HIE and Oxygen Deprivation at Birth: Washington Lawyer

Hypoxic-ischemic encephalopathy, or HIE, is a brain injury that happens when a baby’s brain does not get enough oxygen or blood flow before, during or shortly after birth. It is one of the most serious outcomes of a difficult labor and the diagnosis behind many cases of cerebral palsy, epilepsy and developmental delay.

Sometimes HIE happens even when everyone in the delivery room does everything right. In other cases the warning signs were on the fetal monitor for a long time, the emergency C-section came too late, or the baby was not resuscitated and cooled quickly enough. Those are the situations where the law allows parents to ask hard questions.

This page explains what HIE is, how mistakes during labor and delivery cause it, the signs parents notice, what a records review shows, the Washington deadline and what compensation covers. Beverly Law, working through licensed local counsel in Washington State, offers a free, confidential case review in English and Spanish.

What is HIE

Hypoxic means too little oxygen, ischemic means too little blood flow, and encephalopathy means the brain is not working normally. The National Institute of Neurological Disorders and Stroke (NINDS) describes HIE as an umbrella term for a brain injury that happens before, during or shortly after birth when oxygen or blood flow to the brain is reduced or stopped. According to Cleveland Clinic, HIE affects an estimated 1 to 6 infants out of every 1,000 births.

In the first hours of life, doctors grade the injury with the modified Sarnat exam, which looks at six areas: level of consciousness, spontaneous activity, posture, muscle tone, primitive reflexes and the autonomic system. The result is recorded as no encephalopathy, mild, moderate or severe. It is a snapshot, not a prediction, but it drives a key decision in the NICU: whether the baby qualifies for cooling.

Therapeutic hypothermia, or cooling therapy, is the main treatment for moderate to severe HIE. Nationwide Children’s Hospital explains that it must be started within the first 6 hours after birth: a cooling system lowers the baby’s body temperature to 91.4°F to 95°F (33°C to 35°C) for up to 72 hours, and then the baby is slowly rewarmed. The goal is to protect the brain from further injury.

HIE is closely linked to lifelong conditions. NINDS lists cerebral palsy, epilepsy, developmental delays and intellectual disabilities among its long-term effects, and Cleveland Clinic estimates that 25% to 60% of infants with HIE have long-term neurological conditions. Nationwide Children’s notes that the severity may not be seen until ages 3 to 4.

How mistakes during labor and delivery cause it

Before birth, a baby gets its oxygen through the placenta and umbilical cord, and labor stresses that supply. That is why hospitals monitor the fetal heart rate. Cleveland Clinic describes the signs of fetal distress as a slow fetal heart rate and repeated late or variable decelerations (brief drops tied to contractions). When the pattern is concerning, the team is expected to act: reposition the mother, give IV fluids, slow or stop contractions and, if the baby does not recover, move to an emergency delivery or C-section.

Some events cut off oxygen suddenly. NINDS and Cleveland Clinic list umbilical cord prolapse or compression, placental abruption (the placenta separating from the uterus), uterine rupture (the uterus tearing open), preeclampsia and very high or very low maternal blood pressure, and the baby’s shoulders getting stuck for a prolonged period. In these emergencies, minutes count.

Medical mistakes usually involve time: not reading the monitoring strip correctly or not escalating to the physician, waiting too long to call an emergency C-section or to get the mother to the operating room, not slowing contractions that are too frequent, failing to recognize an abruption or rupture, leaving high blood pressure untreated, and a slow or disorganized resuscitation once the baby is born. Because cooling has a 6-hour window, a delay in recognizing HIE after birth can also cause lasting harm.

Signs parents notice

HIE is diagnosed by doctors, but parents are usually the first to sense that something is wrong:

• A low Apgar score. It is given at 1 and 5 minutes after birth and rates breathing, heart rate, muscle tone, reflexes and skin color; MedlinePlus says any score below 7 means the baby needs medical attention.
• The baby needed resuscitation: help breathing right after delivery, sometimes for 10 minutes or longer.
• Seizures or unusual movements in the first days of life. Some seizures are subtle and only show up on an EEG.
• A NICU stay, often with cooling therapy, an EEG and a brain MRI.
• Trouble feeding: a weak suck, choking, or needing a feeding tube.
• Unusual muscle tone: floppy and weak, or stiff and tense.
• Pale, blue or gray skin, lips or fingers, or a weak cry.
• Later, missed milestones such as holding the head up, sitting or crawling, or a diagnosis of cerebral palsy, epilepsy or developmental delay.

Is it medical negligence?

Medical negligence, also called medical malpractice, means a doctor, nurse or hospital did not act the way a reasonably careful professional would have in the same situation. Washington’s statute, RCW 7.70.040, describes this standard of care as the care, skill and learning expected of a reasonably prudent provider in the same profession, in Washington, acting in the same or similar circumstances. The question is not whether the outcome was bad; it is whether the care fell below that standard and whether that failure was a proximate cause of the injury.

HIE can happen without anyone being negligent. Nationwide Children’s Hospital notes that often the exact cause of HIE is unknown, and Mayo Clinic points out that lack of oxygen during a hard labor or delivery is a less common cause of cerebral palsy than previously thought. A sudden abruption or a cord accident can injure a baby even with excellent care. That is why every case starts with the records, not with assumptions.

A records review looks at timing. The fetal heart-rate strips show when the pattern became concerning; the nursing notes show when the physician was told; the operative record shows when the C-section was ordered and done. The cord blood gas shows whether the baby was acidotic at birth (the cooling criteria at Children’s Hospital of Philadelphia include a pH of 7.0 or lower), and the resuscitation and cooling records show whether treatment started inside the 6-hour window. The brain MRI, usually done at 4 to 7 days of age, can show where the brain was damaged. Physicians in obstetrics, neonatology and pediatric neurology review these records to say whether the injury was preventable.

Deadline to file in Washington

In Washington State, a medical malpractice case must be filed within the time set by RCW 4.16.350: three years from the act or omission, or one year from when the injury and its cause were discovered or reasonably should have been, whichever expires later. For a child, that clock is generally paused until age 18. In Schroeder v. Weighall (2014), the Washington Supreme Court struck down the law that denied minors this pause in malpractice cases, and the Legislature removed it in 2023. For a baby hurt during labor or delivery, that usually means the child’s own case can be filed until about the 21st birthday. The old eight-year outer limit was struck down in Bennett v. United States (2023). Parents’ own claims are not paused, and claims against public hospitals add a required step, so it is safer to get advice early.

Some Washington babies are born at public hospitals, and a claim against them starts with paperwork, not a lawsuit. The University of Washington, which runs UW Medical Center, is part of state government: under RCW 4.92.100 and 4.92.110, a claim on the state’s standard tort claim form must be presented to the Office of Risk Management, and no lawsuit may be filed until 60 days after that. Public hospital districts, such as Valley Medical Center in Renton and EvergreenHealth in Kirkland, are local government entities: under RCW 4.96.020 the claim goes to the agent the district has appointed, within the time limit for the lawsuit, followed by the same 60-day wait. Harborview Medical Center is owned by King County and operated by UW Medicine, so a claim may need to go to more than one public body. The filing deadline is paused during the 60 days, but a missing or misdirected claim can put a case at risk.

What compensation covers

A child with moderate or severe HIE may need care for life. A claim in Washington can seek the cost of that care, based on a life-care plan prepared by medical and economic experts: lifetime medical care, seizure medication, surgeries and nursing; physical, occupational, speech and feeding therapy; equipment such as wheelchairs, braces and communication devices; home and vehicle modifications; and special education with one-on-one support at school.

A claim can also seek the earning capacity the child will lose as an adult, the income parents give up when one of them stops working to become a caregiver, and pain and suffering, loss of enjoyment of life and other non-economic harms.

Washington does not cap damages in a medical malpractice case. In Sofie v. Fibreboard Corp. (1989), the Washington Supreme Court held that the state’s limit on non-economic damages violated the right to a jury trial in article I, section 21 of the state constitution, and in 2023 the Legislature repealed that old limit (RCW 4.56.250). A jury can award the full amount of a child’s losses: economic damages such as lifetime medical care, therapy, equipment, home modifications and lost earning capacity, and non-economic damages such as pain, suffering and loss of enjoyment of life, with no statutory ceiling on either. Under RCW 4.24.010, parents can also recover their own losses, including the child’s medical expenses and the injury to the parent-child relationship. Any settlement for a child must be approved by a court.

What to ask the hospital for

Parents can request copies of their own and their baby’s medical records. Ask in writing as early as possible and keep everything; under Washington’s RCW 70.02.080, a health care provider must respond no later than 15 working days after receiving a written request. The most useful items are:

• Complete prenatal records and the full labor and delivery chart.
• Fetal heart-rate monitoring strips for the entire labor.
• Nursing notes and physician notes with time stamps.
• Apgar scores at 1, 5 and 10 minutes.
• Umbilical cord blood gas results (pH and base deficit).
• The newborn resuscitation record, with who was present and when each step happened.
• Complete NICU records, including the neurological (Sarnat) exam.
• Cooling-therapy records: start time, temperature log and rewarming record.
• Brain imaging: head ultrasound and MRI reports and images.
• EEG reports.
• The discharge summary for mother and baby.

How Beverly Law helps

Beverly Law is a Los Angeles personal injury firm. In Washington State, we take birth-injury cases through licensed local counsel, in English and Spanish. A birth-injury case takes records, medical experts, time and resources that most families do not have while caring for a newborn with special needs. We take on that work so you can focus on your child.

It starts with a free, confidential case review. We listen, the complete hospital records are requested on your behalf, and physicians who handle deliveries and care for babies with HIE review them. If the standard of care was not met, we explain your options, make sure every claim form and filing deadline is met, and pursue the compensation your child’s care will require. If the injury could not have been prevented, we tell you that honestly.

There is no fee unless we win. Call 1 (877) 427-2752 or send us a message to schedule your free consultation. Hablamos español.

Questions parents ask

Related pages

Cerebral Palsy · Erb’s Palsy / Brachial Plexus Injury · Statute of Limitations · Damages in Washington · Washington birth injury lawyers

Important: This page is general information about birth injuries and Washington law, not legal advice, and reading it does not create an attorney-client relationship with Beverly Law. Every case is different — talk to a lawyer about your own situation. Attorney advertising. Prior results do not guarantee a similar outcome. No fee unless we win. Last reviewed: 2026-09-30.