In September 2025, a full bench of the High Court dismissed the appeal of the Eastern Cape MEC for Health against a liability finding for hypoxic‑ischaemic brain injury sustained by a child during delivery. The child’s mother alleged that substandard obstetric care, marked by inadequate monitoring, after documented bradycardia, the failure to escalate care and delayed delivery, caused the injury, resulting in cerebral palsy. The MEC disputed negligence and causation, advancing alternative explanations, including suggested intrauterine growth restriction, a tight double nuchal cord, and rapid labour progression. The MEC also challenged the trial court’s treatment of medical records and expert joint minutes.
The court confirmed that, after 17:00 on the day in question, hospital staff failed to follow the Guidelines for Maternity Care in South Africa. From 17:20, bradycardia was indicated, and the child’s heart rate remained non-reassuring, yet there were material gaps in monitoring. No monitoring occurred between 17:20 and 18:20. Despite warning signs of foetal distress, escalation steps such as preparation for urgent caesarean section and timely delivery were not undertaken. At 18:30, the child’s heart rate remained non-reassuring, and by 18:45, the doctor still had not personally attended to the claimant. These failures went against established guidelines and contributed to the child’s injury.
The court carefully reviewed the expert opinions, giving preference to those that were logically reasoned and matched the actual medical timeline, rather than those based on speculation. When experts disagreed, the court checked whether their views matched the medical records, the order of care, and accepted guidelines. The court preferred the claimant’s experts on negligence and causation, finding their explanations to be better supported by the facts. Alternative theories like growth restriction or a tight double nuchal cord were not enough to change the main conclusion.
The court held that a reasonable practitioner would have foreseen the risk of foetal harm and taken steps to guard against it. As such, the hospital staff’s failure constituted negligent and substandard care. The court further found that timely intervention would probably have avoided the injury.
The appeal was dismissed. The court confirmed that the hospital staff’s conduct was negligent and amounted to substandard care which caused the child’s injury.
The judgment makes it clear that if maternity units do not follow monitoring procedures, courts may find their actions to be negligent. Courts will look at whether staff took reasonable action when there were warning signs. Courts base their decisions on evidence and expert opinions that fit with the medical records.