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.

Pogmella, it's not a tiny increase in risk, it's a near doubling in risk. Statistics and maths are clearly not your strong point....

The point of 'singling in' on the home birth aftercare is to say that this is probably not the cause of the CP, and so suing on this basis is probably not going to be fruitful.

We are 13 years (mmm maybe 14) into a med neg claim for CP due to birth injury, with very little chance of a financial outcome. (That wasn’t why we started it).
In our case, (post Caesarian VBAC) we did not have continuous foetal monitoring in accordance with NICE guidelines. Ironically, the LACK of CFM means there won’t ever be closure, because without actual evidence (or readings consistent with same) it is impossible to pinpoint the time of hypoxia (whether by cord compression or whatever) /brain damage, and therefore to pinpoint the time that action should have been taken (AND WAS NOT, which is the ‘negligence’ bit), and so despite knowing that brain damage was caused and that brain damage caused CP, there is no evidence of negligence.
So. My advice is not to take this anywhere, because you will not be able to prove that a specific reading (fhr) at any time was indicative that hospitalization (or Caesarian) should have happened within 15 minutes of same, and ergo no evidence of negligence.
Dd2 was born with a FHR of 28bpm and apgars through the floor. She had seizures due to the hypoxia, was ventilated, tube fed, and spent six weeks in SCBU, and was discharged with full therapy team support.
We all know that she suffered a hypoxic birth injury causing CP (she’s just 17 now and the case rumbles on) but there is no evidence of negligence because there was no monitoring during the final stages of labour. Why? Good question. Irrelevant question, as it turns out. Everyone agrees there should have been. But no monitoring means no evidence, means no negligence. 😊 A lack of something doesn’t mean negligence, apparently. Unless you can prove that providing it definitively WOULD have caused a different clinical outcome.
She’s 17 now and has athetoid cp (originally dx with spastic cp, didn’t walk or talk until 7, has an IQ of 142 and intends to study neuroscience. Also on debate team and training for Paralympics.)
I’m a little unclear why you are forking out for private therapy though. With an NHS dx, she should have access to physio, OT and SLT if required. And you have presumably already claimed DLA or whatever it’s called now. Dd2 was in receipt of high rate from 6mos.
Honestly, save yourself years and years of fighting. CP is notoriously impossible to prove causation. Even when you are in the damned hospital when the brain injury occurs! 😊
Be kind to yourself and crack on with life. The opportunities are limitless. 😊

Someone1987
I'm sorry you had a such a difficult birth experience and PND

I have not read the whole thread but it sounds to me like the meconium is more likely to be a symptom than a cause of CP and a hospital transfer only likely to be beneficial if the baby is showing obvious breathing difficulties.

This link seems quite informative in explaining the issues and the decision to transfer.

www.homebirth.org.uk/meconium.htm#:~:text=References-,Introduction,the%20baby's%20gut%20is%20mature.

www.homebirth.org.uk/meconium.htm#:~:text=References-,Introduction,the%20baby's%20gut%20is%20mature

There are quite a few comments about being in hospital meaning you would have been continuously monitored and problems picked up. That’s not my experience.

Babies can swallow muconium in the water which can make them unwell. If your dd had been taken into hospital then monitoring might have picked up this earlier. In this case though it’s a moot point as she never did become unwell. I can’t see how your decision to stay at home can be linked in any way to your dd CP.

If you are concerned about your care during labour you probably need to look at your dd’s heart rate during labour to see if there was any sign of distress that could’ve indicated there was an issue.

There was meconium in my waters and DS couldn't breathe when he was born as a result, it was very very clear there was a problem and he was taken to intensive care immediately and stayed in special care for a further couple of days.

I don't know the ins and outs at all and have no knowledge around the links between meconium and cerebral palsy but from my experience you/the midwife would have known if it was causing an issue.

That said, I was in a birth centre and it was made very clear that if there was meconium I would have to be transferred straight to hospital, which I was when I was fully dilated and ready to push so they maybe should have done the same or gave you more information.

I hope you're able to find closure regardless of the outcome

The NHS does not discourage home births for second or further children. Should they?
I presume you've read this - including the links at the bottom:
www.nhs.uk/conditions/pregnancy-and-baby/where-can-i-give-birth/
Only 1 in 50 choose a home birth.
What you effectively do with home birth is to trade in your superior risk profile for ... for whatever reason you chose a home birth.
No-one seems to want to explain this to those who need to know.

OP was there continuous monitoring during labour? Or intermittent monitoring with a CTG strip in the notes or notes made of fetal heart rate etc? If none of these are available it is not provable when the injury occurred. You can request your maternity notes from the hospital for a small charge and get a midwife to look them over, if you do not want to see a solicitor immediately. As @nachthexe says, you can't have negligence and causality without evidence of negligence.

Hemiplegia is cause by a blood clot or a bleed into the brain, usually pre birth, and is more often not a result of negligence as it can occur at any time during late pregnancy. It can occur during a difficult labour, but you would need evidence to prove timing.

I would certainly look into this. Not so much for financial support, but because it helps to know nothing would have changed the outcome, and it is what it is for no reason you could have changed no matter what choice on birth you made, and that you were in no way responsible, and neither was anyone else. This is actually easier to live with than knowing it was avoidable.

Children with a hemiplegia usually do very well, walking and talking and attending school like other children. It just takes them a little longer. As you realise therapy is the key and is something worth spending time and money on now in the early years. NHS services are ok but very sparse on the ground.

There is a slight increased risk for HBs versus a hospital birth for delivery of your first child but the pros far outweighed the cons for us.

I don't follow. So you knew that there was a higher risk, you chose that higher risk and now you want to sue for what exactly? The problem with a higher statistic is that someone is that statistic. I'm very sorry that this happened to you but I'm not sure you have much of a claim.

So many people spectacularly missing the point The home birth didn't cause the CP! It sounds as if continuous monitoring during labour could possibly have identified and prevented the problem (if it even happened during labour and hadn't already been caused by an undetected issue during pregnancy) and you obviously don't get continuous monitoring at a home birth, but you don't get it automatically at a birth centre or hospital either - if it's a straightforward birth with no risk factors, there's no need to. Once there is meconium in the waters, then you would monitor, but by that point the problem might already have happened (and the meconium is a symptom not a cause).

MAS (meconium aspiration) can cause severe hypoxia (lack of oxygen) and complications secondary to that. As others have said this becomes aparent quickly after birth. It isn't associated with an isolated hemi.

@rorosemary I don’t think part of the risk is not being informed properly by the healthcare professionals. This could have occurred whether I was giving birth in a hospital, at the side of the road or at home. The quality of care should not be any less at home. The fact that I gave birth at home is irrelevant to my concern.

I agree with everyone that it cannot be proved at which point my daughter had her stroke or the cause the CP but I think what I am asking is whether we could still be entitled to some compensation for not receiving the correct information at the time, leading us to make a decision that was not informed.

In what way do you feel you weren't informed ? You were told what hospital admission was for and why they were recomending it. FWIW meconium complicates something like 20% of all births, a tiny fraction of those go on to have problems. In the circumstances if the baby was showing no problems I don't think it was unreasonable not to go to hospital.

You would have to prove that a majority of medical professionals wouldnt have acted the same and made the same decisions in that moment in time.

And I think that is what you will struggle with

[quote Judey2020]@rorosemary I don’t think part of the risk is not being informed properly by the healthcare professionals. This could have occurred whether I was giving birth in a hospital, at the side of the road or at home. The quality of care should not be any less at home. The fact that I gave birth at home is irrelevant to my concern.

I agree with everyone that it cannot be proved at which point my daughter had her stroke or the cause the CP but I think what I am asking is whether we could still be entitled to some compensation for not receiving the correct information at the time, leading us to make a decision that was not informed.[/quote]
But they gave you the option to transfer to the hospital instead of staying home. They don't do that if the chances are exactly the same at home. Otherwise why would they give you that option?

I realise that I sound a bit mean, and that's not what I want but I just doubt you have a claim here. It sounds like you were mostly overwhelmed at the time and not thinking things through. Totally understandable during/after birth but they can't override your consent to do the preferred thing because there are laws against that.

@Judey2020

You will not receive compensation for not being told your baby must be monitored in hospital. The reason is compensation is based on negligence and causality.

Did the midwife have a duty of care to impress on you the importance of monitoring for a period in hospital? I'd say probably yes if this is normal practice, but no, if you were given all the information needed to make an informed choice, including a strong recommendation to attend hospital, but decided not to.

So, ok, maybe negligence if it wasn't impressed on you the importance of monitoring. But did not going to hospital and being monitored for the affects of the meconium have any affect on the outcome? Apparently no, as your baby was fine, did not become unwell, have breathing difficulties or develop pneumonia.

So the decision not to attend hospital was the right one for you as there was no adverse outcome. Therefore the advice you were given had no affect on the outcome at all. Therefore no compensation at all. Sorry but there are very strict legal rules regarding compensation, medical negligence cases and so on. There's no wriggle room. Even if you had been given no advice whatsoever and there was no adverse outcome, there would be no compensation, despite clear negligence.

You may get an apology and it's worth looking at that if you want to, but I'm sorry to say, without evidence during labour via fetal monitoring, there would be no case.

I'm sorry your daughter has difficulties, but knowing your decisions had no affect on her that you are aware of, is comforting to know going forward.

You can't sue for negligence if it didn't lead to a bad outcome.

So even if the midwives should have insisted you went to hospital for monitoring, your baby was fine after birth and did not develop respiratory distress or pneumonia. So there was no bad outcome that needs compensating for.

OP, ex midwife here. From the facts as you have presented them I would say that there was absolutely nothing wrong with your care. I hope that clarification from senior staff has helped you understand what happened and why it happened. When a child is born with a disability it is very natural for the parents to look for a cause, however there is not always one to be found.

Your decision was an informed one, OP. You chose to stay at home and no harm came to your baby. As PP say, likely the insult happened at a point which no one can pinpoint and there is no one to blame. I'm sorry you're going through this.

I agree with everyone that it cannot be proved at which point my daughter had her stroke or the cause the CP but I think what I am asking is whether we could still be entitled to some compensation for not receiving the correct information at the time, leading us to make a decision that was not informed.

You would have to show that the failure to give you the correct information led to the damage which was caused. You seem to be suggesting that that is impossible, in which case you should forget claiming. But it does rather depend on the medical evidence - has anyone been able to pin down when your daughter had the stroke and what might have caused it?

It might possibly be that if you'd been in hospital on continuous monitoring then the fetal distress (which caused the passage of meconium) might have been picked up sooner, which might have led to intervention such as an emergency caesarean section, which might possibly have prevented the CP. But if you feel that you made an appropriately informed decision to have a home delivery, then I doubt you'd have a case for that. As it would rest on you not having been properly informed.

There is a smaller chance that a rapid transfer to hospital and emergency caesarean section, as soon as distress could be picked up in a home delivery, might have prevented CP.

However, that she was born in such good condition reduces the odds that either of these would have made a difference. It suggests that there may well have been an in utero insult prior to labour, from which she had partially recovered.

There is basically no chance that a meconium aspiration was both bad enough to cause sufficient hypoxia to cause CP, and yet so mild that there were no signs and the baby recovered with no support. When babies are really struggling to breathe it is very visible.

Op I wouldn’t be relying on views on this thread (I’m sure you aren’t) as to whether there is or isn’t med neg. I would speak to AVMA who specialise in this area and get them to put you in touch with a specialist med neg solicitor who can give you an informed view.

OP I’m really sorry this has happened to you. Being a parent of a child with additional needs is TOUGH, and not knowing exactly why it has happened is even tougher, but I don’t think you’d be able to prove negligence in this case.

You say yourself you were well informed of the pros and cons of home birth vs hospital birth and you chose home birth.

An ambulance was called when meconium was noted - you say your partner called but I’m guessing this was at the behest of the midwives?
You also mention that fetal monitoring was conducted, which is in line with good practice, and that there were no indications of distress, and you were offered to go to hospital for monitoring and declined but that your baby showed no signs of distress or difficulties following the birth so going to hospital would not have made any difference in this case even if you had been informed to a greater extent than you felt you were?

As others have noted, with no other signs of fetal or neonatal distress other than the meconium, it does seem like the CP was likely already present so I think you’d have great difficulty in proving any medical negligence on the NHS’s part.

@Blusteryday2020

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?

Just a small point - but the burden of proof in civil cases (ie medical negligence) is “balance of probabilities”. They wouldn’t have to prove anything beyond all reasonable doubt as it’s not a criminal prosecution