$7.7 Million Birth Injury Verdict in Pennsylvania: What Prolonged Second-Stage Labor Litigation Means for Attorneys
A Chester County, Pennsylvania jury recently returned a $7.7 million verdict in a birth injury case that centered on two issues familiar to any attorney handling obstetric malpractice: prolonged second-stage labor and delayed neonatal resuscitation. The case, Soring et al. v. Askinas et al., No. 2022-05818-TT (Chester County Court of Common Pleas), underscores why labor management decisions continue to generate some of the highest-value verdicts in medical malpractice litigation.
The Facts Behind the Verdict
Christine Soring and Andrew Bailey alleged that their son suffered severe hypoxic brain injury after clinicians allowed Soring to remain in the second stage of labor for more than seven hours before proceeding to cesarean delivery. The pregnancy was complicated by elevated blood pressure, a diagnosis of preeclampsia, and uterine anatomy described as small and differently shaped. Although delivery at 37 weeks was recommended, it was delayed by six days. When Soring was admitted on June 7, 2021, she presented with dangerously high blood pressure, and the induction process lasted approximately 38 hours.
When the child was finally delivered by cesarean section, he was apneic and hypotonic, with the umbilical cord wrapped around his neck three times. The newborn was briefly declared dead before gasping minutes later and showing signs of life. The child continues to experience seizures, developmental delays, and persistent speech deficits.
After a 14-day trial, the jury found obstetrician Dr. Jared Tepper negligent and concluded that his conduct fell below the relevant standard of care and caused harm to the child. The litigation originally included several physicians and hospital entities, including Children’s Hospital of Philadelphia and Chester County Hospital, but only three defendants remained by the time of deliberations. The jury imposed liability solely on Dr. Tepper, who was practicing at the time under Regional Women’s Health Group LLC (identified in filings as Axia Women’s Health). According to the family’s counsel at Kline and Specter PC, the verdict is expected to be entered as a judgment of approximately $9.5 million after the addition of legally available amounts.
Why Second-Stage Labor Duration Is a Standard-of-Care Flashpoint
The second stage of labor, defined as the interval from complete cervical dilation through delivery of the neonate, has become one of the most scrutinized phases of obstetric care in malpractice litigation. The American College of Obstetricians and Gynecologists (ACOG) Clinical Practice Guideline No. 8, published in January 2024, addresses this directly.
Under current ACOG guidance, a prolonged second stage is defined as three hours or more of pushing in nulliparous patients and two hours or more in multiparous patients. Second-stage arrest can be identified earlier when there is a lack of fetal rotation or descent despite adequate contractions, pushing efforts, and time. The guideline also recommends that clinicians weigh the risks of continued labor against the potential benefit of vaginal delivery on an individualized basis.
In the Soring case, the plaintiffs alleged that the second stage lasted more than seven hours, more than twice the duration even the most generous interpretation of clinical guidelines would support. That gap between the documented duration and the published standard of care gave the plaintiffs’ experts a clear benchmark to work from when testifying about breach.
This is a recurring pattern in birth injury litigation. The standard of care is not a rigid numerical cutoff, but when the documented timeline dramatically exceeds published guidelines, the burden on the defense to justify the clinical decision-making becomes substantially heavier.
Preeclampsia as a Compounding Risk Factor
The presence of preeclampsia added another layer of complexity to both the clinical picture and the litigation. Preeclampsia is associated with placental insufficiency, meaning the placenta may not deliver adequate oxygen and nutrients to the fetus. In a patient with preeclampsia, prolonged labor carries heightened risks because the fetal reserve, the fetus’s ability to tolerate the stress of labor, may already be compromised.
For attorneys evaluating birth injury cases, preeclampsia is a critical fact to identify early. It changes the risk calculus for every subsequent clinical decision, from the timing of induction to the threshold for proceeding to cesarean delivery. When preeclampsia is documented in the medical records and the care team nonetheless permits an extended labor course, the deviation from the standard of care becomes more difficult to defend.
Delayed Resuscitation and the Neonatal Timeline
The second major liability theory in this case involved delayed neonatal resuscitation. The complaint describes the newborn being declared dead shortly before 3 p.m. and then gasping minutes later. That sequence raises questions about the adequacy and timing of resuscitative efforts in the delivery room.
The Neonatal Resuscitation Program (NRP) guidelines, developed by the American Academy of Pediatrics and the American Heart Association, establish clear protocols for immediate assessment and intervention when a newborn does not breathe spontaneously. Every minute matters. Delays in initiating positive pressure ventilation or other resuscitative measures can extend the duration of hypoxia and worsen neurological outcomes.
For trial preparation, the resuscitation timeline is often reconstructed through delivery room nursing notes, neonatal records, and Apgar scores recorded at one and five minutes of life. Inconsistencies between the documented timeline and the clinical presentation can be powerful evidence for plaintiffs.
Expert Witness Considerations in Birth Injury Cases
Birth injury cases involving prolonged labor and neonatal resuscitation typically require expert testimony from multiple specialties. An obstetrics and gynecology expert can address whether the decision to continue labor rather than proceed to cesarean delivery met the standard of care. A neonatology or pediatric neurology expert can speak to the timing and adequacy of resuscitation and the causal relationship between hypoxia and the child’s neurological injuries.
The challenge for attorneys is finding experts who can communicate these complex medical concepts to a jury in terms that are both accurate and understandable. The science behind hypoxic-ischemic encephalopathy, fetal heart rate monitoring interpretation, and placental pathology can be dense. Effective expert testimony in these cases requires not only clinical knowledge but the ability to connect the medical evidence to the legal standard of care in a way that resonates with jurors.
What This Case Signals for Obstetric Malpractice Litigation
The Soring verdict reflects a broader trend in birth injury litigation. Juries are increasingly willing to impose significant liability when the evidence shows that clinicians continued a labor course in the face of mounting risk factors without adequate justification. The combination of preeclampsia, prolonged second-stage labor far exceeding published guidelines, and delayed resuscitation created a compelling narrative for the plaintiffs.
For attorneys handling birth injury cases, this verdict reinforces several practical takeaways. First, the medical records from the labor and delivery period are the most critical documents in the case. Every nursing note, fetal heart rate tracing, and physician order tells part of the story. Second, early identification of the applicable standard of care guidelines, particularly ACOG guidance on second-stage management, provides the framework for evaluating whether a breach occurred. Third, the selection of qualified expert witnesses who can bridge the gap between clinical medicine and legal standards remains the single most important factor in building a persuasive case.
The defense in Soring indicated that post-trial motions and appellate options were being evaluated, so the final resolution of this case may still evolve. But the jury’s $7.7 million verdict, with an expected judgment of approximately $9.5 million, sends a clear message about how seriously juries take labor management decisions when the outcome is a child with permanent neurological injury.
Med Legal Pro connects attorneys with qualified medical expert witnesses across all specialties, including obstetrics, neonatology, and pediatric neurology. If you are evaluating a birth injury case and need expert support, contact us to discuss your case.
