The theme of this year’s birth trauma awareness week is informed consent. You can find more information about informed consent in our blog article: Birth Trauma Awareness Week – What Is Informed Consent?
As medical negligence solicitors, we advocate for mothers and children in cases where they were not adequately informed about the risks associated with a specific treatment, which has resulted in them suffering an injury.
Here are some maternity care examples of when a lack of informed consent can lead to injury, which could have been avoided.
Shoulder Dystocia
Erb’s Palsy, also known as brachial plexus paralysis, is a traumatic birth injury that can leave a baby’s arm severely paralysed. The brachial plexus, a network of nerves, is most commonly injured during delivery when subjected to excessive pulling force. This condition is often associated with larger babies who encounter difficulties during birth (a situation known as shoulder dystocia).
In some cases, negligence can occur before birth. Mothers at higher risk of experiencing shoulder dystocia include those with:
- A history of previous deliveries complicated by shoulder dystocia
- Previous delivery of a large baby (weighing more than 4.5 kg)
- Diabetes (type 1, 2, or gestational)
- A BMI exceeding 30
- Babies identified as large during antenatal scans
- Induction of labour using oxytocin
- Prolonged first or second stages of labour
- Instrumental deliveries (such as ventouse or forceps)
Where there is an identified higher risk for shoulder dystocia, mode of delivery should be considered and discussed with the patient, particularly a vaginal delivery or caesarean section. Both options come with risks and benefits and it is important that a patient is provided with the knowledge and support to help make an informed decision.
Unfortunately, informed consent regarding delivery mode is sometimes overlooked due to the perception that “the doctor knows best” or even availability of a doctor to discuss the options. Sometimes, there are missed opportunities to consider different modes of delivery where a patient’s risk factors are not identified.
Caesarean Section
In the Montgomery v Lanarkshire Health Board (2015) case, the Supreme Court stated that if there is any increased risk in a vaginal birth, a caesarean section should be offered.
A caesarean birth can be requested, even if a doctor or midwife does not think that there is a medical need for one. This is called a maternal request caesarean birth.
Your hospital must listen to reasons for wanting a caesarean birth and have good reason for saying no. The doctor must also offer information about the risks and benefits of a c-section or any other treatment options. This information should be personalised to focus on what is important to the patient in their circumstances.
Perineal Tears
Vaginal delivery is associated with a high risk of perineal trauma which occurs in around 80% of women1. When a woman has already experienced perineal trauma, she should be informed about the risks of a recurrent tear and worsening symptoms in any later pregnancy.
A patient must be very carefully counselled on the options for delivery, particularly the risks of attempting vaginal birth following a perineal tear. There is a real risk of worsening incontinence and more severe injury with in a subsequent vaginal delivery.
If a patient has a vaginal delivery, following a previous perineal tear, without being made aware of the risks of worsening incontinence or other symptoms, there may be a claim in negligence.
Advice and Support
Contact us for more information about making a claim for medical negligence. Our team will listen to your story and deal with your enquiry in a sensitive manner. If we believe that there are sufficient prospects to pursue a claim, we will guide you through the process and ensure that you get the compensation you deserve to enable you to obtain support and assistance when you need it the most.
Call us on 0113 284 5000 or email us at clinneg@isonharrison.co.uk for further information and free advice.
Resources
The Birth Trauma Association charity is founded and run by women who have experienced birth trauma, and they work to support parents and families.
The charity MASIC provides information about the causes and impact of obstetric anal sphincter injuries.
Birthrights is a UK charity that champions respectful maternity care by protecting human rights. They provide advice and legal information to women and birthing people, train healthcare professionals to deliver rights-respecting care and campaign to change maternity policy and systems.
