Representing victims of medical malpractice across Ontario
Obstetrics is one of the highest-risk specialties in medicine. A normal labour can become an emergency in minutes, and a single missed signal — on a fetal heart monitor, in a maternal blood pressure reading, in the progress of a delivery — can mean the difference between a healthy newborn and a child with lifelong neurological injury.
Paul Cahill is an Ontario medical malpractice lawyer and a Law Society of Ontario Certified Specialist in Civil Litigation. He has represented Ontario families in some of the most complex obstetrical malpractice claims in the province, including a $11.5 million jury verdict against a negligent obstetrician for the mismanagement of twin-to-twin transfusion syndrome that left a twin with cerebral palsy.
Consultations are free. There are no fees unless your case is successful.
Obstetrics is the field of medicine concerned with pregnancy, childbirth, and the postpartum period. Obstetrical negligence is the failure of an obstetrician, family physician, midwife, nurse, or hospital to meet the accepted standard of care during that time — resulting in preventable injury to mother, baby, or both.
In Ontario, obstetrical care is delivered by a team that includes obstetricians, family physicians, registered midwives, labour-and-delivery nurses, anesthesiologists, neonatologists, radiologists, and ultrasound technologists. Each member of that team owes a duty of care to mother and baby. When that duty is breached and a preventable injury follows, the family may have a claim for medical malpractice.
Obstetrical malpractice is one of the leading causes of large compensation awards in Canada — not because the litigation is easy, but because the lifetime cost of caring for a child injured at birth is staggering. These are also among the most legally and medically complex cases in Canadian civil litigation. They require lawyers who understand the medicine, the science, and the courtroom in equal measure.
Most obstetrical malpractice claims in Ontario arise during the intrapartum period — the active phase of labour and delivery. The medicine is well-developed, the warning signs are well-known, and yet the same patterns of failure appear over and over in the cases that end up in litigation.
Paul Cahill investigates and litigates the following categories of obstetrical negligence claims across Ontario.
Electronic fetal monitoring (EFM) gives the labour-and-delivery team real-time information about how the baby is tolerating labour. Standards published by the Society of Obstetricians and Gynaecologists of Canada (SOGC) require careful interpretation of fetal heart rate tracings throughout labour. When abnormal or non-reassuring tracings are missed, misinterpreted, or ignored — or when the monitor is simply not watched closely enough — the baby may be deprived of oxygen for far longer than is safe. Inadequate fetal surveillance is the single most common allegation in obstetrical malpractice claims involving brain injury.
Oxytocin (Pitocin) is a powerful drug used to induce or strengthen contractions. It carries serious risks. Excessive dosing can cause uterine tachysystole — contractions so frequent and intense that they cut off the baby’s oxygen supply. The standard of care requires careful titration of the dose, continuous fetal monitoring, and prompt reduction or discontinuation when tachysystole develops. Failure to recognize and respond to oxytocin-induced uterine hyperstimulation is a recurrent theme in cases involving hypoxic brain injury.
When fetal monitoring shows that the baby is in distress, when labour is failing to progress, or when other complications arise, the standard of care requires a prompt decision to deliver by C-section. Hospital protocols generally require that an emergency C-section be performed within 30 minutes of the decision. Delay in calling, preparing, or performing the C-section is one of the most common allegations in birth injury litigation — and often the difference between a healthy baby and one with permanent neurological injury.
Shoulder dystocia occurs when the baby’s anterior shoulder becomes lodged behind the mother’s pubic bone after the head has delivered. It is an obstetrical emergency. The standard of care requires the obstetrician to anticipate the risk in patients with known risk factors (maternal diabetes, fetal macrosomia, prior shoulder dystocia, prolonged second stage), and to manage the dystocia using a defined sequence of manoeuvres — the McRoberts manoeuvre, suprapubic pressure, and others — without applying excessive lateral traction on the baby’s head. Failure to follow the standard sequence, or excessive force on the baby’s head, can cause permanent brachial plexus injury, fractures, hypoxic brain injury, or death.
Preeclampsia — characterized by elevated blood pressure and protein in the urine — is a leading cause of maternal and neonatal harm. The standard of care requires regular blood pressure monitoring throughout pregnancy, urine testing, and prompt admission, treatment, or delivery when preeclampsia is diagnosed. Missed diagnosis, inadequate monitoring, or failure to deliver when indicated can lead to eclamptic seizures, stroke, HELLP syndrome, placental abruption, and the death of mother or baby.
In monochorionic (shared-placenta) twin pregnancies, blood can flow unevenly between the twins through shared placental vessels — a condition known as twin-to-twin transfusion syndrome. TTTS is treatable when caught early through fetoscopic laser surgery, but missed diagnosis or delayed referral to a fetal medicine specialist can leave one or both twins with profound neurological injury. This is the very issue underlying Paul Cahill’s $11.5 million jury verdict against the obstetrician.
Operative vaginal delivery using forceps or a vacuum extractor is sometimes necessary, but improper technique — wrong placement, excessive force, repeated failed attempts, or failure to abandon the procedure and proceed to C-section — can cause skull fractures, intracranial hemorrhage, scalp injuries, and brain damage. The standard of care includes assessment of fetal station, proper application, and clear criteria for abandonment in favour of operative delivery.
Umbilical cord prolapse, true knots, and cord compression can cut off oxygen to the baby in seconds. The standard of care requires recognition of cord complications on ultrasound or fetal monitoring and immediate emergency delivery when indicated. Delay in responding to a prolapsed cord is an obstetrical emergency that can cost a baby its neurological future in minutes.
Placental abruption (premature separation of the placenta from the uterine wall) and uterine rupture (a tear in the uterine wall, particularly in patients attempting vaginal birth after cesarean (VBAC)) are catastrophic events. The standard of care requires recognition of warning signs — abnormal bleeding, severe abdominal pain, fetal heart rate decelerations — and an immediate response with emergency delivery. Failure to recognize or respond to these emergencies often leads to severe injury or stillbirth.
Uncontrolled gestational diabetes leads to fetal macrosomia (an unusually large baby), increasing the risk of shoulder dystocia, birth trauma, and the need for C-section. The standard of care requires routine screening for gestational diabetes between 24 and 28 weeks, dietary and insulin management when diagnosed, and appropriate planning for delivery. Failure to screen, diagnose, monitor, or appropriately plan for delivery in diabetic pregnancies is a recognized source of obstetrical liability.
The first minutes of a depressed newborn’s life are critical. The Neonatal Resuscitation Program (NRP) algorithm sets out a defined sequence of interventions — drying and stimulation, positive pressure ventilation, chest compressions, intubation, medications. Failure to follow the algorithm — through delay, inadequate ventilation, missed equipment, or failure to call appropriate help in time — can transform a survivable hypoxic event into permanent brain injury.
Ontario midwives provide excellent primary care in low-risk pregnancies, but their scope of practice is limited to low-risk patients. The most common allegation against midwives is the failure to recognize a complication and the failure to transfer care to an obstetrician in a timely way. This can have devastating consequences when a low-risk pregnancy becomes high-risk and the response is delayed.
Obstetrical malpractice is unique in that a single episode of negligence can injure two patients at once. Maternal injuries that may give rise to a claim include:
The injuries to babies caused by obstetrical negligence are often profound and permanent. The most common include hypoxic-ischemic encephalopathy (HIE), cerebral palsy, brachial plexus injuries (Erb’s palsy), skull fractures, intracranial hemorrhage, seizure disorders, and stillbirth.
A properly framed obstetrical malpractice claim may name any combination of the following defendants:
In Ontario, physicians are typically defended and indemnified by the Canadian Medical Protective Association (CMPA), and hospitals by the Healthcare Insurance Reciprocal of Canada (HIROC). Both are sophisticated, well-resourced defendants who do not settle cases at fair value unless they are convinced the plaintiff’s lawyer is genuinely prepared to go to trial.
Common red flags include:
You don’t need to know whether negligence occurred before you call. That’s our job — we will request and review the medical records, retain medical experts, and advise you on whether you have a viable claim.
When you are choosing a lawyer for an obstetrical negligence claim, three things matter most: experience, results, and judgment.
Certified Specialist. Paul Cahill is recognized by the Law Society of Ontario as a Certified Specialist in Civil Litigation. Fewer than 1% of Ontario lawyers hold this designation.
Recognized by peers. Paul has been listed in Best Lawyers in Canada for Medical Negligence and Personal Injury Litigation since 2021.
Trial-tested. Obstetrical malpractice cases are vigorously defended by the CMPA, and most defence counsel know which plaintiff lawyers will go to trial and which will not. Paul has tried these cases to verdict — including the $11.5 million jury verdict for a twin born with cerebral palsy from negligent management of twin-to-twin transfusion syndrome, and a trial verdict against an emergency room physician who caused the death of a 34-year-old mother of four.
Leadership in the bar. Paul is a past director of the Ontario Trial Lawyers Association (2020–2023) and former Chair of its Medical Malpractice Section (2019–2020).
Trial counsel. For select matters, Paul acts as trial counsel to other lawyers handling complex medical malpractice and personal injury claims — a measure of his standing among his peers.
Obstetrical malpractice claims in Ontario typically unfold over several years. Understanding the process helps families know what to expect.
Step 1 — Free consultation. We listen to what happened and identify whether the case warrants further investigation.
Step 2 — Records review. We obtain the complete prenatal, labour and delivery, neonatal, and follow-up records — including fetal monitoring tracings, anesthesia records, and operative notes. Birth records can run hundreds of pages and must be reviewed line by line.
Step 3 — Expert review. We retain qualified medical experts — typically obstetricians, neonatologists, pediatric neurologists, and life care planners — to review the records and provide opinions on standard of care and causation. Because the medical community in Canada is small and tightly connected, plaintiff’s experts are often retained from outside the province or sometimes even the country.
Step 4 — Statement of claim. If the experts support a case, a statement of claim is issued in the Ontario Superior Court of Justice.
Step 5 — Discoveries and mediation. The parties exchange documents, conduct examinations for discovery of the treating providers, and usually attend mediation.
Step 6 — Trial or settlement. Most cases resolve before trial, but defendants — particularly those represented by the CMPA — will only offer fair value when they believe the plaintiff’s lawyer is genuinely prepared to try the case. The settlements that achieve life-changing results are the ones built on a foundation of trial readiness.
Ontario’s Limitations Act, 2002 generally requires civil claims to be commenced within two years of when the claim was discovered. For obstetrical malpractice claims involving children, special rules apply: the limitation period does not start to run while the child is a minor or under disability, and for severely disabled children may be tolled indefinitely.
For maternal injury claims, the two-year limitation period generally applies, subject to discoverability principles.
That said, evidence disappears, witnesses move, and memories fade. Even when the formal limitation period has not expired, delay can damage a case. The earlier you call, the better.
Damages in successful obstetrical negligence cases in Ontario can include:
A properly prepared life care plan, prepared by an experienced occupational therapist or rehabilitation consultant, is often the cornerstone of a multi-million-dollar damages claim.
A birth injury is any harm to the baby (or sometimes the mother) that occurs around the time of delivery. Obstetrical negligence is the legal cause — a failure by the obstetrical team to meet the accepted standard of care that resulted in the injury. Not every birth injury is the result of negligence. Determining whether a birth injury was preventable requires expert medical review.
You can name the obstetrician as the defendant in a lawsuit, but in practice damages are paid by the Canadian Medical Protective Association (CMPA), which defends and indemnifies almost every obstetrician in Canada. Your claim is against the doctor, but the cheque is written by the CMPA.
Yes. They are among the most complex cases in Canadian civil litigation. Causation is particularly difficult — defendants commonly argue that the injury occurred before labour began, or that even with timely intervention the outcome would have been the same. Defeating those arguments requires careful expert evidence, sophisticated review of fetal monitoring strips, and a deep understanding of neonatal neurology. This is why having an experienced plaintiff’s lawyer matters.
Most obstetrical malpractice claims take three to five years to resolve. Catastrophic injury cases involving infants often take longer — the child’s developmental trajectory must be observed before a reliable life care plan can be prepared.
The vast majority of obstetrical malpractice cases in Ontario settle before trial. But settlements only happen at fair value when the defendant believes the plaintiff is genuinely prepared to go to trial. Choosing a lawyer with real trial experience is the single most important predictor of a strong settlement.
Initial consultations are always free and confidential. Most obstetrical negligence cases are handled on a contingency-fee basis — meaning legal fees are payable only if your claim is successful. Litigation disbursements (expert reports, transcripts, court fees) are advanced by the firm. You do not pay out of pocket to pursue your claim.
Yes. Ontario midwives are regulated healthcare professionals who carry their own liability protection. The most common allegation against midwives is failure to recognize a complication and failure to transfer care to an obstetrician in a timely way. Learn more about midwife negligence claims.
Paul represents clients across Ontario from offices in Toronto, Huntsville, and Bowmanville. He is a partner at Davidson Cahill Morrison LLP, a boutique civil litigation and appellate advocacy firm. Initial consultations can be arranged in person, by telephone, or by video.
If you believe medical negligence caused your child’s birth injury, contact Paul Cahill for a free, confidential consultation. There is no obligation, and you will not pay a fee unless we win your case.