Law reports: Court rules antenatal care was not negligent

Jones v North West Strategic Health Authority (Queen's Bench Division — 5 February 2010)

In 1992 the claimant was born following a stormy natural delivery. Immediately prior to delivery there was concern of cord prolapse (ruled out following examination). Subsequently, a 15-minute delay between delivery of the claimant's head and body, indicating shoulder dystocia, compromised the claimant's oxygen supply. He suffered asphyxia resulting in permanent brain damage (cerebral palsy).

In 2009, the claimant alleged that his mother — a Jehovah's Witness — with an obstetric history of shoulder dystocia and large babies, and obese, received negligent antenatal care. He alleged she should have been warned of the significant risks of shoulder dystocia associated with natural birth and offered a caesarean delivery, which she would have agreed to. The consultant contended he would have advised against this. The associated risks of a caesarean — DVT, infection and anaesthetic complications — outweighed the risks of shoulder dystocia eventuating (approximately 10%) during vaginal delivery.

The claimant also alleged negligent delivery as the midwife should have sought timely intervention by a consultant, resulting in the claimant being delivered sooner than 15 minutes thus avoiding permanent damage and/or sustaining lesser injuries.

The court held that the defendant should have mentioned caesarean delivery as an option to the mother at 20 weeks gestation. On balance, the judge found that based on 1992 experiences (paternalistic approach of doctors) the mother would have followed the defendant's advice, electing natural delivery. Further, it was unlikely she would have agreed to a caesarean as there was a risk she would need a blood transfusion, which was contrary to her beliefs.

The court also found that the 15-minute interval was causal to the claimant's injuries arising from the cord compression following shoulder dystocia. Preferring the factual evidence of the delivery team, the judge found that the course of events undertaken, including what procedures the senior consultant did or did not undertake, was not negligent.

Comment

The claimant failed as his mother could not convince the court that in 1992 she would have gone against her doctor's advice. Had this case been based on events in the more recent past, the court may have accepted the patient's testimony (medical advice not followed).

Lesley Payne, BLM London

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