The hospital has denied negligence and has also pleaded the boy's mother was negligent in allegedly delaying his delivery.

When Michelle Gilroy was in labour, she was never told her son Paul Fitzpatrick was in foetal distress or that an episiotomy [ a surgical incision to enlarge the vagina to assist childbirth], which she was offered but declined, was required to deliver him, her counsel Aongus Ó Brolcháin SC said yesterday.

Paul, through his mother, Ms Gilroy, of St Catherine's Close, Carman's Hall, Dublin, is alleging negligence against the hospital in the circumstances of his birth there at 8.03am on December 26th, 2001. It is claimed that, had Paul been delivered some 20 minutes earlier, he would not have sustained the injuries alleged.

The NMH denies the claims and pleads that Ms Gilroy herself was guilty of negligence and had delayed delivery by not consenting to the episiotomy and refusing forceps assistance.

It also claims Ms Gilroy delayed the progress of and/or management of her labour by not consenting to the delivery accelerant drug Oxytocin being administered until 4.30am on December 26th, 2001, although it had been sought to administer it at 2.45am.

Opening the case yesterday, Mr Justice Daniel Herbert was told by Mr Ó Brolcháin that the word "distress" was not used when Ms Gilroy was told her baby needed to be delivered. It appeared it was the policy of the hospital not to use that word.

Ms Gilroy was told the baby was tired and needed to be delivered, counsel said. She was offered an episiotomy but was not told that the procedure was needed to deliver the baby. The child was in utter distress but this was not conveyed to the mother who did not know, counsel said.

He said the first issue to be decided by the court was of liability. It is claimed the hospital was negligent in that it failed to act upon the deterioration of the boy's foetal heart trace at 6.30am and failed to stop the use of Oxytocin. It is also claimed there was a failure to carry out a second foetal blood sample to check the baby's condition and a failure to perform a Caesarean section.

It is claimed the oxytocin infusion was continued when it was inappropriate and dangerous to do so. There was a failure to perform an urgent delivery at 7.10am when there was a dramatic and major deterioration in the nature of the CGT trace, it is alleged.

Paul Fitzpatrick was born at 8.03am, it is claimed, and his first gasp was at 13 minutes of life. He was transferred to the neonatal intensive care unit. An MRI scan a week later showed several abnormalities.

Mr Ó Brolcháin said there was an issue concerning the amount of oxytocin administered. When a blood sample from the baby at 5.03am showed he was normal, the oxytocin should have been stopped then and a doctor should have been involved from 6am. A CGT trace clearly indicated that there was a problem with the child at 6.50am and, from five minutes later, there were serious difficulties with the baby, he said.

From 7am, there was an emergency and a doctor should have been present, counsel said. The doctor was called at 7.20am. His case was that Paul would not have suffered significant damage if delivered by 7.43am. The case, which is expected to last more than five weeks, continues today.