Sarah was pregnant with her first child. Her pregnancy was high risk and she was referred for Consultant led care.
At 40+4 weeks Sarah was admitted to Leeds General Infirmary for induction of labour. She made good progress over the next few days. The baby’s heart rate had dropped but once the induction was stopped, it returned to normal.
Rather than allowing labour to progress, a decision was made to trial instrumental delivery in theatre.
Sarah was taken to theatre for forceps delivery. The delivery was complicated by shoulder dystocia (when a baby’s shoulder becomes stuck during delivery). An episiotomy was performed and the baby was delivered shortly after, weighing 9lbs 8oz.
Sarah lost a large amount of blood and she required stitches for the episiotomy and further stitches to repair a tear, which had occurred during the forceps delivery. Sarah overheard the Obstetrician say that it was a 4th degree tear.
Tears are categorised as first, second, third and fourth-degree tears.
First-degree tears (where only the skin is torn) and second-degree tears (when skin and vaginal muscle are torn) are the most common types of tears. Perineal and vaginal tears can sometimes cause pain and may increase recovery time.
A third-degree tear is a laceration in the vaginal tissue, perineal skin, and perineal muscles that extends into the anal sphincter (the muscle that surrounds your anus). Third-degree tears can also be subdivided into grades 3a, 3b and 3c.
A fourth-degree tear goes through the anal sphincter and the tissue underneath it. It’s also possible to tear in other places.
The following day the Obstetrician came to see Sarah, she asked about the tear and was advised that she had not suffered a 4th degree tear, but a buttonhole tear, that was caused by shoulder dystocia. He explained the buttonhole tear as a thinning of the skin, and said it was not quite like a hole.
Before Sarah was discharged she was asked if she had opened her bowels, which she hadn’t, and if she was able to pass wind. Sarah explained that she was passing wind but she couldn’t control it. No one gave Sarah any advice about this or raised it as a concern.
The Community Midwife visited Sarah at home the day after she had been discharged. The midwife didn’t have any notes about the birth or the complications that occurred.
Sarah still hadn’t opened her bowels since giving birth. Her body was trembling and she had spasms in her thighs and lower abdomen. Later that day a small piece of hard stool passed through her vagina. Sarah was devastated. She knew she needed to go back to hospital but was distraught at the idea of having to leave her newborn baby.
Medical Negligence
She was admitted to hospital and was reviewed by a Colorectal Surgeon. She was taken to theatre for an examination, to investigate how the vaginal tear had been repaired and any possible issues.
The surgeon had explained that worst case scenario she would require a colostomy, but Sarah wouldn’t know whether this was required until she woke up from the anaesthetic. The prospect of waking up and having a stoma terrified Sarah.
The examination revealed a large 4th degree tear between the rectum and the vagina, which was 9cm long and had been caused by the delivery. Unfortunately, this was missed by the doctors.
Sarah had to have further surgery to repair the tear and a colostomy was sadly required.
Impact of the negligence
Once she was discharged from hospital Sarah required care and assistance for herself and support with caring for her baby, as she’d had major abdominal surgery. She suffered terrible pain and discomfort, which caused her to spend long periods of time in bed.
Sarah had not long given birth when she had the colostomy, and as her body changed over the coming weeks, it caused issues with her stoma. It would leak faeces and the skin surrounding the stoma would become sore, weep and bleed.
Sarah was reluctant to leave the house initially in case the stoma leaked. Once she built up the confidence to leave the house, Sarah needed to know how close the toilets were at all times and to carry spare clothes. Sarah struggled to adapt to life with a stoma and the ongoing complications.
She went on to develop a parastomal hernia and had to wear a hernia belt for support, which she found restrictive and uncomfortable.
The stoma remained in place for 16 months until it was able to be reversed and the hernia was repaired. The surgery was more complicated than expected, and she required open abdominal surgery, leaving her with extensive scarring.
Following the surgery Sarah developed an infected haematoma which required the wound to be re-opened and flushed. She was then left with an open wound which prolonged her recovery.
Once the colostomy was reversed, Sarah developed sharp abdominal pain and bowel spasms. She also suffered with faecal urgency, frequency and incontinence. She will now require medication for the rest of her life to manage her abdominal symptoms.
As a result of the negligence, Sarah developed Tokophobia, which is a fear of pregnancy and she suffered with ongoing anxiety and depression as a result of her injuries. This took a toll on her relationship with her partner and eventually the relationship came to an end.
Following her maternity leave, Sarah returned to work, however she found they didn’t really understand her injuries and offered little to no support. She was eventually asked to step down from her role, as she was unable to carry out all of the duties. Sarah feels that because of her injuries, she has missed several opportunities to progress her career.
Despite everything she has been through, Sarah has remained determined to overcome any obstacles that she faces and to be a role model for her child. Sarah sought damages from the Defendant to enable her to get the future treatment she needs; plastic surgery to improve the appearance of the scarring, Cognitive Behavioural Therapy to overcome the Tokophobia, and a possible caesarean section if she decides to have more children in the future.
Making a Claim
Sarah instructed Ison Harrison Solicitors to pursue a Clinical Negligence claim on her behalf. Records were obtained and an expert Obstetrician and a Colorectal Surgeon were instructed to prepare reports addressing breach of duty and causation.
A Letter of Claim was served on the Defendant setting out the allegations of negligence; that it was inappropriate to take Sarah to theatre for a trial of instrumental delivery, and there was a failure to identify and repair a 9cm 4th degree tear.
After investigating the matter, the Defendant provided a Letter of Response which denied liability. However, Sarah’s experts remained supportive of the claim and steps were taken to assess Sarah’s physical and psychiatric condition and prognosis.
Court proceedings were issued, and investigations were undertaken to value the claim. Expert evidence was served upon the Defendant and shortly after they made an offer of £100,000. The offer was considered too low and it was rejected. The Defendant commissioned their own expert reports and admissions were made in respect of breach of duty, but causation remained in dispute.
Following negotiations, the claim was settled in the sum of £245,000.00.
Sarah’s comments:
I was in such shock and self-doubt at the beginning, I honestly went into this not knowing what to expect, and Ami changed that from the first meeting. I was fully informed every step of the way and Ami made it really easy to understand what was happening and why. From start to finish I’ve felt supported and understood, which has been so beneficial to moving forward with my life.
My life changed that day in hospital and Ami has done everything she could to make it happen again, but for the better. The most important thing I achieved with my claim is acceptance. It gave me the ability to accept what had happened and helped me learn how to live with it going forward.
I couldn’t be any happier with the results and I cannot thank Ami enough.
Ami’s comments:
It was a privilege to represent Sarah. She has shown incredible resilience dealing with her ongoing medical issues and throughout the litigation process, especially when coming to terms with the idea that her injuries would have been avoided but for the Defendant’s failures.
I’m grateful that Sarah was able to trust me, which in turn, gave her the confidence to discuss incredibly personal details in order to explore the full extent of her injuries.
The process of investigating and settling the claim has enabled Sarah to process an extremely traumatic experience, and the damages will enable her to undergo the treatment she desperately needs to rebuild her life.
What to do if you have concerns
Ami is particularly passionate about representing Claimants who have sustained injuries of this nature. If you have concerns about medical care that you or a loved one have received, please contact Ami or a member of the Clinical Negligence Team on 0113 284 5000 or alternatively email clinneg@isonharrison.co.uk for a free, no obligation conversation to see if we can help you.