Maternal-Fetal Medicine Expert’s Testimony on Birth Injury is Excluded for Lack of Peer-Reviewed Research

Court: Court of Appeals of Georgia
Jurisdiction: Federal
Case Name: Smith v. Braswell
Citation: 2017 Ga. App. LEXIS 402


The plaintiff’s son began to have seizures after he was born and a CT scan revealed ischaemic injuries to his brain. After this, the plaintiff filed a suit against the midwife and hospital involved in the delivery of the baby. The plaintiff alleged that the defendants were negligent in managing her labor and delivery, and sought damages. The defendants filed a motion for summary judgment and a motion seeking to exclude the testimony of the plaintiff’s maternal-fetal medicine expert witness. The trial court granted the defendants’ motion, prompting the plaintiff to appeal, arguing that the trial court had erred in allowing the motion to exclude the testimony of her maternal-fetal medicine expert witness.

The Maternal-Fetal Medicine Expert Witness

The plaintiff’s maternal-fetal medicine expert witness was an obstetrician/gynecologist with a maternal-fetal medicine sub-specialty qualification. At the time of the trial, the expert’s work was primarily giving lectures, conducting research, and writing. The expert had not had hospital privileges in approximately six years and the last time he practiced as a full-time maternal-fetal medicine physician was 17 years prior. The last time he had delivered a child was about 14 years earlier.

The maternal-fetal medicine expert witness opined that the infant’s injury was the result of ischemia caused by mechanical compressive forces on his brain during the plaintiff’s labor. The mechanical compressive forces included excessive uterine activity, pushing before the plaintiff’s full cervical dilation, fundal pressure, malposition of the infant, and the use of Pitocin. The expert coined this mechanism of injury as cranial compression ischemic encephalopathy (CCIE). The trial court concluded that the expert’s testimony concerning the mechanism of the infant’s injury was inadmissible under OCGA § 24-7-702(b) and Daubert. Upon appeal, the plaintiff contended that the trial court had erred in throwing the testimony out.


Contrary to the plaintiff’s claim that the expert’s position was only one aspect of the hypothesis of causation, the court noted that the case was based on the expert’s testimony as to the mechanical forces of labor that injured the infant. The court also noted that the expert has co-authored a chapter of a book where he proposed the concept of CCIE and explained that the overall contribution of mechanical forces to ischemic brain injury during labor is difficult to establish. The chapter explained that in modern obstetrics, the necessary details of these various factors are often undetected, unrecorded, and not considered.

The expert also deposed that there have been no long-term epidemiological studies on the mechanism of injury and suggested studies would be helpful in better understanding CCIE as a potential injury cause. The court noted that in his book chapter, the expert accepted that the scientific community does not currently accept this injury mechanism, and more research is needed. Moreover, another of the plaintiff’s expert witnesses deposed that the maternal-fetal medicine expert’s hypothesis was not well known by his peers, which is why he intended to write and publish an article on the theory.


The appeals court upheld the trial court’s decision to exclude the maternal-fetal medicine expert witness’s testimony.