A plan was made to induce labour at 39 plus five days due to a reduction in the baby's growth. There was no discussion with the consultant regarding suitability for induction and the midwife did not query the plan to administer Propess, a drug used to induce labour.
The woman continued to experience increasing pain at the site of her scar. A patient in another bed eventually had to call for a midwife to attend which took some time. There were then difficulties in locating the fetal heart rate. Eventually a doctor examined the woman and the decision was made for Category 1 emergency caesarean. Obstetric and neonatal crash calls were initiate because it was by then evident the mother's uterus had ruptured and the baby was lying in her abdomen.
The baby had suffered severe fetal bradycardia for approximately six minutes prior to delivery because of the uterine rupture. She was born in poor condition with no heart beat and required one minute of CPR and ventilation breaths. She was intubated at three minutes old on the second attempt. She was then transferred to Bradford Royal Infirmary for brain cooling and it was noted she sustained HIE Grade 3 and a cranial ultrasound and MRI showed the severity of her hypoxic ischemic injury.
The baby has now been diagnosed with four-limb, dyskinetic cerebral palsy and is fed via a gastrostomy. She has relatively preserved cognition.
In the Particulars of Claim prepared on behalf of the mother, Jane highlighted delays in calling an obstetrician once the fetal heart rate could not be located. Had the decision been made to deliver the baby by emergency caesarean before her mother's uterus ruptured, she would likely avoided any injury. The Trust also admitted there was a nine-minute delay in delivery and 12 minute delay in restoring the fetal heart rate. The hypoxic ischaemic injury lasted for 24 minutes.
Following investigation, the HSIB (Healthcare Safety and Investigation Branch) made safety recommendations to include ensuring mothers are given full and documented information about Induction of Labour and that local guidance is followed where the first language is not English.
Meanwhile, although it was not accepted by the Trust, Jane negotiated £30,000 for the mother in a psychiatric claim for Tokophobia – a fear of future pregnancy. The injuries to the baby continue to be assessed with a view to a full settlement once medical reports are finalised.
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