Inexperienced midwife delays delivery and causes devastating brain injury
Baby A's mother fell pregnant in December 2013. She visited a private consultant obstetrician as she was concerned about cephalopelvic disproportion due to her height of four feet and 11 inches. She was advised that she may needed an elective caesarean section if she had difficulties during labour and that there should be a lower threshold for considering a caesarean section.
Labour began on 1 August 2014 and she attended Chelsea and Westminster Hospital. By the early evening auscultation of the fetal heart showed an anomaly in the fetal heart rate. The mother was noted to be fully dilated and was wrongly advised that she could remain in the birthing pool. Further decelerations in the fetal heart rate were recorded at 18.28, 19.10, 19.29, 20.22 and 20.30.
We argued that electronic fetal heart monitoring (CTG) should have been commenced at 17.15 in the Labour Ward and monitored. The midwife failed to recognise that the mother was in the active second stage of labour. CTG monitoring would have been non-reassuring resulting in expedited delivery of Baby A.
The midwives caring for the mother did not call an obstetrician until five minutes before the delivery, even though there were recurrent decelerations in the fetal heart and delay in delivery. Following arrival of the obstetrician, an instrumental delivery took place and Baby A was delivered at 20.34.
Sadly, the baby suffered a hypoxic ischaemic injury and he required resuscitation and passive cooling.
The Chelsea and Westminster Hospital investigated the incident in a Serious Incident Report. The report confirmed that an obstetrician should have been called to review the mother earlier. Liability was strenuously denied. This stance was even more surprising when it emerged that the Supervisor of Midwives was highly critical of the care given to Baby A's mother by the midwives. The lead midwife was very inexperienced and had not been trained adequately in interpreting CTGs. It also emerged that there was a newly qualified midwife who was not adequately orientated to the Birth Centre. She had only ever worked on the Birth Centre once previously and had not in fact delivered a baby since qualifying as a midwife nearly a year previously, in September 2013.
Following disclosure of the documents, the Defendant served an amended Defence admitting liability, but causation remained in dispute.
A trial in the matter was fixed to commence on 16 April 2018. The case settled a few weeks before the trial.
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