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.

@Volcanicorange I think most first time mothers would see “very slight” not as don’t do it, but as be aware there’s a little bit more risk.

@Volcanicorange I was told by a very experienced mw that hb was safe. Why wouldn’t I believe that?

On what basis has she been diagnosed wirh cerebral palsy?
Has there been an MRI showing specifuc brain injury?
Apart from meconium there seems no clear evidence of birth injury? Eg born blue or floppy??
Sometimes CP is a catch all diagnosis but later genetic tests show an underlying condition
Has she had genetic testing?

Would would any money you got by suing do to benefit?

@Judey2020 What type of cerebral palsy does your baby have? Different types have different causes. Strokes and hemiplegia usually occur pre labour and birth.

@Volcanicorange I was told by a very experienced mw that hb was safe. Why wouldn’t I believe that?

For a second pregnancy where the first pregnancy had no complications and a normal birth, the risks are the same.

For a first pregnancy the risks are doubled. So the chance of a serious outcome is twice as likely.

@SendHelp30 Is that a fucking serious question?

@Volcanicorange I think most first time mothers would see “very slight” not as don’t do it, but as be aware there’s a little bit more risk.

Well, yeah. Be aware there's a bit more risk, which if it affects you can be devastating.

"choice should have been taken out of my hands"
You have the capacity to make decisions, choice should never ever be taken out of your hands. Human rights are human rights.
You should however, have been given all the information to make YOUR informed choice about YOUR child.

Just some examples of misdiagnosis of CP.
If you do have MRI showing stroke or bleed consistent with birth injury then of course that might be different.but most likely newborn would have been v distressed...

You might expect some obvious clear catastrophic event during birth and very apparent distressed newborn for a negligence claim. ? It seems baby was healthy enough for medics to be happy with your choice to stay home .. if baby was distrressed or not breathing this would have been apparent and they woukd have surely insisted. reading and knowing of people with successful claims there were usually very clear issues at birth low or zero apgar etc etc

www.ncbi.nlm.nih.gov/pmc/articles/PMC6160622/

www.childbirthinjuries.com/cerebral-palsy/diagnosis/misdiagnosis/#:~:text=Neurological%20Diseases,skills%2C%20not%20just%20motor%20skills.

I love how passionate everone is about their own opinions, it's great 👏🏼.

So her diagnosis is cerebral palsy, confirmed by MRI with follow up from the consultant neurologist. The CP has caused Hemiplegia affecting one side of her body but mainly affecting her upper limb. From the moment we suspected a problem we have been doing physiotherapy privately and have recently started a more intensive therapy to help her rehabilitation. Lucky for us our daughter is bright, determined and happy so we will continue to support her in every way to thrive and achieve the best outcomes for her.

@NameChange30 thank you, my son appears so far to be ok, but it did leave me with horrendous PND. I am in no way criticising, being a mother is not a comparison or judgement. Perhaps from stories of home births I've heard, I worry about women having them. You don't have a surgery on hand if you need an emergency c - section - my friend had a placental abruption and was a cat 1 emergency c - section whereby there was immediate threat to mother and baby. She was anaesthetised and baby had to be out within 30 minutes. I worry if she had been at home, that couldn't have occured (she lives 45 minutes away from the hospital already).
I'm sorry if it came across criticising, a woman can do whatever she wants.

Ah ok mri confirmed cp

If impact is "only" one upper limb then she may not need millions in care.. ??.. but you can always contaCt medical negligence lawyers later if you want to clarify

Well did she have any noticeable breathing problems the first few days?

Hi Judey,
I’m sorry to hear about your daughter’s CP, but I’m pleased she is bright and doing well with physio.
The monitoring after meconium is to identify meconium aspiration syndrome early - which a lung problem that occurs when babies inhale the meconium. From what you’ve said, If your daughter was well post birth and didn’t need transmission she won’t have had MAS. The monitoring performed in hospital (temp, heart rate, breathing rate) wouldn’t have prevented or identified sooner your daughter’s CP. It doesn’t sound like your totally reasonable decision to stay at home would have affected the outcome.
It is possible that other areas of care were lacking. Most hospitals offer a birth reflections clinic where you can look through your notes with a senior midwife and may be helpful?

It’s expressed as 9 in 1k because most people would see 0.009% as very hard to visualise, but perhaps that figure would be more helpful for people convinced first time home births are sufficiently risky that they should not be attempted by anyone. I’m slightly astounded in the circumstances OP is getting any flak for weighing things up and deciding 0.004% risk was tolerable- it’s a decision many people would make! I’m sure far greater statistical risks are at play based on things like postcode or NHS trust but no one gets a grilling for choosing to give birth within those if their child needs extra support.

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.

No, OP wouldn't. OP's child would be a party to the action and therefore any damages she receives would be payable to her and held in trust for her to be used for her benefit until such time as she is able to manage the funds herself.

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

No, the burden of proof is lower, on a balance of probabilities.

Pogmella

Erm, it's 9 in 1000 is 0.9%

As in 10 times less than 9 in 100.

So almost a 1% chance of a serious problem, compared to a 0.5%. Not much on an individual level, but out of the 1000s of homebirths a year it's a number of women and babies who have serious outcomes that could be avoided.
When people weigh up the pros and cons they don't think they will have a bad outcome. I can't imagine many people would say the pro of being in your own living room outweighs the con of a birth injury/neonatal death

“If the risks were so huge then it would not be endorsed by the medical profession in the way that it ia.”

I’m afraid in lots of other countries home births are either not endorsed and/or not permitted. I am English but didn’t have either of my daughters in the U.K. Home births were not allowed in either of the countries where they were born and thank goodness because we would have been among those with a catastrophic outcome had I chosen that route (which I may well have done).

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.

OP is presumably saying that, if she had been properly informed, she would have agreed to the baby going into hospital and being thoroughly checked there, and that that might have made a difference.

Even if OP could demonstrate negligence around being allowed to refuse to go to hospital, how would you prove that this caused the CP, and not the homebirth?

That would be a matter for experts reviewing the notes, scans and evidence both before and after birth. None of us are in a position to say whether there is proof of the cause of CP without having access to the same information.

[quote Onceuponatimethen]@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[/quote]
@Onceuponatimethen

Thank you. Due to my condition. Both my children were born early. (Different births). Tommy’s were phenomenal.

I even got interviewed by Tommy’s. It was published. They said it was one of the most horrific births they’d ever heard of. Sadly due to the births I’ve been left with life long. Life limiting problems

I’ve since tried to shout from the rooftops about my births. How I feel there is little help for mothers of premature babies. How I feel there is little help for mothers with severe disabilities or depression. How we need more support and Tommy’s have helped me do that. Advocate for mothers like me.

Pogmella

I can't see where you got 0.004% risk from either.

If you had a hospital birth the risk of a serious outcome would be 5 in 1000 or 0.5%
If you had a home birth for your first baby the risk of a serious outcome would be 9 in 1000 or 0.9%, so nearly double.

@SendHelp30

Would would any money you got by suing do to benefit?

Daft question, with every respect. If you had ever had a disabled child you would be aware that there is quite major expense associated with caring for them. For the child, it is compensation for being disabled, for loss of opportunities and enjoyment of life, for pain, the costs of ongoing care and specialist education, and much more.

@Volcanicorange the data states there’s a 0.4% increase in outcomes. It does not state home births are the cause, and this correlation may well not indicate causation. Do we know if the sample is made up of only midwife attended births? Or whether free births are included? Unplanned rapid deliveries not in living rooms at all?

It’s a tiny increase in risk which is unlikely to be anywhere near as relevant as choices like where you live, BMI, your NHS trust’s ratings, your/partner’s gene pool etc etc.

As many pps have helpfully stated the home birth aftercare is very unlikely to have contributed to OP’s DD’s diagnosis so I’m not sure what singling in on that decision does to help anyone.