Most women who give birth in an Australian hospital will spend some or all of their labour attached to it. It sits beside the bed, usually to one side, printing a continuous paper trace or displaying a live graph on a screen. Electrodes are attached to the mother’s abdomen. Numbers move. Lines rise and fall. Nobody explains what any of it means.
If you laboured in a hospital in the last two decades, you almost certainly spent time connected to a cardiotocograph — a CTG machine. And like most women, you probably had no idea what it was reading, what the clinicians looking at it were looking for, or what the difference between a normal trace and a concerning one actually was.
That information gap matters. Because the misreading of a CTG trace — the failure to recognise the signs that a baby is in distress and act on them in time — is one of the most commonly litigated issues in Australian birth injury law. It sits behind a substantial proportion of infant brain injury claims, neonatal death cases, and the most severe maternal injury outcomes. And in many of those cases, the harm was preventable.
What a CTG Actually Does
A cardiotocograph monitors two things simultaneously: the baby’s heart rate, and the mother’s uterine contractions. The combination of those two data streams — read together, in real time — gives clinicians a picture of how the baby is coping with the physical demands of labour.
During labour, each contraction temporarily reduces blood flow through the placenta. For most babies, this is tolerable. The heart rate fluctuates in ways that indicate the baby is well-oxygenated and responding normally. But when a baby is already compromised, or when contractions are too frequent or too intense, the oxygen supply can fall below safe levels — a state known as foetal hypoxia. The CTG trace is the window through which a trained clinician should be able to see that happening.
Normal CTG traces have recognisable features: a baseline heart rate within an acceptable range, variability in that rate that indicates a healthy, responsive nervous system, and a characteristic response to contractions. Abnormal traces — decelerations in heart rate that are poorly timed, reduced variability, rising or falling baseline — are warning signs that the baby may be in distress and that action may be required.
The problem is that reading a CTG trace accurately and consistently is a clinical skill — and one that requires ongoing training, adequate staffing, and the kind of focused attention that is difficult to sustain in an understaffed, time-pressured hospital environment.
What “Foetal Distress” Actually Means
The term foetal distress refers to a state in which a baby is not receiving adequate oxygen during labour. It is detected primarily through abnormal patterns on the CTG trace — though it can also be indicated by meconium-stained amniotic fluid (the baby has passed stool in utero, which can be a sign of oxygen deprivation) and, in some cases, through direct foetal blood sampling.
When foetal distress is identified, the clinical obligation is clear and urgent: act. The standard response to significant foetal distress is an emergency caesarean section — removing the baby from the compromised environment before the oxygen deprivation causes permanent harm.
Every minute matters. The brain is uniquely vulnerable to oxygen deprivation. Within minutes of significant hypoxia, brain cells begin to die. The extent of the resulting brain injury — whether it manifests as mild developmental delay, cerebral palsy, or profound permanent disability — is directly related to how long the deprivation lasted and how quickly the baby was delivered once distress was identified.
The failure to recognise and respond to foetal distress in time is one of the most tragic and most preventable causes of infant brain injury in Australian hospitals.
How CTG Failures Cause Harm
CTG-related negligence does not take a single form. In our experience, the failures most likely to cause serious harm include:
Misinterpretation of the Trace
A clinician looks at the CTG, sees features that indicate foetal compromise, and misreads them as normal — or understates their significance. This is not always a failure of knowledge. It can be a failure of attention, a failure of process, or the product of a culture in which concerns about CTG traces are routinely normalised rather than escalated.
In one litigated case, a mother was admitted to hospital in active labour at almost 40 weeks’ gestation. The CTG trace showed abnormal foetal heart rate patterns and the presence of meconium-stained fluid throughout labour. Both are recognised warning signs of foetal compromise. Neither was acted upon in the way a competent clinician should have responded. The baby was delivered by spontaneous vaginal birth — pale and floppy. Resuscitation was unsuccessful. Chloe died that evening. Her mother developed chronic major depressive illness. The case settled for $550,000.
Delayed Response to a Recognised Abnormality
Sometimes the abnormality is noted — and then nothing happens. The concern is recorded in the notes and not escalated. The senior clinician is informed but does not attend. The decision to perform an emergency caesarean is made, but the procedure is not performed promptly.
In cases involving delayed emergency caesarean following recognised foetal distress, the question is a precise one: at what point was the distress identified, and how much of the brain injury would have been avoided if the caesarean had been performed at that point rather than when it was actually performed? That is a question that requires expert obstetric and neonatology evidence — but it is a question with an answer, and that answer can form the basis of a substantial claim.
Failure to Monitor When Monitoring Was Required
A CTG trace is only useful if it is being read. In some cases, the failure is not one of interpretation but of attention — the trace was running, but no qualified clinician was reviewing it with the regularity and focus that a high-risk labour required.
Women with recognised risk factors — advanced maternal age, gestational diabetes, previous caesarean, multiple pregnancy, induced labour — are at elevated risk of complications that may manifest on the CTG. The obligation to monitor them appropriately is heightened accordingly. A failure to provide that monitoring, or to ensure it was being reviewed by someone qualified to act on what they saw, is a failure in the standard of care.
Over-Stimulation Through Labour Medications
Syntocinon — synthetic oxytocin used to induce or augment labour — increases the frequency and intensity of contractions. In appropriate doses, carefully titrated and closely monitored, it is a standard obstetric tool. But when it is administered to a woman whose CTG trace already shows signs of foetal compromise, or continued when the trace is deteriorating, it can dramatically accelerate the harm being caused to the baby.
In the case involving the death of baby Chloe, the claim alleged that Syntocinon was administered to the mother despite the presence of abnormal CTG features — potentially worsening the foetal compromise rather than facilitating a safe delivery. This is a recognised form of CTG-related negligence, and one that appears with concerning frequency in the birth injury cases we see.
The Maternal Dimension — CTG Failures and Injury to Mothers
CTG monitoring is primarily discussed in the context of infant outcomes — and the most catastrophic consequences of CTG failure do fall predominantly on babies. But the failure to recognise foetal distress and act on it in time also causes serious maternal harm.
A woman whose emergency caesarean was delayed because foetal distress was not identified promptly may have experienced prolonged labour in a compromised situation, been subject to instrumental delivery that caused severe perineal injury, or suffered a uterine rupture that caused catastrophic blood loss. The delay in acting on the CTG trace is the thread that runs through all of those outcomes — and it connects the maternal injury claim to the same failure that may have injured or killed the baby.
Jennifer’s Case — CTG Failure and a Third-Degree Tear
Jennifer, a young Indigenous woman with a documented history of childhood sexual abuse, presented at her local public hospital in labour. An abnormal CTG demonstrating foetal distress was noted — and Jennifer was discharged home. The following day she was readmitted. Further delays followed in acting on further abnormal CTG findings. Jennifer was not given the option of caesarean section. She delivered vaginally and suffered a third-degree perineal tear.
Jennifer’s case demonstrates the convergence of multiple failures: the initial failure to act on the CTG, the discharge of a high-risk woman without appropriate escalation, the failure to offer caesarean section to a woman whose risk factors made it the appropriate recommendation, and the eventual injury that resulted.
Her claim settled for $400,000 inclusive of costs. The CTG failures were central to establishing what should have happened — and why what did happen fell below any acceptable standard of care.
What This Means If You Are Reading This
The CTG trace from your labour exists. Medical records, including CTG printouts, are retained by hospitals and are accessible through a formal records request. Those records can be reviewed by expert obstetricians and neonatologists who can assess whether what the trace showed was recognised, and whether the response was adequate.
If your baby was born with a brain injury, cerebral palsy, or hypoxic injury — or if your baby did not survive — the CTG record is likely to be one of the most significant pieces of evidence in any legal assessment of your case.
If you remember being told during labour that the baby’s heart rate was being watched, or that there were some concerns, or that things needed to move faster — those memories matter. They are worth exploring with a specialist who understands what the records will show and what they mean.
You do not need to understand the CTG trace yourself. That is what the experts are for. What you need to do is ask the question.
Start the Conversation
If you believe that failures in foetal monitoring contributed to the harm your baby suffered, or to the injuries you experienced during your delivery, Birth Injury Lawyers is here to help you find out.
Anthony Porthouse has spent more than 36 years in personal injury law, 15 years as a specialist medical negligence solicitor, and has litigated CTG-related claims across multiple Australian jurisdictions. He works with the country’s leading obstetric and neonatal experts — the people who can read the trace, explain what it showed, and say clearly what should have happened next.
An initial consultation is free, confidential, and without obligation. It begins with a conversation.
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This information is general in nature and does not constitute legal advice. Every case is unique. We encourage you to contact us directly to discuss your specific circumstances.
