Home Birth Possible Medical Negligence

[Judey2020]

Hello.

I am here to ask advice. I had my daughter at home 18 months ago and she has since been diagnosed with Cerebral Palsy. I asked for a copy of my maternity notes following this news to check to see if everything was handled in the correct way during the birth. She is our first child so we cannot compare the birth to another and we don’t know anyone else who has had a home birth.

When my waters broke late on in the labour- just 30 minutes before she was born it was apparent meconium was present in the fluid. So, an ambulance was called in case of complications with potential to transfer to hospital before the birth. My daughter was however born shortly after this and the paramedics arrived just as I was giving birth.

She cried straight away when she was born and she was seemingly healthy on arrival. The midwives gave us the option to transfer to hospital to have our daughter checked and monitored because there was a higher risk of chest infection due to the meconium, but we were also given the option to monitor her from home. We decided on the latter because she seemed healthy and we thought we could look out for signs of a chest infection easily.

It has only become apparent in the last few days after consulting a senior midwife and asking questions about my maternity notes that the meconium was considered ‘thick’. I have looked up guidance on NICE which are the national guidelines and they state that a baby born in thick meconium should be monitored every 2 hours for the first 24 hours. So, I now feel we may have made the wrong decision not transferring to hospital.

I do however also feel like we were not given enough information at the time to make an informed decision and we were not aware of the risks as I believe it could amount to more than a chest infection. I am also wondering whether we should have been given a choice at all. It seemed very informal and non serious at the time but if I had read the guidelines I would have made a different decision.

There is an obvious link between meconium and asphyxiation which could lead to stroke/cerebral palsy in babies so this is why I am now wondering if this decision could have contributed to her condition.

I am wondering if we would have a case against the NHS for not giving us the information to make an informed decision or giving us a choice whether to go to hospital where actually the guidelines are very clear that the baby should be closely monitored after this event.

Any advice, guidance or similar experiences would be greatly appreciated.

I'm sorry about your daughter's diagnosis.
I'm not a HCP and don't know much at all about cerebral palsy but I believe there are lots of possible causes and not just something going wrong during/just after the birth.
www.nhs.uk/conditions/cerebral-palsy/causes/

When DC1 was born, there was thick meconium in the waters but no issues at all - he was born at 41+4 and apparently it can be normal for babies born after their due date. What gestation was your DD when she was born?

I believe that it is only a problem if the baby inhales meconium (MAS or meconium aspiration syndrome), do you know if there were any signs that your baby did, eg had breathing problems? If not it might not be the cause of the cerebral palsy, it might be something that happened before she was born, that was no one's fault at all.

It does sound as if your midwife should have advised you more strongly to go into hospital so your baby could be monitored more closely, so perhaps you could consider making a complaint about that. But it might not be the cause of the cerebral palsy. I don't know if that helps you to feel better at all.

You would need to make the case about how you would use the funds from a judgement to benefit your DD for the harm done by her not being transferred. Also how the observations in hospital could have led to treatment that prevented or reduced the severity of her CP.

A lot of CP is idiopathic: nobody knows what caused it. You need to try to show that your DD's CP is probably not idiopathic, too.

It would be a long haul of evidential hurdles, so you want to be clear what benefits you hope to get.

One benefit might be that it didn't happen again if it was the M that caused it and mw at home births make sure the woman does go to hospital for a proper check if anything goes slightly wrong for second opinion.

I'm really not keen on 1st births being at home.

I am not sure if going into hospital could have made a difference to your DDs condition? I think this could be a long and painful journey that ends in a finding that yes, you should have been advised to go but it would not have made a difference to the outcome.

Sorry OP. It's really hard to come to terms with a condition and even harder if there's a glimmer of doubt that it was unpreventable. I have a step sister with cerebral palsy. She is the most beautiful person I know both inside and out and her condition has never seemed like a barrier to her. She sometimes gets tired but otherwise no one would have any idea that she had it.

Thanks for your replies. I know that there can be many causes of CP and I will never know when it happened but my question would be if the risk could have been reduced if we had transferred and had her monitored. At the time we were naive, had no knowledge of potential risks of inhaling meconium and from what we were told the only risk was that our daughter could develop a chest infection which to us didn’t seem like a serious risk. Also, at the point I was asked if we wanted to transfer I had been in labour for over 15 hours, missed a nights sleep and has just given birth so I am not sure I was in the correct position to make an informed decision. From what I have read it seems as though the choice should have been taken out of my hands and I should have been told to go.

So post birth meconium observations are recommended to make sure there’s no respiratory difficulties caused by meconium aspiration.

I might be wrong but I’m pretty sure that for anything to be serious enough to cause cerebral palsy at this point that the respiratory issues would have had to be really significant and it’s unlikely you wouldn’t have noticed them. Did you have a midwife visit the next day as well? And if so I’m guessing they didn’t see any respiratory issues?

I am sorry that your Dd has cerebral palsy.....it’s more likely it was an antenatal event or an intrapartum event.

However it’s still worth seeking legal advice. A solicitor firm like Leigh Day will have an obstetric expert scour the notes and see if they pick up anything you maybe wouldnt realise about. Was growth plotted correctly on the growth charts antenatally? Did they listen into the FH at correct intervals during the labour, etc? They’d be likely to take the case on a no win, no fee type basis.

Cerebral palsy can sometimes be determined whether it was an antenatal or intrapartum event by a brain scan....they can see which part of the brain the damage is in. It’s not my area of expertise at all and I don’t know if this is something which can still be done 18 months after the birth or not. But might be worth asking about.

You would have to prove beyond reasonable doubt that if there had been a medical intervention in the first 24 hours of your daughter’s life then cerebral palsy, or the severity, would have been prevented. Did you go to A&E or did your daughter need medical assistance in the first 3 days of life? If the answer is no then it seems highly unlikely that anything would have been picked up by a 24 hour hospital stay. The observations they perform on babies is their temperature, heart rate and respiration rate - nothing groundbreaking. They’re essentially looking for early warning signs of deterioration, and if your daughter never deteriorated then they wouldn’t have been found - if that makes sense.

Unfortunately it sounds as though you weren’t able to make an informed choice about the options available, but many women in your shoes would have made the same decision and been fully informed of the risks involved. Perhaps a better route would be to feedback to the maternity team about how the information was relayed by the midwife and how you didn’t feel you were told all risks?

Also, at the point I was asked if we wanted to transfer I had been in labour for over 15 hours, missed a nights sleep and has just given birth so I am not sure I was in the correct position to make an informed decision. From what I have read it seems as though the choice should have been taken out of my hands and I should have been told to go

I'm sorry you're having to look back and question your care. I just wanted to pick up on this point. In my opinion this is a slightly misjudged position to take. You would be essentially arguing that women in your position (tired, post-natal etc) automatically lack the capacity to make decisions about their own and their babies medical care and so staff should make decisions in their best interests. That's not the general medical or ethical position taken.
It doesn't mean it's not important to take into account, eg before birth lots of women think through scenarios or discuss with their birth partner how they can advocate for them etc knowing it's a harder situation to make decisions in, and midwives should present information in clear and understandable ways and take this into account.
And if you had said something like 'I can't make the decision, what do you recommend?' then obviously the MW has a clearer position she can take. But I just wanted to say the argument that the decision should have been taken out of your hands will likely fall flat.

Homebirth here (Ireland), and MW was very clear beforehand that any meconium in the waters would mean an automatic hospital transfer. No discussion. In fact there’s a whole list of stuff that would have meant automatic hospital transfer. No grey areas, no choices on those things. Not sure if that helps for context. I’m sorry you’re going through this.

It should always be the patient/nok decision to consent or not to consent so the issue about going to hospital is did they give you enough information to an informed decision.

I'm not sure what you are arguing. You say that the ambulance arrived after you had delivered so nothing could have reasonably be done. Home births are a choice and statistically safer so I understand why you chose this. But if your choice affects the outcome I'm not sure you can sue.

@SandMason there’s always choice. Meconium present in labour would mean a very very strong recommendation to transfer in (which is what the plan was in this scenario). But the baby was born before transfer and seemingly(?) in a good condition, therefore there should have been a clear discussion about recommendations/guidelines/risks/benefits etc. Midwives and paramedics have no power to force you into an ambulance. Guidelines are guidelines and there is always choice. @KormaKormaChameleon makes a very good point.

I would think about your aims - do you want an apology and for things to be changed? After my poor medical care I got this through a brief reflections meeting or you could go through pals or are you wanting something else?

Op I am really sorry to hear about your dd’s diagnosis. I hope you have good RL support.

I have a child with a different condition, not birth related and had a home birth where I received poor midwife care (with a different dd).

I would suggest the following, based on my experience. Call AvMA the charity specialising in medical accidents - they will be good at advice on this.

There is a solicitor called Iona Meeres-Young, who is a partner at a law firm called Fieldfisher. She gave advise to my cousin on potential poor care in her pg which might have led to brain damage. The conclusion from the medical expert was that it didn’t, but it was very helpful for my cousin to have clarity on that.

You can ask any lawyer if they will speak to you on a no-cost basis initially and whether they would offer a no win no fee arrangement, so you know your options.

I got really good support from Tommy’s the charity about my own poor care during a home birth. Their midwife helpline is very good and it really helped me to talk through what was going on.

I am so sorry you are going through this and just wanted to send you sympathy

op -I say this kindly as a mum of a dc (now grown up) who has some disabilities - we look for causes & what could have been done differently, or what we could have done differently. Sometimes there maybe nothing we/whoever could have done that would have made any difference.
Its is quite understandable that you feel like this
What I would say as someone who did go through the medical negligence route (not for my dc for another member of my family) is that it is complicated emotionally wearing & you have to have a really strong case to proceed. & it costs even if you do the no win no fee, The rules may differ for a baby but your first step will be to get a full copy of the notes. You will than have to go through the hospital (are the midwives connected to the hospital system or another body? again the rules may differ a bit for this)
complaints system not just PALS.
Than you go to the solicitor & they will look through the case & decide whether there is case that has a reasonable chance of success. It can take well over a year to through all the legal hoops & it will cost even if you have no win no fee.

Your house insurance legal cover might cover clinical negligence. Ours does.

My DC1 was born post dates with thick meconium and we were not monitored at all either. I did some research after as I was worried and from memory most suggested that if the meconium caused an issue it would be obvious in the hours following birth - as you mentioned breathing difficulties. That said I do think it's worth raising a complaint as they have not followed protocol and could cause harm to future babies.
I know someone who's son has CP and it is due to antenatal factors rather than any issues surrounding his birth. Do you think the hospital could investigate this for you.

I’m sorry about your daughter’s diagnosis.

Our DD was born in hospital. There was meconium in the water that was missed by the first midwife. We were concerned as had been informed of this risk at NCT classes. Our concerns were completely ignored by the midwife.

Second midwife came in (shift change) asked us for an update. We said we thought there was meconium in the water, we showed her a used sanitary towel. As soon as she saw it she pushed the red button and moved me immediately to a different area to see a consultant.

She probably saved my daughter’s life. Unfortunately DD ingested a lot and as a result, very shortly after the birth she had to have a procedure to pump her stomach. I couldn’t be there with her because I needed surgery so my DH took her. He said it was a very distressing experience.

She was transferred to the high dependency unit and I joined her there where we stayed for close observation for the first 12 hours. She vomited black/brown sludge for the first couple of days, despite the stomach pump.

I made a complaint to the hospital once we were home. They investigated and found a number of errors in our care. I received an apology. My DD does have some medical conditions but none related to the birth or the meconium - as far as I’m aware.

Id sue based on the fact they told you that they did not advise you about the risks of home birth. If you was a hospital birth you would have seen a paediatric dr obs doctor and baby taken for monitoring. Possible emergency section

I am sorry you are feeling uncertain of what happened to your daughter.
Coming from someone who was left in a similar position, I can truly empathize, unlike some of these other posters. I am shortly going to have a meeting with the hospital.
Did they offer any explanation as to why your daughter has CP?

OP I'm sorry you're having to look back and ask these questions. I would recommend getting in touch with a personal injury law firm (someone mentioned Leigh Day, there's Irwin Mitchell and lots of others). Look for a solicitor who specialises in CP. They should give you a free consultation to guide you on whether or not there's a case, or what would need to be done to decide as such. I could write a book on the pros and cons of a litigation case in a situation like this but go along, ask the questions and you'll figure out if it's the right thing for you and your family or not.
Sending all the strength

Can I second the Tommy's charity.

I had a life threatening event. Where I spent nearly a year after the birth of my first child in hospital. 8 months of that in ICU. Tommy's were so amazing. My story is rare.

Id sue based on the fact they told you that they did not advise you about the risks of home birth.

How do you know that?

OP needs to take responsibilty for her choices. She chose to have a homne birth for her first baby, she chose not to go to hospital even though an ambulance had been called due to the meconium. Nobody forced her to make those choices. It's very unfair to blame the midwives who attended her birth, rang an ambulance and advised her to go to hospital.

OP, meconium is the baby pooing due to distress. This can mean the baby isn't doing well during the birth, which may have been picked up if you were in hospital and monitored more closely. The problem after birth with meconium is that the baby could have breathed it in which could cause a chest infection. If the baby didn't have any breathing problems after birth then attending hospital wouldn't have made any difference.
It may have made a difference if you had been monitored closely on a CTG in hospital instead of birthing at home. It may not. This is the risk you take having a home birth, which are associated with a greater chance of complications. Why did you choose a home birth?

It might be worth getting your notes and going through them with a midwife. Be be aware most midwifes will document thoroughly, and the discussion about your birth plan, i.e. the home birth, will have been documented, risks and all.

@Happyheartlovelife I’m so sorry you had such a hard experience but I’m really glad Tommy’s helped you.

I had assumed they were for mums of premmies only but they were so supportive when I called them. It really helped me recover mentally from a very difficult birth. I believe the midwives are specially trained on the helpline and it really showed