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, Pogmella's quote is straight off the NHS website.

This scares me..

www.nhs.uk/conditions/pregnancy-and-baby/where-can-i-give-birth/

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

1. any reasonable midwife would have given different information to what you were given (either regarding home birth or re going to hospital after the birth)
2. if that different information had been given, you would have acted differently (ie gone into hospital for birth or after the birth)
3. if you had acted differently and gone into hospital, the hypoxic event would have been avoided.

All this needs to be demonstrated on the balance of probabilities. It’s going to be exceptionally hard to get over all 3, especially number 3.

I am the mother of a DD with CP which I strongly believe was caused by bad practice during her birth. I am also an experienced litigation lawyer. I have never considered suing, for more than a few seconds anyway, because I know how time consuming, expensive and unpredictable litigation is, and I know how difficult it is to prove negligence and to prove that the negligence caused the damage.

I’m really sorry this happened to your DD. I am still angry it happened to mine. But as the previous poster who is 13 years into her claim advised, it may be best to save your energy for your DD’s treatment and care.

Meconium in your waters in it self is not an issue, it’s when a baby inhales meconium that it is a concern. Babies with Meconium aspiration are usually quite unwell and this is not something you or your husband would have missed.

I'm sorry that your baby has CP and I hope you can get all the appropriate treatment and support OP but I am with the majority in thinking that from what you have said you would be unlikely to have a case.
I'm no expert, but one of my children was suspected to have inhaled meconium at birth (thankfully he was ok) and I was given quite a lot of information on the subject then.
The only way that I can see that meconium could have caused CP would be if meconium aspiration syndrome caused severe/prolonged hypoxia which subsequently caused damage to the brain. But you would know if that was the case as your baby would have been very unwell. Being admitted to hospital may or may not have led to signs of MAS being picked up sooner if it had occurred, but since it didn't occur I can't see that the decision to stay at home can be implicated.
Of course it could be that something else caused both the CP and your baby to pass meconium prior to birth - the association between CP and meconium isn't necessarily a causal one. Both could be related to intauterine hypoxia but I am not sure how you could prove that happened, and if it did that it was caused by negligence. I wonder if a debrief of your pregnancy and the birth might help you? I think most Trusts offer this now.

@minipie thanks for your response. Yours has been one of the clearest for me. I think you are right on point 3. I think points 1 and 2 I could demonstrate.

In my trust babies born through meconium are only monitored closely if they required any sort of resuscitation at birth. If not, they’re treated like any baby born without meconium present. a baby who has aspirated meconium is very obviously unwell, which yours was not.

It doesn’t sound as if meconium could have caused your child’s CP, it seems more likely that she had an insult either antenatally or in labour, which wasn’t picked up on the intermittent Doppler monitoring done by your midwife.

Perhaps if you had been in hospital and on a CTG (although why would you be if you had a low risk pregnancy?) issues with her heart rate may have been identified and acted upon but you chose a home birth knowing that there wouldn’t be continuous monitoring

Perhaps if you had been in hospital and on a CTG (although why would you be if you had a low risk pregnancy?) issues with her heart rate may have been identified and acted upon but you chose a home birth knowing that there wouldn’t be continuous monitoring

I’d just like to pick up on something. The home birth here would Realistically have made no difference. The OP would have had the same intermittent auscultation in the hospital as she did at home which did not pick up any problem so there wouldn’t have been a change to CTG until possibly the point that the media was noticed. But it sounds like the baby was born very quickly after thjs anyway.

What evidence do you have the stroke could have been avoided?
Likely none.

Compensation woud be related to the level of care.
look at successful cases..very high needs 24 7 care needed. Clear neonatal distress scbu etc etc.
A bright child with one dodgy arm is not high level...the amount of compensation would be small.
Though of course you might wait to see how she develops.

Sometimes it just is and no one could have predicted. (Those of us with dc with de novo random genetic conditions know this)

Go speak to hospital for full debrief.
Speak to a lawyer with your notes.

Then park it and enjoy your child.
Put in your claims for DLA etc
Dont let drive for blame become the focus..

It's certainly worth trying to get someone to look at all birth records, because children who have had strokes and have a hemiplegia are more likely than other CP children to develop epilepsy, although the severity of the stroke is a major risk factor, and is less likely for your DD as she appears quite mild.

@embracelife she has an estimated 30- 50% brain damage so although she is only presenting mildly I don't think her condition should be trivialised.

True
But compensation if there was any would be linked to level of "damage" and level of care needed long term.
Good luck i hope she does well .

[quote Judey2020]@embracelife she has an estimated 30- 50% brain damage so although she is only presenting mildly I don't think her condition should be trivialised.[/quote]
Absolutely. It’s obviously impacted on you and on your little one. However, compensation may be linked to the needs your DD has. It would be some years, I assume, until you know the full extent of her disability and her potential. I’ve seen a number of people who’ve successfully claimed compensation through the job I do. Needs tend to be considerable and won’t be awarded until the child is older.