Causation asks whether the injury probably would have been avoided if care had met the expected standard. It requires a medical explanation of how the injury happened and a legal judgement about responsibility. A diagnosis alone never answers either question.
Building the care chronology
Investigation usually starts with a minute-by-minute reconstruction of labour and birth, drawn from midwifery notes, CTG traces, medication charts, operative records and newborn observations. The aim is to pin down when warning signs appeared, what decisions were made, and when delivery or treatment actually happened.
Gaps, late entries or inconsistent clock times can matter. Experts may need to reconcile differences between records before they can give an opinion.
Testing alternative causes
Many conditions linked with birth injury have several possible causes. Cerebral palsy, for example, may relate to events during pregnancy, infection, genetic factors, prematurity or circumstances around birth. Experts are expected to consider each realistic explanation rather than assume the injury happened during labour.
- Infection or inflammation before or during labour
- Genetic or metabolic conditions
- Placental problems or events earlier in pregnancy
- Prematurity and the complications that come with it
Timing, imaging and test results
Brain MRI patterns, cord blood gas results, Apgar scores, placental pathology and the newborn's early clinical course can help experts estimate when an injury probably occurred. This timing is critical. If the injury most likely happened before the period in which different care could have changed the outcome, causation may not be established, even if the care was criticised.
How expert reasoning becomes legal causation
Medical experts explain the mechanism of injury: what physically happened and when. Legal causation is a separate step. It asks whether, on the balance of probabilities, proper care would have prevented the injury or reduced its severity, and whether responsibility should extend to that harm. A solicitor applies the relevant law to the expert evidence.
Living with uncertainty
Experts sometimes disagree, and some causes cannot be determined. A claim can be assessed as weak on causation even where a family's concerns about care are understandable. Understanding why an explanation is uncertain can still help families make informed decisions about whether to proceed.
For your next conversation
- Cord blood gas results and the timing of the sample
- Placental pathology report, if one was done
- All newborn brain imaging and the radiology reports
- Any genetic or metabolic testing results
- Your list of the specific moments in care you want examined
Common questions
If the hospital made a mistake, does that prove it caused my baby's injury?
No. A lawyer must show both that care fell below the expected standard and that the shortfall probably caused or worsened the injury. Experts may agree an error occurred but conclude the injury had already happened, or had a different cause.
What happens if the experts disagree about the cause?
Disagreement is common. Lawyers may ask experts to explain their reasoning further, seek additional opinions, or arrange conferences where experts identify where they agree and disagree. A court or the parties ultimately weigh which reasoning is more persuasive.
Sources & further reading
- Healthdirect: cerebral palsy (opens in a new tab)
- RANZCOG: fetal surveillance guideline (opens in a new tab)
- Legal Aid Queensland: negligence, duty of care and loss (opens in a new tab)
These references support the topic’s starting points. They do not determine the facts, standard of care or law applicable to an individual matter.