Tennessee residents who wish to learn more about catastrophic brain injuries may be surprised to learn that they typically occur in a motor vehicle accident or during a baby’s birth. In a court case that is believed to be the nation’s largest jury award for medical malpractice, a 4-and-a-half year old girl suffered complications during her birthing and delivery, which resulted in lasting and severe brain injuries, as reported by the Baltimore Sun.

In 2014, a 16-year-old pregnant woman was admitted to Johns Hopkins Bayview Medical Center in Baltimore, Maryland after experiencing dangerous levels of high-blood pressure due to preeclampsia. Once admitted, doctors informed the mother that her baby was viable outside the womb and it may suffer brain damage or die as a result of her preeclampsia complications. The mother, however, refused to undergo a cesarean section, and instead, doctors induced her into labor to deliver the 25-week old baby vaginally. Two minutes after the delivery, the baby was not breathing and a heart rate was not detected. Doctors began chest compressions and inserted a breathing tube.

The lawsuit alleged that the baby may not have suffered severe brain injuries if the doctors had delivered her by cesarean section. Claiming that her doctors were mistaken in their initial prognosis, the baby’s mother decided to forgo a cesarean. The defense team argued that the baby’s complications were a result of her mother refusing to deliver her through a cesarean section. After a two-week trial, the jury awarded the 4-year-old girl $229.6 million for the medical care and treatment she may require for the rest of her life to treat cerebral palsy.

According to the Merck Manual for the Consumer, brain injuries are more likely to occur when babies are delivered naturally through the birth canal and experience physical pressure.