MNHQ here: Have you had a bad experience with your treatment during pregnancy, labour or childbirth? Ask Leigh Day's lawyers about your rights here

[BojanaMumsnet]

Hello

We at MNHQ have teamed up with a law firm, Leigh Day, to provide a free online clinic on maternal health rights. The clinic will run from today, and the Leigh Day maternal health team will be responding to questions from Monday. Please take a look below to see what kinds of questions they can take and to see how this will work. We hope you find this useful, and please do bear in mind that there will be experiences posted here which may be upsetting to read.

Thanks
MNHQ

Terms & Conditions – between Leigh Day and visitors to the clinic

Free online advice clinic
Leigh Day is delighted to be teaming up with Mumsnet to provide a free, online legal clinic, offering advice on healthcare and treatment issues during pregnancy, labour and childbirth. The advice will be provided by senior lawyers from our maternal health team, who act in cases where there has been a failure in treatment and injury to a mother and/or baby during labour and birth.

Many women are unsure of their rights particularly regarding consent in relation to antenatal, labour and postnatal care. The clinic will provide free advice and raise awareness of issues for women to consider when planning pregnancy and childbirth, or after the event.
We work with charities, such as Birthrights, MASIC, Group B Strep, and other organisations who, like us, are committed to offering choice and improving safety and care for mothers and babies.

The clinic will take the form of a 'Q&A' session on Mumsnet’s website, with members of the public posting questions on a dedicated public discussion thread. Our specialist solicitors will take necessary any additional detail via private messaging (username: LeighDayMaternalHealthTeam) before posting up answers and advice. This is to check for a conflict of interest.

The clinic will run for a week from Monday 4th November to Monday 11th November. We will do our best to provide all answers during the week but, at the latest, by the Friday of the following week. You can find information on where to go for more help once the clinic has ended here. You can find some advice on how to raise a concern with your doctor about your care or treatment here.

Please note that we can answer questions concerning consent and issues in childbirth, specifically in relation to maternal injuries such as:

• Perineal tears – third and fourth degree
• Injuries following caesarean sections
• Poor care during the antenatal period of your pregnancy. For example, from mismanagement of pre-eclampsia or gestational diabetes
• Sepsis after childbirth

We can also advise on injuries or sub-standard care relating to your child, including:

• Cerebral palsy
• Birth asphyxia and brain injuries
• Fractures to the skull, legs, arm, shoulder and collarbone
• Failure to diagnose fetal abnormality

We also represent families at an inquest if there has been stillbirth or death of the baby after birth.

What to do if you’d like to post a question

1. If you have a question about your rights in pregnancy or childbirth, please post it online during the week, providing as much information as possible, including if relevant a concise history. Remember that this is an online forum and can be viewed by the public – including any hospital or service provider. You can use the private message facility to disclose any information you would prefer to keep off the public forums.

1. Please send your name and the name(s) of any relevant service providers by private message to: LeighDayMaternalHealthTeam so the information can be passed on to our maternal health lawyers. We cannot post a reply until you have sent this information by private message.

Terms and Conditions – please read
The advice provided to an individual poster is based only on the information provided by that poster. Advice on this thread is also particular to the individual who has asked for it and will be specific to that person’s situation and cannot be taken to relate to another individual’s situation or potential case. Mumsnet and Leigh Day accept no liability for any loss suffered as a result of an individual choosing to follow advice provided to another poster's question on the thread. Please take care if you choose to apply that advice to your own situation - it is recommended that you first take advice from one of the sources we have suggested here.

Leigh Day’s lawyers, all of whom are specialists in clinical negligence, particularly relating to injuries to mothers and babies during childbirth, will be providing free advice in respect of the clinic. Any personal information collected as a result of the clinic will be held by Leigh Day and will be deleted after 18 months. If you wish to make a complaint about the service you received, please see Leigh Day’s complaints policy here.

Edited by MNHQ to extend the clinic

[Helen45678]

Hi,
I am not pregnant but wondered about what my legal rights would be if I were to become pregnant and request a Caesarian section. I am a doctor myself.

I am very aware that the NICE guidelines are not legally binding. However I am interested to know what the legal position would be in the instance that a patient was refused a maternal request caesarean but suffered a complication which is a known/normal complication of vaginal delivery - example a third or 4th degree tear, or even a second degree tear (which occurs in the majority of women who have their first vaginal deliveries) with persistent symptoms such as pain during intercourse. Can you argue legally that even though you have experienced normal complications of vaginal childbirth, these would not have occurred had NICE guidance been followed?

[Dogsaresomucheasier]

Just out of interest, has there ever been a successful case of a woman claiming damages for psychological injury caused by poor care during pregnancy and birth?

[Marwen12]

Hi every one

[LeighDayMaternalHealthTeam]

Hello!

We're really pleased to be hosting this clinic with Mumsnet. Thanks for the questions so far. We look forward to answering them and to seeing what other questions we can help you with over the course of the week.

[AnyMinuteNow]

Can I just ask you cannot answer a question without the specific name of the service provider?

Does it alter the advice/legal position depending on whether the gp was in say, one part of london or another? Obviously it would alter by country or even maybe in wales, but by nhs trust or private?

I just wonder what difference it makes to the law depending on the specific provider?

[AnyMinuteNow]

Sorry obviously I don't mean specifically GP, but consultant obs, midwife, etc.

[TwittleBee]

Hello,

DS1 was born with sepsis and I also had sepsis following child birth - I was seriously ill and had to spend time in hopsital post birth but no one told me what had happened or why. I only know we both had sepsis 2 years later when I asked for all my medical notes following the death of DS2 from sepsis post birth. Should I have been told we had sepsis? How comes it got that far to sepsis rather than just an infection? Could having known we both had sepsis have informed DS2's birth and helped prevent his death?

DS2 was not given antibiotics until 3 hours post his birth, depsite the NHS Trust where he was born having a 1 hour rule post birth. Could these extra 2 hours have made any difference?

We were not told DS2 had sepsis - we were continually told he was fine and would be okay - I assume this is wrong? Why would health professionals hide that DS2 had sepsis?

The labour of Ds1 and Ds2 were very similar - bleeding in the week prior waters breaking pre-term and then having a slow and dragged out labour. With Ds1 I was induced and laboured for a further 48 hours before a forecep delivery - could a C section have been the better option if they had spotted the infection risk? The with Ds2 they decided on C section to deliver him as they could see his heart rate indicated he was in distress but it took them 6 hours from initially spotting he was in distress to delivery - should this have been done quicker?

I felt dismissed the whole time I was bleeding and with broken waters with both Ds1 and Ds2, especially so with Ds2. They kept telling me everything was fine and it was just my anxiety disorder that was making me worried. Should they have listened to me and delivered Ds2 sooner?

Post care with both Ds1 and Ds2 I felt alone, isolated and clueless.

[TwittleBee]

Forgot another point too that seems tiny in comparison to the death of my son - but my placenta was incinerated without my consent. Really it should have gone off for testing given DS2's birth situation. But I wasnt even given the option to keep my placenta, they just tossed it aside. It took me months to find out what had happened to it too.

[RowanMumsnet]

@AnyMinuteNow

Can I just ask you cannot answer a question without the specific name of the service provider?

Does it alter the advice/legal position depending on whether the gp was in say, one part of london or another? Obviously it would alter by country or even maybe in wales, but by nhs trust or private?

I just wonder what difference it makes to the law depending on the specific provider?

Hello

Leigh Day can follow this up, but when we've run clinics with employment solicitors before, they had the same request (that Mners should divulge the name of the employer in question via private message before the solicitors could answer the query). In that case it was because the solicitors had to check that they didn't have a conflict of interest - ie, that they were not about to offer advice in a case where they already had an established interest in the other party. I think this is standard for solicitors in situations like this.

[AnyMinuteNow]

Thank you @RowanMumsnet That makes complete sense, especially for individual employer cases conflict of interest.

I guess that could exclude of lot of nhs trusts as they are large entities.

Good online clinic, I hope it raises awareness and helps many.

[RowanMumsnet]

@AnyMinuteNow Thanks!

[LeighDayMaternalHealthTeam]

@TwittleBee

Hello,

DS1 was born with sepsis and I also had sepsis following child birth - I was seriously ill and had to spend time in hopsital post birth but no one told me what had happened or why. I only know we both had sepsis 2 years later when I asked for all my medical notes following the death of DS2 from sepsis post birth. Should I have been told we had sepsis? How comes it got that far to sepsis rather than just an infection? Could having known we both had sepsis have informed DS2's birth and helped prevent his death?

DS2 was not given antibiotics until 3 hours post his birth, depsite the NHS Trust where he was born having a 1 hour rule post birth. Could these extra 2 hours have made any difference?

We were not told DS2 had sepsis - we were continually told he was fine and would be okay - I assume this is wrong? Why would health professionals hide that DS2 had sepsis?

The labour of Ds1 and Ds2 were very similar - bleeding in the week prior waters breaking pre-term and then having a slow and dragged out labour. With Ds1 I was induced and laboured for a further 48 hours before a forecep delivery - could a C section have been the better option if they had spotted the infection risk? The with Ds2 they decided on C section to deliver him as they could see his heart rate indicated he was in distress but it took them 6 hours from initially spotting he was in distress to delivery - should this have been done quicker?

I felt dismissed the whole time I was bleeding and with broken waters with both Ds1 and Ds2, especially so with Ds2. They kept telling me everything was fine and it was just my anxiety disorder that was making me worried. Should they have listened to me and delivered Ds2 sooner?

Post care with both Ds1 and Ds2 I felt alone, isolated and clueless.

Hello @TwittleBee
I am very sorry to read about what happened to your son DS2.

I understand that your main concern arises out of a diagnosis of sepsis in your first labour and the impact this had in respect of the management of your labour and delivery with DS2.

In the first instance, you may find it helpful to meet with the Hospital so that you can raise the concerns you have regarding your/DS2’s medical treatment. Some patients do not wish to do this/ you may have already met with the Hospital in which case you can make a formal complaint in writing to the Hospital. The Hospital should formally investigate your concerns and respond in writing. Alternatively, you could approach a clinical negligence solicitor for advice on investigating a claim. You may also find it helpful to approach a charity such as Group B Strep Support (www.gbss.org.uk), who may be able to provide further information/support.

In order for you to succeed in a clinical negligence claim you would have to show that the management of your labour and delivery with DS2/postnatal care of DS2 fell below a reasonable standard of care that you would expect from a medical professional. It would be for an obstetrician/midwife to comment on the management of your labour and delivery and for a neonatologist or similar doctor to advise in respect of DS2’s postnatal management, specifically in respect of the management of sepsis and antibiotics. You also need to show that with better care, DS2 would have avoided injury. This would be for an expert in Paediatric Infectious Diseases to advise on, specifically the management and timings of antibiotic treatment.

English law provides that if you wish to bring a claim in clinical negligence, you must do so within three years from the date of injury. In respect of your injuries (following the birth of DS2) and DS2’s death this would be three years from the date of DS2’s death.

Emmalene Bushnell

[TwittleBee]

Thank you for your reply Emmalene Bushnell - I have already met with the hospital, after much pushing for them to do so - their response was that no one could have saved my son from dying of sepsis and it very well could happen again with my current pregnancy (so i am now shitting myself)

[LeighDayMaternalHealthTeam]

@TwittleBee

Thank you for your reply Emmalene Bushnell - I have already met with the hospital, after much pushing for them to do so - their response was that no one could have saved my son from dying of sepsis and it very well could happen again with my current pregnancy (so i am now shitting myself)

I know only too well, from working with numerous clients as they navigate the complaints system, how frustrating it must be for you that the outcome of your meeting with the Hospital did not provide you with the reassurance you were hoping for, particularly in light of your current pregnancy.

It is important that the obstetric and midwifery staff involved in your antenatal care now are fully aware of your obstetric history and are able to provide you with medical support and guidance throughout your pregnancy. It may also be helpful for you to discuss any concerns with your GP.

For additional support and advice you may wish to contact the charity Group B Strep Support //www.gbss.org.uk

I wish you all the best.

[LeighDayMaternalHealthTeam]

@Helen45678

Hi,
I am not pregnant but wondered about what my legal rights would be if I were to become pregnant and request a Caesarian section. I am a doctor myself.

I am very aware that the NICE guidelines are not legally binding. However I am interested to know what the legal position would be in the instance that a patient was refused a maternal request caesarean but suffered a complication which is a known/normal complication of vaginal delivery - example a third or 4th degree tear, or even a second degree tear (which occurs in the majority of women who have their first vaginal deliveries) with persistent symptoms such as pain during intercourse. Can you argue legally that even though you have experienced normal complications of vaginal childbirth, these would not have occurred had NICE guidance been followed?

Hi @Helen45678

The NICE Guidelines on Caesarean Section set out that women should be offered information and support to enable them to make informed decisions about childbirth. Integral to the decision-making process should be discussing and addressing a woman’s views and concerns.

Some women choose to have a caesarean section for non-medical reasons. If you ask your midwife or doctor for a caesarean section when there are not medical reasons for one, they should discuss with you the overall risks and benefits of a caesarean to you and your baby compared with a vaginal birth.

If you request a caesarean section because you have anxiety about childbirth, you should be offered a referral to a healthcare professional who can provide support to help address your anxiety.

If, after discussing all the risks and considering the support on offer, you still feel that a vaginal birth is not an acceptable option, you should be offered a planned caesarean section. If your doctor is unwilling to perform a caesarean section, they should refer you to a doctor who will carry out the caesarean section.

If you suffer a perineal tear during a vaginal delivery, it will depend upon the individual circumstances of your case as to whether you may be able to bring a legal claim for the injuries suffered. This will include whether or not it was reasonable to advise a vaginal birth, the management of the delivery, the extent of the perineal tear and whether it was negligently caused etc. This will also include the consenting process for the woman.

Whilst it is true that the NICE guidelines are not legally binding and the word “guidelines” may give the impression that they are discretionary or optional, ignoring the NICE guidelines may lead to legal consequences. This is particularly so following the landmark case of Montgomery v Lanarkshire (2015) which has had a significant impact on the way patients should be consented for treatment. Decisions regarding medical treatment should be made by women on the basis of clear and complete information so that they can make an informed decision about their mode of delivery.

Maria Panteli

[LeighDayMaternalHealthTeam]

@AnyMinuteNow

Can I just ask you cannot answer a question without the specific name of the service provider?

Does it alter the advice/legal position depending on whether the gp was in say, one part of london or another? Obviously it would alter by country or even maybe in wales, but by nhs trust or private?

I just wonder what difference it makes to the law depending on the specific provider?

Dear @AnyMinuteNow

Claims against healthcare providers in England and Wales are most often brought in negligence; this does not vary by location, nor by service provider.

To bring a successful claim in negligence, you need to establish that the healthcare provider owed you a duty of care (this is almost always the case in a healthcare/patient context), that the care was substandard, and, that the substandard care caused you harm.

The identity of the Defendant in a clinical negligence claim can vary, however, depending on the context in which the care was provided. For example:

• If you were bringing a claim arising from the poor care provided by, say, a midwife, obstetrician, doctor or nurse, the Defendant would usually be the NHS Trust under which the hospital operates.
• If you were bringing a claim arising from the poor care provided by a GP, then the Defendant may be the GP or the partners of their GP surgery.
• If you were bringing a claim arising from the poor care provided by a private surgeon at a private hospital, then the Defendant would usually be the surgeon and possibly the private hospital.

When considering who to pursue a clinical negligence claim against, it is important to consider the likely ability of a Defendant to pay compensation in the event the claim is successful, and the extent of the insurance cover they have in place. This is a particularly relevant when pursuing a claim against a doctor who works privately, as their insurance providers may, depending on the circumstances, refuse to provide cover under the policy in place or try to argue that the insured’s actions have the effect of invalidating the policy.

Where the alleged negligence occurred after April 2019, claims brought against GPs now benefit from state indemnity through a body within the NHS called NHS Resolution (the equivalent body in Wales is called NHS Wales Shared Services Partnership, or NWSSP).

Emmalene Bushnell

[LeighDayMaternalHealthTeam]

@Dogsaresomucheasier

Just out of interest, has there ever been a successful case of a woman claiming damages for psychological injury caused by poor care during pregnancy and birth?

Dear @Dogsaresomucheasier

It is possible for a woman to claim damages for psychiatric/ psychological injury in cases concerning negligent care during pregnancy and birth. In order to bring a claim for clinical negligence, it is necessary to establish that the doctor or nurse involved in your care was negligent and that the negligence caused your injury. There are 3 main heads of loss that can be claimed:

• General damages: this is a sum of money to reflect the pain, suffering and loss of amenity that you have suffered as a result of the injury.

• Special damages: this is a claim for the expenses that have been incurred as a consequence of the injury. These are numerous and diverse and may include loss of earnings, cost/value of care provided, medical expenses, travel/transport costs, aids and appliances, accommodation/adaptation costs.

• Future losses: this is a claim for the losses which might reasonably be incurred in the future. This may include loss of earnings and loss of pension.

The claim for psychiatric/psychological injury falls under the general damages head. In order to claim such damages, there must be a recognisable psychiatric injury. The Judicial College’s Guidelines for the Assessment of General Damages in Personal Injury Cases provides guidance for the assessment of such damages. The Guidelines can be helpful in order to establish a ballpark figure for the likely award within the range or to see if there is any scope for arguing that a particular case falls outside the Guidelines. You can also refer to comparable case law.

Maria Panteli

[AnyMinuteNow]

I was also interested to see if there had been a successful claim for psychological harm against a health provider, but I couldn't see that answered?

Also, wrt providing specific details by pm, I couldn't see that answer to that either?

Thank you

[AnyMinuteNow]

I am referring to pp q's, as I can't see they've been answered? I haven't asked myself, or pm'd you, but did want an answer to that and my own pp q.

[LeighDayMaternalHealthTeam]

Thanks @AnyMinuteNow. Maria will respond asap.

[LeighDayMaternalHealthTeam]

@LeighDayMaternalHealthTeam

Thanks *@AnyMinuteNow*. Maria will respond asap.

Sorry *@AnyMinuteNow, that should be Emmalene* will respond asap.

[LeighDayMaternalHealthTeam]

@AnyMinuteNow

I was also interested to see if there had been a successful claim for psychological harm against a health provider, but I couldn't see that answered?

Also, wrt providing specific details by pm, I couldn't see that answer to that either?

Thank you

We have successfully concluded claims for individuals who have suffered psychiatric injury.

In order to bring a claim for psychiatric injury the individual must prove s/he has suffered a recognised psychiatric injury (i.e. a diagnosable condition). It is not sufficient for them to only prove fear, upset, distress, horror, anxiety or grief.

The leading case of Alcock [1992] 1 AC 310 (House of Lords) separated persons who suffered psychiatric injury into two categories:
• Primary Victim
• Secondary Victim

A primary victim is usually someone who could reasonably foreseeably suffer physical injury as a result of the health providers actions. For instance, a mother who suffers injury to herself as a result of a mismanaged labour or whose child suffers injury at birth will be a primary victim. A primary victim does not have to suffer actual physical harm to qualify.

In the vast majority of clinical negligence cases the patient will qualify as a primary victim.

A secondary victim is someone who has witnessed the injury caused to another person. The position of a secondary victims is more complicated and has been subject to much case law. To assist, I have outlined the criteria that needs to be satisfied to bring a secondary victim claim:

1. The psychiatric injury arose in witnessing the injury or death, or extreme danger or discomfort to the primary victim;
2. The injury arose from sudden unexpected shock;
3. There were close ties of love an affection between the primary and secondary victims;
4. The Claimant was present at the scene of the event or witnessed the aftermath a short time later;
5. Injury of that type to that Claimant was reasonably foreseeable.

In answer to your second question it would help us to provide more detailed advice, specific to your particular concerns if we know the type of health provider i.e. GP, doctor/nurse/midwife in an NHS or private setting, involved.

Emmalene Bushnell

[AnyMinuteNow]

Thank you and very helpful.

So no specifics of naming the provider just so long as you know hcp type. I see. Thanks.

I have heard many many horror stories on MN of such cases as you wouod sue for. I hope plenty will see this thread and take up your advice, there is certainly much assault in womens care (non consensual and unnecessary procedures).

[ChilledBee]

This is for a friend who I have been a Birth Partner for 2 out of the 3 times she has given birth. She's due again soon... and she's considering a knitting needle herself (no exaggeration).

Her first labour was an induction. 20 hours from time her waters were broken ,nearly needed forceps but didnt. Just as they were about to use the forceps they found her waters had reformed a bubble or hadn't been broken properly to start with(!). They were broken and baby quickly came down and was born quickly.

Second labour I was present, labour stalled at 9cm after spontaneous start and progressing steadily. Her waters didnt break. She was then fully dilated but didnt make progress even though they gave the baby time to come down before she started to push. After an hour of pointless pushing, the midwife broke her waters and the baby was born quickly afterwards. She said a big bubble of water had formed in front of the baby and was stopping the head coming down.

3rd labour I was present- spontaneous labour. She spoke to antenatal midwife about needing her waters broken to speed things up. After discussion it was written on birth plan and signed by midwife to say she understands the risks/lack of benefit. We attend in labour and get a really nice midwife. Friend is 5cm. She discusses breaking waters again and MW says she cannot due to guidelines. Friend tries to explain that if she waits that long, she could go 4 hours with no progress but lots of exhausting contractions. Midwife says it doesn't speed up labour (true according to research but not true for my friend). Ignores birth plan.

Midwife goes on break. Other midwife takes over. Friend explains situation to other midwife who says she will do it if she wants. She does it and finds she has made about 1cm progress in 3 hours. Midwife on break comes back just as baby is being born, so again, it worked for her. Midwife who broke her waters said "Christ your membranes are like a duvet", when she was examining the placenta after birth.

This time she is in a new hospital (needed a bigger house after all those kids) and thinks it will be even harder to get them to just break her bloody waters because it works for her and shortens her labour. Her antenatal midwife helpfully said "I would but I won't be there."

Is there anything legal that means you can request such an intervention against guidelines?

I brought this up at doula training where I compared it to elective caesarean and they said it is totally different so she can't ask on the same merit and they reiterated that research concludes that it doesn't speed up labour where as a caesarean section on request will avoid mental harm and that her BPs and MWs should focus on supporting her through the pain rather than securing an intervention(!).