Restrictions on liability for psychiatric injury have been developed in leading cases involving rail and road accidents and other disasters. In such cases the parties are nearly always strangers. In medical negligence cases, the parties are in a pre-existing relationship involving the provision of care. Medical procedures are different from "accidents", and relatives are not in a position to witness mistakes. The author argues that the rules established in the accident cases should not necessarily apply in medical negligence situations. This applies particularly to birth mishaps, where analyses based on the accident cases obscure the true position of the parties.