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PubMed This is a summary of 8 peer-reviewed journal articles Updated
Obstetrics · Hypoxic-Ischemic Encephalopathy

Did Something I Did During Pregnancy Cause My Baby's HIE?

At a Glance

Ordinary pregnancy activities—such as a normal diet, moderate exercise, travel, work, and everyday stress—do not cause a baby's hypoxic-ischemic encephalopathy (HIE). HIE may arise from complex medical events or conditions, and testing may not reveal one exact cause.

When a baby is diagnosed with Hypoxic-Ischemic Encephalopathy (HIE)—a type of brain injury caused by a lack of oxygen and blood flow before, during, or shortly after birth—it is entirely normal for parents to search for answers. The birthing parent, in particular, often replays every moment of the pregnancy, wondering if a food they ate, a workout they did, or a routine lifestyle choice somehow caused their baby’s injury.

The short answer is no: ordinary day-to-day activities during pregnancy—such as eating a normal diet, moderate exercise, travel, work, and everyday stress—do not cause HIE [1][2]. When clinicians review a pregnancy for causes, they are looking for complex medical events, maternal illnesses, or placental complications. These are medical vulnerabilities and risk factors, not a parent’s “fault” [3].

Medical Events and Conditions Associated with HIE

HIE is often a complex, multifactorial condition. The lack of oxygen and blood flow can begin before labor, during labor and delivery, or shortly after birth [4].

One recognized category of causes involves acute, sudden clinical emergencies during labor and delivery, often called sentinel events [5]. These emergencies can rapidly and severely reduce oxygen delivery to the baby [6]. Examples include:

  • Placental abruption: When the placenta (the organ that provides oxygen to the baby) prematurely separates from the inner wall of the uterus [6][3].
  • Umbilical cord prolapse or severe compression: When the umbilical cord drops through the open cervix ahead of the baby, or becomes tightly squeezed, cutting off the oxygen supply [6][3].
  • Uterine rupture: A rare medical emergency where the wall of the uterus tears [6][3].

While these are critical obstetric emergencies requiring urgent intervention, they are just examples of potential causes, and they are not the result of a parent’s routine lifestyle choices [6][2].

When There Is No Clear Event

A specific, dramatic sentinel event is not identified in every case of HIE [7]. In many situations, the injury may be linked to underlying medical factors that were difficult or impossible to detect during pregnancy [4].

These can include issues like placental insufficiency (where the placenta does not develop or function properly), fetal growth restriction, maternal infections, or chronic low-level oxygen issues that occurred earlier in the pregnancy [4][8]. Like acute delivery emergencies, these underlying vulnerabilities are complex medical complications.

The Limits of Testing

Parents often hope that medical records, fetal monitoring strips (recordings of the baby’s heart rate during labor), placental pathology (laboratory examination of the placenta), or an MRI (a detailed brain scan) will provide a definitive answer about exactly when and why the injury occurred.

While these tests can provide important clues, they often cannot pinpoint an exact time or a single cause [7][8]. A definitive explanation may remain impossible even after a thorough review, which further underscores that this is a complex medical issue, not a preventable maternal mistake.

Coping With Guilt After HIE

Parental guilt is one of the heaviest emotional hurdles following an HIE diagnosis. But the medical literature does not support blaming yourself for ordinary daily actions [1][2].

If you are carrying guilt, have an open, honest conversation with your baby’s neonatologist or neurologist. Ask them to review the available tests and clinical records with you. Acknowledging together that the medical cause may be complex or unknown can be a powerful step in releasing unearned guilt.

Furthermore, experiencing guilt and trauma is incredibly common, even when you intellectually understand you are not at fault. Please ask your care team to connect you with a perinatal mental-health counselor or a neonatal social worker. If you are experiencing severe depression, anxiety, trauma flashbacks, or thoughts of self-harm, seek urgent professional support immediately. You do not have to carry this burden alone.

Common questions in this guide

Can normal pregnancy activities cause my baby’s HIE?
No. A normal diet, moderate exercise, travel, work, and everyday stress are not considered causes of hypoxic-ischemic encephalopathy (HIE). HIE is linked to complex medical events or conditions, and these are not a parent’s fault.
What medical problems can contribute to HIE before or during birth?
HIE can be associated with problems that reduce oxygen or blood flow to a baby, including placental abruption, umbilical cord prolapse or severe compression, and uterine rupture. Other possible contributors include placental insufficiency, fetal growth restriction, maternal infection, and longer-lasting low oxygen levels. These complications can be difficult or impossible to predict or detect.
Can testing show exactly when my baby’s HIE happened?
Fetal heart-rate monitoring, placental examination, and MRI can provide important clues about a baby’s condition and possible timing. However, they often cannot identify one exact moment or a single cause. Even after a careful review, the cause may remain uncertain.
Does the absence of a major delivery emergency mean I caused HIE?
No. A sudden major delivery emergency is not found in every HIE case. The injury may involve underlying placental or medical factors that were hard to detect, and not finding one event does not make a parent responsible.
Where can I get help with guilt after my baby’s HIE?
Tell your baby’s neonatologist or neurologist about the guilt, anxiety, or trauma you are experiencing and ask for a referral to a perinatal mental-health counselor or neonatal social worker. Severe depression, trauma flashbacks, or thoughts of self-harm need urgent professional support. You do not have to manage these feelings alone.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Can you walk me through the delivery records to help me understand if a specific 'sentinel event' or emergency was identified?
  2. 2.Did the pathology report on the placenta show any abnormalities that might give clues about when or why the oxygen deprivation occurred?
  3. 3.What can the MRI results and other testing tell us, and what can they not tell us, about the cause and timing of the injury?
  4. 4.Could more than one factor have contributed to my baby's HIE?
  5. 5.Are there any ongoing investigations or tests we are waiting on?
  6. 6.Can you connect me with a neonatal social worker or perinatal mental-health clinician for support?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

Can Mild HIE Affect Development Later in Childhood?How Are Silent Seizures Detected in Newborns With HIE?How Does Early Intervention Therapy Help Babies With HIE?Is Cooling Therapy Used for Mild HIE? What to KnowWhat Clinical Signs Define Sarnat Stages in Newborn HIE?What Are the Risks During HIE Rewarming Therapy for Babies?What Are the Side Effects of Cooling for Neonatal HIE?What Doctors and Specialists Should a Baby With HIE See After NICU?What Do Lactate and pH Blood Tests Mean in Newborn HIE?What Does a “Watershed” Brain Injury Mean in Neonatal HIE?Neonatal Encephalopathy vs HIE: What's the Difference?What Is the Standard HIE Follow-Up Schedule for Children?Why Do Babies With Suspected HIE Need Genetic Testing?Why Is Brain MRI Timed for Days 4-10 in Newborns With HIE?

References

References (8)
  1. 1

    Antenatal and intrapartum risk factors for neonatal hypoxic ischemic encephalopathy.

    Peebles PJ, Duello TM, Eickhoff JC, McAdams RM

    Journal of perinatology : official journal of the California Perinatal Association 2020; (40(1)):63-69 doi:10.1038/s41372-019-0531-6.

    PMID: 31611618
  2. 2

    Hypoxic-ischemic encephalopathy following intrapartum asphyxia: is it avoidable?

    Tarvonen M, Jernman R, Stefanovic V, et al.

    American journal of obstetrics and gynecology 2025; (233(5)):475.e1-475.e13 doi:10.1016/j.ajog.2025.04.073.

    PMID: 40348116
  3. 3

    Perinatal antecedents of moderate and severe neonatal hypoxic ischaemic encephalopathy: An Australian birth cohort study.

    Stoke R, Schreiber V, Hocking K, et al.

    The Australian & New Zealand journal of obstetrics & gynaecology 2023; (63(3)):409-417 doi:10.1111/ajo.13665.

    PMID: 36974351
  4. 4

    Blood biomarkers for neonatal hypoxic-ischemic encephalopathy in the presence and absence of sentinel events.

    Broni EK, Eke AC, Vaidya D, et al.

    Journal of perinatology : official journal of the California Perinatal Association 2021; (41(6)):1322-1330 doi:10.1038/s41372-020-00850-5.

    PMID: 33024259
  5. 5

    Antenatal and Intrapartum Risk Factors for Hypoxic-Ischemic Encephalopathy in a US Birth Cohort.

    Parker SJ, Kuzniewicz M, Niki H, Wu YW

    The Journal of pediatrics 2018; (203()):163-169 doi:10.1016/j.jpeds.2018.08.028.

    PMID: 30270166
  6. 6

    Optimizing the management of acute, prolonged decelerations and fetal bradycardia based on the understanding of fetal pathophysiology.

    Chandraharan E, Ghi T, Fieni S, Jia YJ

    American journal of obstetrics and gynecology 2023; (228(6)):645-656 doi:10.1016/j.ajog.2022.05.014.

    PMID: 37270260
  7. 7

    Risk Factors for Neonatal Hypoxic-Ischemic Encephalopathy in the Absence of Sentinel Events.

    Novak CM, Eke AC, Ozen M, et al.

    American journal of perinatology 2019; (36(1)):27-33 doi:10.1055/s-0038-1639356.

    PMID: 29579759
  8. 8

    The Placenta and Neonatal Encephalopathy with a Focus on Hypoxic-Ischemic Encephalopathy.

    Dehner LP

    Fetal and pediatric pathology 2023; (42(6)):950-971 doi:10.1080/15513815.2023.2261051.

    PMID: 37766587

This page explains possible causes of a baby’s HIE and parental guilt for educational purposes only; it does not replace medical advice. Ask your baby’s neonatologist or neurologist to interpret the records and tests for your family.

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