At just three years old, little Likothemba Ncapayi has already endured four operations, and doctors say she will still need two more.
Her left arm hangs limp and largely unusable, while complications mean her parents often watch her anxiously as she sleeps, fearing she may stop breathing.
Her mother, Siphokazi Ncapayi, 36, from Delft outside Cape Town, believes her daughter’s injuries were caused during a traumatic delivery at Mowbray Maternity Hospital. The family has now instituted a medico-legal claim against the Western Cape department of health as the costs of caring for their daughter continue to mount.
“We are raising a special-needs child now,” said Ncapayi. “The doctors saw that the baby was big, but they failed to do an operation.”
She said she was between 37 and 38 weeks pregnant when she first felt labour pains and went to the hospital.
“The doctor said I had labour pains and needed to be admitted. I was also bleeding. She said I should be given morphine to stop the labour pains,” she said.
A scan showed the baby was large, but after spending the night at the hospital she was discharged the following day and told to return when she reached 40 weeks.
When she returned, she said she was still experiencing pain and bleeding.
“This time I was assisted by a student doctor during morning rounds. She said I was not supposed to be in that ward and referred me to the labour ward,” she said.
Her waters broke that morning, and she was already nine centimetres dilated.
“I was still with the student doctor. After some time, my colour changed, and they called a nurse to bring me juice to bring up my sugar levels. I was in pain.”
She recalled telling her husband, Luvuyo, that she felt she was losing energy and might pass out.
“I could faintly hear the doctor saying I was an emergency case. He said they can’t lose two patients at the same time. They told my husband to keep talking to me so that I wouldn’t close my eyes.”
Luvuyo said the delivery became increasingly tense as medical staff tried to help his wife give birth.
“They used a vacuum and forceps to assist the delivery. It was during that process that our daughter’s left shoulder and neck were injured,” he said.
My wife was also injured in her right leg and could not walk. Our baby would not stop crying. It was only when an elderly nurse went looking for the doctor and found him sleeping that things changed.
— Father
The injury, he said, was later identified as a brachial plexus injury, damage to the network of nerves that sends signals from the spinal cord to the shoulder, arm and hand.
According to the National Institute of Neurological Disorders and Stroke, these nerves control movement and sensation in the arm and hand. Damage to them can lead to weakness, paralysis or loss of movement. In some cases, such injuries occur during difficult births.
Luvuyo said both mother and baby were taken to the ward afterwards, but the attending doctor allegedly did not return to check on them.
“My wife was also injured on her right leg and could not walk. Our baby would not stop crying,” he said.
“It was only when an elderly nurse went looking for the doctor and found him sleeping that things changed.”
He said the doctor was angry at being woken and instructed the nurse to call a paediatrician.
“The nurse reported the incident, and the next day the head of the hospital came to see my wife and apologised. He said they were trying to save her life and that of our child.”
When the family was discharged, they were referred to Groote Schuur Hospital for specialist care.
“One of the doctors told us the child would be partially normal,” said Luvuyo.
Likothemba underwent her first operation at just four months old, when surgeons took a nerve from another part of her body to repair the damaged nerve in her shoulder.
Despite the surgery, her arm remains weak and largely immobile.
“Her arm is floppy, like someone who has had a stroke,” said Siphokazi.
The toddler also suffers from breathing problems because her diaphragm is elevated, which affects her lung function.
“She sometimes stops breathing for a few seconds. What hurts is that no one is telling us what exactly is happening or what will happen with her lung,” she said.
The family says Likothemba requires daily physiotherapy and frequent hospital visits.
“I am the only one employed,” said Luvuyo. “Sometimes we struggle to find money just to take her to the hospital. We also worry about what will happen if she struggles to breathe while sleeping.”
Their case comes amid growing concern about the rising cost of medical negligence claims in the Western Cape.
In 2024, the Special Investigating Unit (SIU) reported that there were 409 medico-legal claims against the Western Cape health department valued at R2.85bn between the 2015/16 and 2020/21 financial years.
During the same period, the department paid out R273.25m in claims.
The SIU also identified 33 fraudulent birth-injury claims worth about R409m in the province’s contingency liability register.
Western Cape health department spokesperson Dwayne Evans said the department is aware of the family’s concerns but cannot comment on the specifics of the case because legal proceedings have been instituted.
“The department acknowledges the concerns raised and understands how distressing birth-related complications can be for families,” he said.
“Our priority remains the safety and wellbeing of mothers and babies receiving care in our facilities.”
Evans said brachial plexus injuries can occur as a complication of difficult deliveries, particularly in cases of shoulder dystocia, an obstetric emergency where a baby’s shoulder becomes stuck during birth.
“Shoulder dystocia is often unpredictable and requires clinicians to act rapidly using established clinical manoeuvres to safely deliver the baby,” he said.
“Even when appropriate clinical management is followed, complications can still occur.”
He added that babies with suspected brachial plexus injuries are referred for specialised follow-up care involving multidisciplinary teams that may include orthopaedic specialists, physiotherapists and rehabilitation services.
“The Western Cape health department continues to strengthen clinical governance processes, training and review mechanisms within maternity services to support safe deliveries and improve outcomes for mothers and babies.”
Meanwhile, the Ncapayi family says their daily reality is raising a child with special needs while struggling to access support.
Siphokazi said they have also battled to obtain their daughter’s medical records, which they need to apply for a disability grant through the provincial department of social development.
Without the grant, they say it is difficult to afford transport for hospital visits and to enrol Likothemba at a suitable early childhood development centre.
“We just want help for our child,” said Siphokazi. “She deserves a chance at a normal life.”
Yoliswa Sobuwa
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