Newborn Injury Expert Witness: Which Medical Expert Do You Need?

OB/GYNs: Pregnancy, Labor, and Delivery

OB/GYNs are generally the main physicians caring for patients throughout pregnancy and delivery. In some settings, that role may be performed by a family physician, but the clinical responsibilities are similar.

In newborn injury cases, an OB/GYN expert witness is often best suited to evaluate questions involving pregnancy, labor, and delivery.

OB/GYNs commonly address issues such as:

• Interpretation of fetal heart rate tracings, also called “strips”
• Timing of cesarean delivery
• Management of labor progression
• Shoulder dystocia, when the baby’s head delivers but the shoulder becomes stuck
• Operative vaginal delivery, including vacuum or forceps delivery
• Uterine rupture
• Maternal hemorrhage
• Cord prolapse, when the umbilical cord comes out before the baby
• Medication management during labor

One of the most common questions I get as a neonatologist is whether I “read strips.” Fetal heart rate tracings can be central in birth injury cases, especially when timing of delivery is questioned.

As a neonatologist, I understand how complications during pregnancy and delivery can affect the baby. But I am not trained to interpret fetal heart rate tracings or manage labor and delivery complications. Those questions are generally better addressed by an OB/GYN or maternal-fetal medicine specialist.

Maternal-Fetal Medicine: High-Risk Pregnancy

Maternal-fetal medicine physicians, often called MFMs, are obstetricians who complete additional fellowship training in high-risk pregnancies. They often become involved before delivery, sometimes weeks or months before the baby is born.

An MFM expert witness may be especially helpful when the case involves:

• High-risk pregnancy management
• Maternal medical disease affecting the pregnancy
• Fetal growth concerns
• Prematurity risk
• Congenital anomalies
• Complex prenatal monitoring
• Decisions made before labor or delivery

MFM specialists can answer many of the same questions as OB/GYNs, but their additional training gives them deeper experience with complex and high-risk pregnancies.

General Pediatricians: Routine Newborn Care and Transition Home

General pediatricians often manage routine newborn care and the transition from hospital to home, depending on the hospital setting.

Their focus is broader and less intensive than that of a neonatologist. Pediatricians are trained to evaluate babies, identify unexpected problems, manage common newborn issues, and recognize when referral to a subspecialist is needed.

A pediatrician expert witness may be useful for questions involving:

• Routine newborn examinations
• Feeding and weight gain
• Jaundice
• Infection screening
• Developmental assessment
• Recognition of unexpected heart disease
• Parental counseling
• Follow-up after discharge

In some cases, the key question is not what happened during delivery or in the NICU, but whether the baby was properly evaluated, monitored, counseled, or referred after birth.

Neonatologists: Newborn Resuscitation and NICU Care

Neonatologists are pediatricians with additional fellowship training in the care of critically ill newborns, especially premature infants. They are trained to manage high-risk newborn resuscitation and complex NICU care.

Once a baby enters the neonatal intensive care unit, or NICU, the neonatologist usually becomes the primary physician.

A neonatology expert witness may be helpful in cases involving:

• Newborn resuscitation
• Respiratory failure
• Prematurity-related complications
• Brain injury
• Sepsis
• Mechanical ventilation
• Nutrition and growth
• Congenital anomalies
• Cooling therapy for hypoxic ischemic encephalopathy, also called HIE
• NICU management and monitoring

One important point is often overlooked: neonatologists are not responsible for how the delivery itself was conducted. They may be able to explain how delivery-related events affected the baby, but they generally do not opine on whether the delivery should have been managed differently.

On the other hand, once the baby is born and requires resuscitation or NICU care, neonatologists are often well positioned to evaluate whether that care was appropriate.

Before choosing an expert, attorneys should identify the specific medical decision or clinical question that needs to be evaluated.

The key is to identify the question first, then match the expert to that question.

Was the question about labor management? Timing of delivery? Newborn resuscitation? NICU care? Long-term neurologic outcome? Imaging interpretation? The key is to identify the question first, then match the expert to that question.

Common Attorney Questions in Newborn Injury Cases

Practical Takeaways for Attorneys

1. Do not assume one “baby doctor” can answer every question in a newborn injury case.
2. Use OB/GYN or MFM experts for pregnancy, fetal monitoring, labor, delivery, and timing of delivery questions.
3. Use neonatologists for newborn resuscitation, NICU management, prematurity, respiratory failure, sepsis, HIE, and cooling therapy questions.
4. Use pediatric subspecialists for focused questions involving neurology, cardiology, surgery, imaging, congenital disease, or long-term outcomes.
5. Start by identifying the specific medical question, then match the expert to that question.