Don’t wait—consult an attorney as soon as you suspect medical negligence.
Claims Against NYC Public Hospitals
If the birth injury occurred at a hospital operated by NYC Health + Hospitals or another government entity, much shorter deadlines apply:
- Notice of Claim must be filed within 90 days of the injury
- The actual lawsuit must be filed within 1 year and 90 days
- These deadlines are strictly enforced—missing them typically bars your claim completely
Public hospitals in New York City include:
- NYC Health + Hospitals/Bellevue
- NYC Health + Hospitals/Elmhurst
- NYC Health + Hospitals/Kings County
- NYC Health + Hospitals/Lincoln
- NYC Health + Hospitals/Jacobi
- NYC Health + Hospitals/Woodhull
Certificate of Merit Requirement
New York requires plaintiffs to file a Certificate of Merit within 90 days after filing a medical malpractice lawsuit. This certificate must be signed by a qualified medical expert (typically a physician) stating they have reviewed the case and believe there is a reasonable basis for the malpractice claim [Source: DeFrancisco Law, 2024].
Why This Matters: You cannot simply file a lawsuit and then look for an expert. You need to have a medical expert review your case and agree to support it BEFORE filing, so you can obtain the Certificate of Merit within the 90-day window.
Steps to Take If You Suspect EFM Errors
If you believe your child’s birth injury resulted from electronic fetal monitoring errors, taking the right steps early can protect your legal rights and help you understand what happened.
1. Obtain Complete Medical Records
Request copies of all medical records related to your pregnancy, labor, and delivery, including:
- Electronic fetal monitoring strips (the most critical evidence)
- Prenatal care records
- Labor and delivery notes (nursing notes, physician progress notes)
- Anesthesia records
- Operative reports (if cesarean delivery occurred)
- Newborn hospital records (NICU records if applicable)
- Pathology reports (placenta examination)
Your Legal Right: Under HIPAA, you have the right to obtain copies of your medical records. Hospitals must provide them within 30 days of your request. There may be a copying fee, but hospitals cannot deny your request.
2. Preserve the Fetal Monitor Strips
The continuous EFM tracing is the single most important piece of evidence in cases involving monitoring errors. This strip shows minute-by-minute documentation of your baby’s heart rate and uterine contractions throughout labor.
Request the original monitoring strips immediately – hospitals are required to maintain these records, but you want to ensure they’re preserved and obtain copies as soon as possible.
3. Document Your Child’s Condition
Keep detailed records of:
- Medical diagnoses and conditions
- All medical treatments, therapies, and interventions
- Healthcare provider visits and recommendations
- Developmental milestones (missed or delayed)
- Medical expenses and insurance payments
- Impact on daily life and care needs
4. Consult a Birth Injury Attorney Early
Birth injury cases involving EFM errors are medically and legally complex. An experienced New York birth injury attorney can:
- Have the medical records reviewed by qualified medical experts
- Determine whether the standard of care was breached
- Evaluate the strength and value of your case
- Ensure you meet all filing deadlines (including the Certificate of Merit requirement)
- Handle all legal procedures while you focus on your child’s care
No Upfront Cost: Birth injury attorneys in New York work on a contingency fee basis. This means you pay no attorneys’ fees unless your case is successful. The attorney receives a percentage of the settlement or verdict (typically 33-40% depending on whether the case settles or goes to trial).
5. Don’t Delay
While you may have up to 10 years to file a lawsuit for a birth injury, waiting has significant disadvantages:
- Memory fades – Witnesses’ recollections become less reliable over time
- Evidence can be lost – Medical records may be destroyed after the legally required retention period
- Healthcare providers move – Key witnesses may retire or relocate, making them harder to locate
- Investigation takes time – Thorough case investigation and expert review can take months
- Financial pressure – Families struggling with medical expenses need timely compensation
Questions to Ask Your Birth Injury Attorney
When evaluating attorneys to represent your child’s birth injury case, ask these important questions:
Experience Questions
- How many birth injury cases have you handled?
- What were the outcomes of those cases?
- Have you handled cases specifically involving EFM errors?
- Do you have relationships with medical experts qualified to review EFM strips?
Process Questions
- What is the typical timeline for birth injury cases?
- How do you communicate with clients throughout the case?
- What expenses should I expect, and when are they paid?
- Do you take cases to trial, or do you typically settle?
Connect with Qualified New York Birth Injury Attorney
If your child suffered a birth injury due to electronic fetal monitoring errors in New York, connecting with an experienced medical malpractice attorney is essential. Get a free case evaluation to understand your legal options and protect your child’s future.
Frequently Asked Questions About EFM Errors
How can I tell if my child’s birth injury was caused by electronic fetal monitoring errors?
Determining whether EFM errors caused your child’s injury requires expert medical review. Warning signs include: late decelerations on the monitor strips that weren’t addressed, documented fetal distress without appropriate intervention, delayed cesarean delivery despite Category III patterns, or continued use of Pitocin despite non-reassuring tracings. An experienced birth injury attorney will have medical experts review your complete labor and delivery records, including the EFM strips, to determine if the standard of care was breached.
What is the difference between external and internal fetal monitoring?
External monitoring uses two transducers placed on the mother’s abdomen—one to track the baby’s heart rate and one to measure contractions. It’s non-invasive and used in most labors. Internal monitoring uses a scalp electrode attached to the baby’s head for direct heart rate measurement and an intrauterine pressure catheter for precise contraction monitoring. Internal monitoring provides more accurate data but requires ruptured membranes and cervical dilation. Healthcare providers should switch to internal monitoring when external monitoring is unreliable or when more precise data is needed to assess a high-risk situation.
Can intermittent monitoring (not continuous EFM) be considered malpractice?
It depends on the clinical situation. For low-risk pregnancies, ACOG guidelines state that intermittent auscultation (checking fetal heart rate periodically) is equivalent to continuous EFM when performed with adequate frequency and a 1:1 nurse-to-patient ratio. However, for high-risk pregnancies or when complications develop during labor (such as Pitocin administration, maternal hypertension, or any sign of fetal distress), continuous EFM is the standard of care. Using only intermittent monitoring in high-risk situations could constitute a breach of the standard of care.
How long do hospitals keep electronic fetal monitoring records in New York?
New York requires hospitals to maintain medical records for at least six years from the date of discharge. For minors, records must be kept until the patient turns 19, or for at least six years, whichever is longer. However, the practical retention period varies by institution. This is why it’s critical to request copies of your medical records—including the EFM strips—as soon as you suspect a problem. Don’t wait years, assuming the records will still be available.
What does a Category III fetal heart rate pattern mean?
A Category III pattern is the most serious EFM classification and indicates the baby is at high risk of abnormal fetal acid-base status (meaning the baby is not getting enough oxygen). Category III includes: absent heart rate variability with bradycardia (slow heart rate), absent variability with recurrent late or variable decelerations, or a sinusoidal pattern (a smooth, wave-like pattern that resembles a sine wave). When a Category III pattern appears, immediate evaluation and intervention are required—this often means emergency cesarean delivery to prevent permanent brain injury.
Why do late decelerations require immediate intervention?
Late decelerations indicate uteroplacental insufficiency—the placenta is not delivering adequate oxygen to the baby during contractions. Unlike early decelerations (which are benign) or variable decelerations (which indicate cord compression), late decelerations signal that the baby is experiencing reduced oxygen delivery with every contraction. Medical standards require immediate intervention: changing maternal position, administering oxygen, giving IV fluids, discontinuing Pitocin, and potentially proceeding to cesarean delivery if the pattern persists. The combination of late decelerations with lost variability is particularly ominous and requires urgent delivery.
Can I sue for a birth injury if I signed consent forms before delivery?
Yes. Consent forms acknowledge that you understand the risks of labor and delivery and agree to treatment. They do NOT waive your right to sue for medical malpractice if healthcare providers breach the standard of care. You cannot consent to negligence. If your medical team failed to properly monitor your baby, misinterpreted clear warning signs on the EFM, or didn’t respond appropriately to fetal distress, signing consent forms does not prevent you from holding them accountable through a medical malpractice lawsuit.
How much time do doctors have to respond to fetal distress?
The timing depends on the severity of the distress pattern. For Category III patterns (absent variability with late decelerations, severe bradycardia, or sinusoidal pattern), the standard is typically “immediate” response—meaning decision for emergency cesarean should be made within minutes, with goal of delivery within 10-30 minutes depending on the situation. For Category II patterns (indeterminate), healthcare providers should implement intrauterine resuscitation measures immediately and reassess the pattern. Brain damage from oxygen deprivation can occur within 10-15 minutes, making rapid response critical.
What is the average settlement or verdict in New York birth injury cases involving EFM errors?
Settlement amounts vary significantly based on the severity of the injury and the strength of evidence showing breach of the standard of care. Cases involving severe permanent injuries like cerebral palsy, cognitive impairment, or developmental delays typically result in higher settlements because lifetime care costs can be substantial (often $1-3 million or more). Factors affecting settlement value include: severity and permanence of the injury, cost of past and future medical care, impact on quality of life, strength of medical evidence, and quality of expert testimony. An experienced birth injury attorney can evaluate your specific case and provide a more accurate assessment of potential value.
Do most birth injury cases go to trial, or do they settle?
The majority of birth injury cases settle before trial. However, having an attorney who is prepared to take your case to trial is essential for negotiating a fair settlement. Defendants and their insurance companies are more likely to offer reasonable settlements if they know your attorney has the resources, experience, and willingness to try the case. The decision to settle or proceed to trial depends on many factors: strength of evidence, quality of expert witnesses, amount of the settlement offer compared to likely trial outcome, and your preferences as the client.
Key Takeaways
- Electronic fetal monitoring is the standard of care in New York hospitals for high-risk pregnancies and when complications arise during labor
- Three main categories of EFM errors cause birth injuries: failure to monitor adequately, misinterpretation of patterns, and failure to respond appropriately to warning signs
- Category III patterns require immediate intervention to prevent permanent brain damage—delays of just 10-15 minutes can result in cerebral palsy or other serious injuries
- Late decelerations are ominous and indicate the baby is not receiving adequate oxygen; they require immediate action regardless of depth
- Moderate variability and accelerations are reassuring; absent variability combined with decelerations is a critical warning sign
- Research shows EFM has limitations, including a 99% false positive rate for cerebral palsy prediction, but proper use and response to true warnings remains the standard of care
- New York’s statute of limitations for birth injuries is typically the child’s 10th birthday, with shorter deadlines for public hospitals (90 days for Notice of Claim)
- The EFM strips are critical evidence—request copies of all fetal monitoring records immediately if you suspect an error
- Birth injury attorneys work on contingency—you pay nothing unless your case is successful, with attorney fees typically 33-40% of recovery
- Early consultation with an attorney is essential to preserve evidence, meet filing deadlines, and obtain expert medical review of your case
Resources and Citations
This article was researched using authoritative medical and legal sources:
- National Institute of Child Health and Human Development (NICHD) – EFM standardized nomenclature
- American College of Obstetricians and Gynecologists (ACOG) – Clinical practice guidelines
- American Academy of Family Physicians (AAFP) – Interpretation of electronic fetal heart rate during labor
- NCBI National Library of Medicine – Fetal monitoring medical research
- Agency for Healthcare Research and Quality (AHRQ) – Patient safety and EFM system errors
- New York State Consolidated Laws – Medical malpractice statutes (CPLR § 214-a, § 208)
- Nature Women’s Health – Recent research on EFM effectiveness and limitations (2024)
- Cochrane Systematic Reviews – Evidence-based analysis of EFM outcomes
Get Expert Legal Guidance
If your child suffered a birth injury in New York, don’t navigate this complex process alone. Experienced birth injury attorneys can evaluate your case, explain your rights, and fight for the compensation your family deserves.
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This information is provided for educational purposes only and is not legal advice. Outcomes depend on the specific facts of each case. Consult with a qualified New York medical malpractice attorney for advice on your specific situation.
