National investigation into fetal heart rate monitoring (CTG) during labour

9 October 2020

As specialist solicitors, we often act in clinical negligence cases where a child has suffered neurological injury (brain damage) because of problems during their birth.   

A common scenario is where a baby’s heart rate drops to dangerous levels during labour.    This indicates that the baby’s brain may not be receiving enough oxygen.  If that continues for a sustained period, the baby may suffer permanent brain injury and disabilities or even death.    These tragic outcomes can sometimes be avoided by expediting the baby’s delivery; for example, by performing an urgent caesarean section.    In order to do this, however, it is necessary for problems with the fetal heart rate to be picked up and acted upon quickly.

The fetal heart rate is typically measured using continuous cardiotocography (CTG), in which sensors strapped to the mother’s abdomen record the fetal heart rate and contractions during labour.    For this to be effective, it is essential that appropriate equipment is used and that concerning readings are escalated, so that an obstetrician can decide whether the baby needs to be delivered immediately.

The Healthcare Safety Investigation Branch (HSIB), which conducts independent investigations into patient safety issues in the NHS, has launched a national investigation into the suitability of equipment and technology used for continuous fetal heart rate monitoring during labour and birth.  HSIB states that: “A review of HSIB maternity investigations into stillbirths, neonatal deaths and babies born with suspected brain injury identified issues with the suitability of equipment and technology used to monitor the baby’s heart rate during labour.”   HSIB’s investigation will consider issues including the choice of CTG equipment, as well as barriers to reliable monitoring and the escalation of concerns.

This week sees World Cerebral Palsy (CP) day and we are reminded that, in some cases, CP is caused by medical negligence during labour and birth; in particular, failures to identify or respond to fetal distress, which lead to the baby suffering a lack of oxygen and developing brain injury (sometimes called hypoxic ischaemic encephalopathy or HIE).  CP refers to disorders of movement and co-ordination and can often occur in conjunction with learning difficulties and other conditions, such as blindness or epilepsy.    A claim for compensation can help a child with CP to access suitable accommodation, equipment, therapies and opportunities to live life as fully as possible.   However, compensation can never fully make up for the challenges that a child with CP will face and the effects on their family.    We welcome HSIB’s investigation into CTG monitoring and hope that its findings will improve standards of care provided during labour and birth, so that preventable causes of CP and other brain injuries can be avoided.

If you, or a member of your family, have been affected by the issues raised in this blog, please contact one of our Medical Negligence & Personal Injury lawyers on 020 7814 1200, or email us at

further information

If you would like to discuss a possible clinical negligence claim please contact one of our Medical Negligence & Personal Injury lawyers on 020 7814 1200, or email us at


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