How Can Medical Negligence Lead to Stillbirth or Neonatal Death?
After 20 years working in medical negligence, all too often I come across common themes.
Bringing about change to practices and procedures is important to many of my clients. And while in most cases we achieve that at a local level with the hospital trust and/or the GP surgery, often those learning points are not shared nationally.
Many years ago I carried out a quantative study into common themes in stillbirth cases. The results then were really no different to what I see now.
The common themes are:
Failure to act on reduced fetal movements. – This is probably the issue I come across the most. Reduced fetal movements are often linked to stillbirth, and if a reduction in fetal movement is detected it should not be ignored. I still hear from clients who have been told by midwives not to worry about reduced movements as the baby grows as the reason for this is that there is less room for the baby to move around inside the womb – a now outdated explanation. It is more likely to be the case that the baby is conserving energy by not moving, but it could also be because the placenta is failing.
Failure to identify Intrauterine Growth Restriction (IUGR) – This is also a common failing that I come across. Again, IUGR can be due to a failure in the placenta which means the baby grows slowly in the womb.
The only way to deal with IUGR is to induce and deliver the baby. Before delivery, a plan should be put in place to regularly monitor, scan and assess the baby’s growth. IUGR can be missed during antenatal appointments by failing to measure the baby’s fundal height, or failing to measure correctly, and failing to plot the growth correctly on the growth chart. Sometimes IUGR is suspected, but there is a failure to refer for an ultrasound scan and therefore the diagnosis is missed.
Failure to monitor the baby in utero in hospital – Once in hospital there is sometimes a lack of fetal heart rate monitoring. How often and when this should take place is far too complex to set out here, however we find that there can be a plan in place in relation to monitoring which is not followed and then leads to a missed opportunity to deliver.
It might be that the unit is too busy, so the monitoring simply doesn’t happen. In other cases, the monitoring might take place, but the midwife fails to interpret the CTG correctly and/or does not call for a review from the doctor and so again delivery does not take place in time to save the baby.
Failure to detect placental abruption – Placental abruption happens when the placenta comes away from the wall of the womb. This means that the baby no longer receives the support that it needs in the womb. Placental abruption is linked to pre-eclampsia and/or IUGR.
In our cases, we find that there is a failure to adequately heed pain that the mother is experiencing in her back and abdomen, pain in her womb, bleeding and painful contractions. These are all signs of potential abruption.
Failure to take note of these warning signs and also to recognise risk factors such as IUGR, pre-eclampsia and previous abruption can mean that an opportunity to intervene is missed. Once the abruption becomes severe, usually a caesarean section is required.
Failure to give antibiotics during labour when GBS is detected – If the group B streptococcus (GBS) infection is detected during pregnancy, antibiotics must be given intravenously to the mother during labour. It is not appropriate to wait until after delivery to give the antibiotics to the baby.
I have acted in cases where there has been a total failure to give antibiotics, a delay in giving antibiotics, and a failure to follow up on test results, so it was not known that GBS was present and that antibiotics were required.
I also see many cases where this is the mother’s first pregnancy to term (often following IVF) and she is over 40 years old, which places her in a higher risk category. The management of the pregnancy quite often fails to take this into account and the mother is left to go to term and tragically loses the baby around 39-41 weeks.
Stillbirth Due to Negligence: A Case Example
Reduced fetal movements
Failure to monitor in hospital
We had a case involving a mother who was in her forties, who had been advised that there was a high risk of stillbirth. Early induction was recommended to prevent that risk, which was good management. The induction was later rearranged as the mother and baby were doing well.
However, when she went into hospital for induction as planned, monitoring of her baby was stopped without explanation. Although she started to experience worrying symptoms, these were not investigated by her midwife.
Despite the mother continuing to complain of concerning symptoms, no further action was taken by her midwife until the next evening. NICE guidelines state monitoring should have taken place, and the midwife should have requested a review from the obstetrician and a caesarean section should have been performed.
The delays meant that it was too late for our client to have a c-section as planned, and instead she had to deliver vaginally. Unfortunately, her baby was stillborn. There had been a placental abruption and the midwife had failed to act on the warning signs.
Get the Compensation You Deserve
If you believe you have suffered a stillbirth due to negligence, like the case above, please get in touch with our empathetic and experienced solicitors. We are seasoned in handling stillbirth claims and can help advise you on your case.