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If only we had the gift of foresight

01 May 2004

Mrs B was expecting her first child when she went into spontaneous labour and was admitted to a hospital in England. She asked for an epidural, and this was given at approximately 10.20 am. Within minutes there was a fall in her blood pressure and the fetal heart rate. Mrs B was rolled onto her left side (she had been lying on her right side) and her blood pressure steadily recovered, as did the fetal heart rate. Within 20 minutes a normal CTG was recorded.

The obstetrician, Mr G, put Mrs B’s sudden hypotension down to the epidural anaesthesia – a known complication. As he expected labour to continue for another four to six hours, he ordered that Mrs B should be kept under close observation. If the fetal condition deteriorated, or the second stage of labour was delayed, he planned to deliver the baby by caesarean section.

No further abnormal signs were noted and, at 12 noon, the epidural anaesthesia was topped up. The top-up caused another sudden reaction, this time even more severe than the first. Mrs B was rushed to theatre and Mr G carried out an emergency caesarean section, delivering a baby girl within 15 minutes.

Unfortunately, despite this swift intervention, the baby was born in a poor condition; she has gone on to develop severe cerebral palsy with learning difficulties.

A negligence claim was brought against Mr G.

Expert opinion

The experts we consulted concluded that the baby had sustained the brain damage during the 20 minutes before a satisfactory circulation was established, shortly after her birth. They agreed that the brain damage would have been avoided if the delivery had taken place earlier.

However, in their opinion, Mr G could not have foreseen the baby’s injury. Moreover, they were supportive of the standard of obstetric care he had provided. In view of the experts’ reports, we defended the claim, which went to trial. The claimant’s case rested on the argument that Mr G should have investigated the cause of the first episode of fetal bradycardia and/or carried out a caesarean section as soon as possible.

Allowing the labour to progress was, it was argued, unreasonable and not in accordance with the opinion of a responsible body of obstetricians.

The judge was not convinced by these arguments. He found for the defendant, holding the following points:

  • Utero-placental perfusion reduction was a reasonable possible explanation for the first bradycardia and Mr G correctly deduced this as the cause. 
  • In the circumstances, it was reasonable to assess the fetus as recovered and not acidotic.
  • As such, Mr G was not negligent in deciding to allow labour to proceed normally.
  • At the time of the epidural top-up, Mr G properly assessed the fetus’s condition as healthy; there was no reason to suspect that a second bradycardia would occur, and the dramatic bradycardia that did occur was unexpected. Mr G took swift steps to get Mrs B to theatre and to perform the caesarean section. As such, he had acted in accordance with a responsible body of obstetric opinion.
  • In all the circumstances, the possibility of a recurrence of fetal bradycardia, of sufficient significance as to be capable of causing any harm to the fetus, was not reasonably foreseeable.