Baby A's mother did not give up. Although he had mild cerebral palsy from a physical perspective, he also had significant learning difficulties, which became more apparent as he grew older. He attended a special school. Eventually, his mother made further enquiries and instructed Claire Horton to re-investigate the claim. By this time, Baby A was in secondary school.
Claire carried out further investigations and was able to secure an admission of liability just before his 18th birthday.
The mother's pregnancy went two weeks beyond term and she was admitted to hospital for induction of labour. Once induction began, she began to experience contractions and a CTG monitor was used to monitor them and the baby's heart rate.
After some time, syntocinon (a drug used to strengthen contractions) was commenced. Then 4-5 contractions were noted to be taking place every 10 minutes and a midwife recorded: "Good resting tone therefore syntocinon increased to 50mls/hour". Later the midwife noted that baby A had a slightly reduced heartrate and the plan was to observe. However, the syntocinon infusion was increased to 75mls/hour.
The doctors and midwives should have known that syntocinon tends to increase both the frequency and the strength and duration of contractions. Baby A was put at risk of brain damage by contractions more frequent than 4-5 in 10minutes. The rate of syntocinon infusion should not have been increased on either occasion. It caused over contraction of the uterus and, as a result, Baby A's heartrate began to drop.
By this time, the mother was found to be 4cm dilated. The membranes were ruptured and the midwife noted that the baby's heartrate improved after the examination. Syntocinon was reduced to 30ml/hour; however, the midwife recorded a plan to increase syntocinon slowly, despite the baby's negative response to the syntocinon earlier. Baby A's mother was dehydrated and catheterised. No action was taken to increase her fluid intake to ensure she remained hydrated.
As planned, syntocinon was then gradually increased and the baby's heartrate began to drop again. Syntocinon was reduced again to 50mls/hour and a doctor was asked to review. The CTG was categorised as "suspicious". The plan was to continue the syntocinon. At 10:30, the doctor noted the CTG was "better than before", however, the mother remained dehydrated.
Baby A's mother was later found to be 7-8cm dilated and the midwife noted that the doctors advised to "keep increasing syntocinon". The CTG again showed a deterioration in Baby A's heartrate. The doctor later reviewed the CTG again and advised to continue syntocinon, increasing it if needed. The syntocinon remained at 100ml/hour until delivery.
Once she was fully dilated, the mother was also found have a temperature of 38.6 degrees. She was treated with paracetamol, ice cubes and a fan but her temperature increased to 39 degrees. A junior doctor advised intravenous treatment with the antibiotic cepedrine, and a reduction of syntocinon. Baby A and his mother should have been a cause for concern. A consultant should have taken over their care and a plan for delivery should have been discussed. Cepedrine should not have been used as a first line antibiotic. Fetal blood sampling was ordered to check the baby's oxygen and this was to be repeated in 30 minutes. This was not carried out.
On advice, the mother commenced active pushing. The midwife noted that the CTG showed the baby had a fluctuating heart rate. Although contractions continued, the delivery was not advancing. A doctor attended and attempted a ventouse and forceps delivery, both of which failed. Another doctor attended and found fresh meconium draining, a sign of distress in the baby. A transfer to theatre was advised for trial of delivery. However, there was a delay in the transfer and in delivering Baby A via C-section.
Baby A was born in poor condition and suffered brain injury due to oxygen deprivation during delayed delivery.
He has some impairment of fine motor skills and has a significant learning difficulty. He also has a speech and language difficulty. Additionally, the brain injury caused epilepsy. He will never be able to live independently and will always require 24-hour care.
The case proceeds in respect of valuation.
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