In spite of advances in obstetrics and neonatology, the reported incidence of cerebral palsy in developed countries is about two per 1000 live births (Graham et al. Am J Obstet Gynecol 2008;199:587–95). The linked paper by Leigh et al. suggests that almost one in seven cases are the result of intrapartum hypoxia, and the UK Confidential Enquiry into Stillbirths and Deaths in Infancy (1999) found that 50% of 567 of such cases investigated were possibly or probably preventable. In the UK, during 2000–2010, awards for cerebral palsy judged preventable by better care totalled £1 263 581 324: 41% of all obstetric settlements (Ten Years of Maternity Claims. NHS Litigation Authority, 2012). In the case of McKenzie vs Fife Acute Hospitals NHS Trust [2006] ScotCS_63, the judgment included a ‘threefold test’ for duty of care. The harm must be: (a) reasonably foreseeable; (b) there must be a ‘relationship of proximity’ (duty of care) between the plaintiff/claimant and the defendant; and (c) it must be ‘fair, just and reasonable’ to impose liability. Evidence from the International Cerebral Palsy Task Force (MacLennan BMJ 1999;319:154–9) was used to support a causal relationship between acute intrapartum hypoxia and cerebral palsy. The case met all of the three essential criteria: (a) intrapartum metabolic acidosis (pH < 7.00 and base deficit ≥12 mmol/l); (b) early onset severe or moderate neonatal encephalopathy at ≥34 weeks of gestation; and (c) subtype spastic quadriplegia or dyskinetic cerebral palsy. The case also met four of the five non-specific criteria: (a) sudden, rapid, and sustained deterioration of the fetal heart rate; (b) APGAR score of 0–6 for >5 minutes; (c) early multisystemic dysfunction; and (d) early imaging evidence of acute cerebral abnormality. Only one criterion was difficult to establish: evidence of an identified sentinel hypoxic event, such as (a) listed above. The plaintiff's lawyers successfully argued that the prolonged use of Syntocinon®, compounded by misinterpretation of the cardiotocogram, was sufficient to cause damaging hypoxia, however. The judge was satisfied that, on the balance of probabilities, there was an act of omission, as had steps been taken earlier to discontinue the Syntocinon® infusion and expedite delivery the damage would have been avoided. There was a failure to exercise the due diligence that was expected from a reasonably prudent and skilled professional. A similar finding was reached in the more recent case of Jack Clayton vs Yeovil District Hospital (http://www.dailymail.co.uk/health/article-2218209/Oxytocin-How-drug-used-speed-births-starve-baby-oxygen.html), highlighting the medico-legal cost of using a powerful drug without due diligence. Obstetricians and midwives must remember that although many cases of cerebral palsy have genetic, environmental, and antenatal causes, this does not obviate their duty to avoid substandard care that will result in them being held responsible for damaging intrapartum hypoxia. None to declare.