Group B Strep (GBS) in Pregnancy and Neonatal Sepsis: Medical Negligence Claims

Understanding Group B Strep (GBS) around birth

Group B Strep is a type of bacteria that naturally lives in the digestive system and vaginal tract of many adults. It is generally harmless to the carrier. In Ireland, it is estimated that a significant percentage of pregnant women carry GBS without ever knowing it. The danger arises when the bacteria travels from the mother to the baby, usually shortly before or during delivery.

How GBS can affect a baby around delivery and in the first weeks

While most babies born to mothers who carry GBS will be perfectly healthy, a small number can become seriously ill. The bacteria can be passed to the baby as they move through the birth canal, or bacteria can travel up into the womb if the waters have broken for a long time. Once the bacteria enters the baby’s system, it can multiply rapidly because a newborn’s immune system is not yet fully developed. This can lead to severe infections of the blood, lungs, or the lining of the brain.

Early-onset vs late-onset infection

Doctors divide GBS infections into two main categories based on when the baby gets sick.

• Early-onset infection happens in the first week of life, often within 12 to 24 hours of birth. This type is most strongly linked to complications during labour and delivery and is the primary focus of preventative antibiotics.
• Late-onset infection occurs after the first week, sometimes up to three months of age. These infections are often acquired from the environment or community after the baby has gone home. While late-onset GBS is serious, legal investigations regarding maternity care typically focus heavily on early-onset cases, where preventative measures during labour could have made a difference.

How neonatal sepsis can develop and why timing matters

Sepsis is a life-threatening reaction to an infection. It happens when the immune system overreacts to the bacteria, damaging the body’s own tissues and organs. In newborns, this can escalate with frightening speed.

Why prompt recognition and treatment is emphasised in maternity and neonatal care

Babies have very small reserves. When they get sick, they can deteriorate much faster than an adult or an older child. Because of this, time is of the essence. Irish maternity guidelines emphasise that if there is even a suspicion of sepsis, treatment should often start immediately, even before test results confirm the exact bacteria involved. A delay of even a few hours in administering antibiotics and fluids can mean the difference between a full recovery and catastrophic injury, such as brain damage or cerebral palsy.

Common serious infection presentations

When GBS or other bacteria take hold, they can cause three main types of severe illness.

• Sepsis: This is an infection of the bloodstream (blood poisoning). It affects the whole body and can cause shock and organ failure.
• Pneumonia: This is an infection of the lungs. It causes breathing difficulties and prevents the baby from getting enough oxygen.
• Meningitis: This is an infection of the fluid and lining around the brain. It is arguably the most feared complication because it carries a high risk of long-term neurological injury or deafness.

Where problems can occur

In our experience at Michael Boylan LLP, medical negligence cases involving GBS and sepsis rarely stem from a single error. They often result from a sequence of missed opportunities.

Antenatal stage

Problems here often relate to communication and record-keeping.

• Missed urine results: A urine test done at 12 weeks might show GBS, but if the result is filed away without being flagged on the antenatal card, the labour ward staff may not know the mother needs antibiotics months later.
• Failure to plan: If a mother has a history of a previous baby with GBS, a clear plan for antibiotics should be written in her notes well before labour starts.
• Inadequate advice: Parents may not be told about the signs of infection to watch out for if their waters break early at home.

Labour and delivery

This is the most critical window for prevention.

• Failure to administer antibiotics: If a mother has a fever or known GBS, antibiotics should ideally be given at least 4 hours before delivery to be most effective. Delays in getting the drip up can be critical.
• Ignoring maternal fever: Dismissing a high temperature as being caused by an epidural or a hot room, rather than investigating it as a potential infection.
• Failure to monitor the baby: An infection often stresses the baby, which may show up as a high heart rate (tachycardia) on the CTG monitor. Failing to interpret this correctly can lead to delayed delivery.

Postnatal ward and after discharge

Once the baby is born, the focus shifts to observation.

• Failure to track observations: Babies at risk (e.g., born after prolonged waters breaking) should have their temperature, heart rate, and breathing rate checked regularly (using an early warning score). Gaps in these checks can mean early signs of decline are missed.
• Dismissing parental concern: Parents often know instinctively when something is wrong. If a mother reports her baby is not feeding or seems "floppy," and staff dismiss this without a proper examination, it can lead to dangerous delays.
• Inadequate safety-netting: If a family is discharged early, they must be given clear instructions on what to look for. Discharging a vulnerable baby too soon without proper advice can be negligent.

Common systems issues that contribute

Sometimes the failing is organisational.

• Handover failures: Information about GBS status not being passed from the antenatal clinic to the delivery suite, or from the delivery suite to the paediatric team.
• Lab turnaround times: Delays in getting blood culture results back.
• Unclear responsibility: Confusion over whether the obstetrician or the paediatrician is responsible for reviewing a baby's condition.

Signs of infection in a newborn

Recognising sepsis in a newborn can be difficult because the signs are often subtle and non-specific. They can look like other common, less serious issues. However, a combination of these signs requires urgent medical review.

Medical staff use the Irish Maternity Early Warning System (IMEWS) to track vital signs. They look for:

• Temperature instability: A temperature that is too high (fever) or, crucially, too low (hypothermia).
• Respiratory distress: Grunting noises with every breath, flaring of the nostrils, or the chest sucking in under the ribs (recession).
• Fast breathing (Tachypnoea): Breathing much faster than normal.
• Heart rate changes: A heart rate that is persistently high or unusually low.

If these signs are present, especially in a baby with risk factors, guidelines dictate that sepsis must be presumed until proven otherwise.

When substandard care may amount to medical negligence in Ireland

Understanding the medical facts is only the first step. To bring a successful legal claim in Ireland, specific legal criteria must be met.

Duty of care and standard of care

All medical professionals owe a duty of care to their patients. To prove negligence, we must show that the care provided fell below the standard expected of a reasonably competent practitioner in that field at that time. If a doctor or midwife failed to follow standard guidelines,such as not giving antibiotics when the criteria were clearly met,this may constitute a breach of duty.

Causation

This is often the most complex part of a GBS or sepsis claim. It is not enough to show that mistakes were made; we must prove that but for those mistakes, the outcome would have been different.

• Would the baby have avoided infection if antibiotics were given earlier?
• Would the brain injury have been prevented if the baby was treated for sepsis three hours sooner?

We must demonstrate that the negligence caused or materially contributed to the injury. If the infection was so aggressive that even the best care would not have changed the outcome, the claim may not succeed on causation grounds.

The role of independent clinical experts in assessing GBS and sepsis cases

A judge in Ireland cannot simply decide that care was poor based on their own opinion. The court relies on evidence from independent medical experts. In these cases, we typically engage experts in obstetrics (to look at the mother's care), neonatology (to look at the baby's care), and paediatric infectious diseases. These experts review the files and provide an opinion on whether the care was substandard and whether it caused the injury.

Evidence that typically counts in GBS and neonatal sepsis claims

If you choose to investigate a potential claim with Michael Boylan LLP, we will undertake the task of gathering the necessary proofs.

We will look to secure:

• GP and Antenatal Records: To see if GBS was detected in urine or swabs during pregnancy.
• Labour Ward Notes (Partogram): To check the timeline of labour, maternal temperature, waters breaking, and antibiotic administration.
• Neonatal / NICU Notes: To review the baby’s condition at birth, the timing of observations, and when treatment was started.

• Urine Cultures: Confirming if bacteria was present during pregnancy.
• Blood Cultures: Showing exactly when the infection was confirmed in the baby and what bacteria caused it.
• Blood Gas Analysis: Showing the acid/base balance in the baby's blood, which helps determine how long the baby had been under stress.

Time limits and claims involving babies and children

The law in Ireland places strict time limits on bringing medical negligence claims, known as the Statute of Limitations.

Generally, an adult has two years from the date of the injury (or date of knowledge of the injury) to issue legal proceedings. However, the law recognises that a baby cannot bring a claim themselves. For a child, the two-year time limit does not begin to run until they turn 18 years of age. This means technically, a claim can be brought any time up until their 20th birthday.

In practice, parents rarely wait that long. Parents usually bring the claim on behalf of their child as a "Next Friend" while the child is still a minor. Investigating the case sooner rather than later is generally better, as medical records are easier to retrieve and memories are fresher.

How these cases are typically investigated

At Michael Boylan LLP, we follow a structured, careful process designed to minimise stress for the family while ensuring thoroughness.

Initial review and record gathering

When you first contact us, we will discuss your story. If we believe there are grounds for investigation, we will take up your medical records from the relevant hospitals and GPs. You do not need to gather these yourself; our legal team handles this administration.

Expert review and identifying the central issues

Once the records are sorted and paginated, we send them to independent medical experts in the UK or elsewhere (to ensure total impartiality). They will write a report telling us if the care was negligent. If the reports are supportive, we then move to the causation experts to link the negligence to the injury.

What families can expect at each stage

• Investigation Phase: This can take several months as we await records and reports. It is a quiet phase for the family.
• Letter of Claim: If the evidence is strong, we write to the HSE or the relevant medical insurers setting out the allegations.
• Proceedings: If admission of liability is not forthcoming, we may issue court proceedings. However, the vast majority of medical negligence cases in Ireland are settled through negotiation or mediation without ever going to a full trial.

FAQs

Is routine GBS screening offered to everyone in Ireland?

No. Currently, the HSE and Irish maternity hospitals do not offer universal screening (swabbing every pregnant woman) for Group B Strep. They use a risk-based approach, treating women who show specific clinical risk factors.

What is antibiotic prophylaxis (IAP) and when is it used?

IAP stands for Intrapartum Antibiotic Prophylaxis. It involves giving antibiotics intravenously (through a drip) to the mother during labour. It is used when the mother is known to carry GBS, has had a previous GBS baby, or develops risks like a fever during labour.

If my baby became unwell after discharge, what records matter most?

If your baby fell ill at home, the discharge summary from the hospital and the notes from any Public Health Nurse visits or GP visits are vital. We look for evidence of whether you were given proper advice (safety-netting) and if early signs were missed by community care providers.

What if GBS was found in pregnancy but nothing was discussed?

If GBS was found in a urine test but not acted upon, and your baby subsequently developed a GBS infection, this is a serious issue. It may represent a failure in the system of care to flag the result, potentially amounting to negligence.

Can invasive GBS in infants be tracked in Ireland?

Yes, laboratories track invasive GBS disease. However, for a legal case, we look specifically at your baby’s blood culture results to prove the infection type.

How long do these cases usually take to investigate?

Medical negligence cases are complex. The investigation phase (getting records and expert reports) often takes 9 to 18 months. If the case proceeds to litigation, it can take several years to conclude, especially if we are waiting to assess the full extent of a child’s development and future needs.

We are here to help you find answers

If your child has suffered a significant injury due to Group B Strep meningitis or neonatal sepsis, and you believe it may have been preventable, you do not have to carry that burden alone.

At Michael Boylan LLP, we are dedicated to securing justice for families affected by medical negligence. We combine empathy with forensic attention to detail to ensure your story is heard and your child’s future is protected.

Contact us today in confidence. We will listen to your experience, explain your legal options in plain English, and help you decide the best path forward.

*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.