AIBU to consider suing the NHS?

[BrokenVag]

Today is the 5th anniversary of my child's due date. In reality she was delivered by forceps after a traumatic labour 2 weeks later. During delivery I was given an episiotomy. For various reasons DH and I didn't attempt sex until 6 months later, and it was clear that something wasn't right. I spoke to my HV who told me to see the GP. The GP didn't examine me, and just said that it was probably just the new scar tissue causing problems, and that it would settle down.

Another year passed, we still didn't manage to have sex, and I went to the doctor's again. Saw a female locum who examined me, said all looked fine and that I should just "get over it" (I was crying in pain at being examined). A year later (so DD is 2.5 at this point) I insisted on a referral to see a specialist. The appointment took a year to come through, and as soon as the consultant examined me she said it was highly irregular for a birth in the UK. Turns out I was given a midline episiotomy rather than a median one (the cut went straight down between the muscles rather than diagonally across one). The result is that the muscles went into permanent spasm and pulled against each other, meaning the scar didn't heal (the consultant split it open just examining me - this is 3.5 years after having DD). She suggested botox to stop the muscles pulling apart, and i had the first done last summer (2014). I was recommended to have it checked and a second dose after 6 months.

I had the second dose today, 15 months after the first. Part of the cut has healed, but not all, and again it split when I was examined. Consultant said that it should help, but she's not sure it will ever fix it completely, and the NHS only allows 3 treatments. Given the NHS caused this problem, which has caused significant issues between DH and I as sex is pretty much impossible (I can't even use tampons), WIBU to sue them in the hope that I'll be given whatever treatment is needed to fix the issue?

I hate to say it but the same happened to me (son is now 23 though!). I had 3 different operations to sort it all out and then cosmetic surgery down there (!!) I am actually a solicitor. However, I chose not to sue as I was just relieved that my son and I were ok (although it was touch and go for him for a while). If he had been born 30 years prior we'd probably both not have survived the birth.

But each to their own. I would also say that my ex and I eventually split up due to the stress on the relationship in the sex department but happily I remarried and now have another son. I was terrified of giving birth the second time round and although the consultant insisted there was no medical reason for me to have a C section he was prepared to induce me early to keep the baby smaller.

Where are you based as I know some firms that specialise in Clinical Negligence rather than personal injury?

That's awful. You should definitely seek legal advice.

Mamma TJ if your son is nine you still have time to pursue a claim re his injury now the three year time rule doesn't start until he is 18.

Definitely not unreasonable. Not only the initial problem but the subsequent failure to recognise that anything was wrong

Find a solicitor. They'll organise getting your notes, and pay the fee for them.

Christ. Your care has been pretty awful. Probably sensible to focus the case on the main issue but I think it was also negligent of the first GP not to examine you, personally - you probably do too, since you mentioned it.

Please do pursue this. I don't see why you should have to - I think they should be investigating it as an incident and compensating you automatically but that's likely to be another world I guess.

I really hope that you get a second opinion via the NHS, and that you also ask around for recommendations on a really good surgeon to do a repair, possibly privately.

The thing is, it's not just the bad cut. It's the terrible aftercare and threat of just leaving you to suffer.

If you'd been examined, apologised to, plus appropriate surgery, and compo, then that would be fair. As it is, you're in pain, scared, can't have sex or another child. That's not right.

Do start the ball rolling tomorrow. It's not like you've asked for a gold-plated fanny.

I work in a Clinical Negligence law firm in the South. Don't want to try to 'pitch' so would suggest you contact AvMA who will recommend a specialist firm in your area.

As others have said, clinical negligence claims are notoriously difficult to establish. You'd need an obstetric expert to say that the standard of care was below that of a reasonably competent clinician. If a body of medical opinion states that a midline episiotomy was an acceptable practice at that time, your claim will fail. Do you know what the NICE guidelines for episiotomy were?

If you can establish breach, the next step is to prove causation - were it not for the breach you'd have avoided your subsequent problems.

You may wish to obtain your records (£50 charge) and / or make a formal complaint to the Trust but ultimately you need specialist advice on the merits of the claim and also the limitation issue which isn't straightforward.

YANBU.
However I would advise that you take the route of complaining first and see if you can get treatment sorted. I know of a case where a hospital arranged for a different, more specialised hospital, to take over care after an error.
Of course be mindful of dates and how long you have to lodge a claim. It might be though that once a claim is lodged the complaints process and sorting it out gets delayed.
Also note that it will cost £50 to get a copy of your medical records.
I agree AvMA is a good resource. Or SEAP if you are going down the complaints route: www.seap.org.uk/services/nhs-complaints-advocacy/

Cross post PinotPony! Said it better than me.

Agree with PinotPony - in terms of the NICE guidelines, these were changed in 2007 and 2014:

Perform an episiotomy if there is a clinical need, such as instrumental birth or suspected fetal compromise.

Whilst a mediolateral episiotomy is recommended, much will depend on your own case.

I can't explain why without completely outing myself but I have a lot of experience, professional and personal, in this 'area'.

Agree completely with PinotPony for the legal stuff but for the medical side.

PLEASE, PLEASE, PLEASE DO NOT WAIT ANY LONGER.

Please ask the GP to refer you to a specialist. St George' in London has a specialist clinic / service:

www.stgeorges.nhs.uk/people/mr-stergios-doumouchtsis/

I know someone who had treatment there (albeit many 10 years ago) but I have to say even then they were far more advanced in their investigations, research, knowledge and treatment options... In fact our local general hospital is nowhere close.

Personally I found there was an overwhelming lack of awareness and information about this. I was very open with friends about my problem and interestingly two of them approach their GP and had repairs after me.

Feel free to PM if you want a chat - my problem was different to yours but happy to share.

PLEASE don't live with it any longer.

I'm a big supporter of the NHS and I also agree that yanbu. You put your trust in them to give you proper care and they fucked up, royally. And now you're suffering the consequences of it and it's obviously affecting your day to day life. I don't have any real advice, but I'm sure some of the other ladies here do. I had an episiotomy with my first and it was so so painful afterwards, I can't imagine what you've been going through these past few years.

YANBU. I am so sorry you have suffered this. That they did that is scandalous. That they have left you so long without appropriate treatment and help is even more scandalous. The "pull yourself together and get on with it" attitude is far too common and the people who exhibit it need to learn compassion and humility, and how to actually effectively treat patients, both medically and as human beings.

Another one saying YANBU. I suggest Simpson Millar for a clinical negligence claim.

Thank you all so much for your posts. I've discussed it all with DH. We both feel grateful that those involved got DD out safely (it was pretty traumatic), but we're not at all happy that the lasting damage caused by someone going against NICE guidance is being treated so glibly. I've spoken to my GP surgery who will copy my file for 10p per sheet. I want to see if there's any mention of the midline episiotomy in my maternity notes. I'll also seek a second opinion - privately if necessary. I've some numbers of injury lawyers to speak to. Then I'll be in a position to decide whether or not to make a formal complaint/bring a case.

Yanbu Poor you :(

I'm a huge supporter of the nhs but i would 100% understand you suing them! Poor you! I would just say I think it would be difficult. My birth was ridiculously managed with midwifes consultants and others argueing in the room about what to do with me to the point I developed septicemia and my son had to be resuscitated and I had to go to theatre with 3rd degree tears. but on my notes it simply said vaginally delivery no pain meds given (I was refused them). Its a good job i wasnt going to sue them anyway because my dh works at the same hospital so little to close to home! Can you remember what was wrote in your notes? Just make sure your in a strong enough place now to deal with it all. I really do feel for you. I wish you the very best off luck and hope recover well

UPDATE: I requested a copy of my entire medical file from Jan 2010 from the GP. I've just picked it up. I'm sure it's incomplete. When I went into hospital to have DD I gave them my maternity file. When I was discharged after DD's birth I was given an envelope with a number of coloured sheets in it and told to drop it into my GP surgery for my file. There's no sign of any of that in the copies I've been given. There's also a report relating to a liver scan I had a year or so back listed but missing from the pack. There's no referral letter from them to gynae and only very basic notes from the appointments I had. Can someone confirm that all of these things should be in my file still and have been copied? I assume the hospital itself keeps no notes? Practice manager says she's "printed off everything from the system". I've told her that i requested everything from my medical file, and I expected that to include paper records too. She says everything gets scanned but that at the midwives keep their own records which aren't included on the medical file (sounds like a great system!).

There's a copy of a discharge form from the hospital which just states that I had a forceps delivery after a prolonged second stage and sent home with paracetamol and diclofenac.

So, what do I do now?

There's a copy of the letter sent to the GP from the consultant from the first consultation in which she says examination was extremely difficult, refers to my midline episiotomy being "granulated", that I would be having botox to alleviate the pain and that if it doesn't improve we'll be looking at surgery.

You need to contact the hospital where you gave birth and ask them for your maternity records. The GP notes will just be what is kept at the GP. It is the hospital notes you need.

I am a hospital nurse. You need to contact the hospital you gave birth in, hospital notes are kept on the hospital system and have no access to GP notes, GP notes are kept on the GP surgery's system and they have no access to the hospital notes. In my trust the only thing they share access to are the "national spine" (patient name, NHS number, demographics etc - no clinical info).

The hospital will have a PALS department, they can process your request for your notes and also assist you in making a complaint. You will have to pay a fee for your notes.

Thank you. I spoke to the hospital earlier and they advised me to write to the head of maternity at the hospital.

What were the notes I was given on discharge and told to pass onto the GP for?