In 2013 the medico-legal journal ‘Clinical Risk’ published a summary of a 10 year (between 2000 and 2010) NHS study looking at the key trends in claims against the NHS relating to injuries suffered by mothers and babies before and during childbirth in NHS hospitals.
The study published by the NHS Litigation Authority makes for very interesting reading into the incidence and causes of claims against the NHS and the need for better training and quality control to assist in the reduction of incidences of medical negligence. The report does highlight however that claims are only brought in 0.1% of births, which goes to demonstrate that, despite media suggestions, the volume of people suing the NHS relating to negligence for poor obstetric care is not high or disproportionate. It is reassuring for mothers to know that general care for them and their babies is of a good quality in an NHS setting.
The primary level of the study was to look at the key reasons why claims were brought. The cases were ordered by way of total value, the highest, at 40%, was for cerebral palsy claims, with shoulder dystocia claims’ value being under 5%. The secondary level of the study looked at 4 key areas of antenatal care giving rise to claims, namely: ultrasound investigations, CTG interpretation, perineal trauma and uterine rupture.
The report concluded that most failures to detect fetal anomalies (such as spina bifida) in the ante natal period were due to human error; such errors may lead to claims for wrongful birth. The report made very important recommendations to reduce these errors by introducing improved and regular staff training programmes and ensuring all Trusts work to the required national standards by way of compliant internal protocols.
CTG monitoring is specifically undertaken during pregnancy and labour to monitor the wellbeing of the baby. Poor CTG monitoring is one of the most common causes for birth injury claims against the NHS which we see at the clinical negligence team, and quite often the most frustrating, where there was a clear opportunity missed to intervene to avoid a brain injury in the unborn baby.
The report in Clinical Risk confirms that ‘CTG monitoring continues to be a major theme in maternity claims, with many instances of failures to recognise a suspicious and/or pathological CTG. In addition the speed of acting on an abnormal CTG is at times inadequate’. Again improved training is recommended.
Perineal trauma is frequently reported by women following childbirth and can be extremely distressing to cope with both physically and emotionally. It is imperative that (in particular 3rd and 4th degree tears) all tears are properly assessed and repaired by experienced NHS staff. Complications include significant pain on intercourse or issues with urine and faecal incontinence.
Uterine rupture is a risk more commonly associated with a VABC delivery (vaginal delivery after caesarean section). The report gives an example of a woman who was negligently induced into a VBAC delivery causing her uterus to rupture and her child to suffer a cerebral palsy injury. The report of course notes a woman’s choice to elect for a VBAC delivery, but only if they are given all the appropriate clinical information to make an informed choice.
The specialist birth injury solicitors at the clinical negligence team are encouraged to note that the NHS are looking to reduce the incidents of poor maternal care with a view to also reducing claims against the NHS. This can only be a positive step in improving the standards of care for women at one of the most vulnerable times of their lives. The effects of injuries to mothers and babies can be catastrophic for families and therefore any steps to improve training for obstetricians and midwives can only be welcomed.