Safer Births

15 February 2019

Birth injuries though relatively uncommon remain the most expensive negligence committed by the NHS, accounting for a projected cost in 2018/19 of £735.7 million (NHSR annual report 2018). The common theme Clinical Negligence lawyers hear from the Government, press and NHS Representatives is that it is far too much and we should be ashamed about claiming against the good old NHS.

The problem is that the NHS is exactly that, ‘the good old NHS’. It is in drastic need of technological and human investment. It is grossly understaffed and grossly underfunded. Systems in neighbouring Trusts cannot interact with each other because they are with different providers, Hospitals lie 90% finished but unopened due to PFI failings and rarely are shifts not trying to cover for a staff member who has rung in sick.

Since the Montgomery decision in 2015 it has been an established facet that all patients must be given full information as to the choices in their treatment. This applies to childbirth. Patients need to know the risks and benefits of each option for delivery. This is not as simple as saying natural, assisted, VBAC or caesarean section. For mothers to be, often the decision is not how, but where they want to deliver?

There are so many options, the calm and relaxing home birth with candles and your designated midwife; the lovely plush stand alone birthing centre; the birthing centre in the hospital; or the full blown Obstetrics ward.

If NHS Resolution is really about saving money, (though surely their aim should be to encourage patient safety and reduce and correct the inherent risks) improving patient knowledge is paramount.

Many people who have a home birth or a birth in a stand alone birthing centre experience no problems. However when a problem happens there, what a problem it is. I was once told there were about 7-10 ambulances a day going from the Blackburn stand alone Birthing centre to Burnley Obstetrics Unit because additional care was needed. If this is replicated across the country it means that every few minutes a baby or mother is being transferred to an obstetrics or gynecology ward for often emergency assistance, be that cord entanglement, omission to advise the parent that they were Group B Streptococcus positive, need for a caesarean, need for an epidural, need for prescribed medication or syntocinon and a multitude of other problems.

A typical brain injury for a child costs the NHS in excess of £1 million pounds, sometimes far in excess of that amount. A stillbirth or neonatal death around £50,000. When we ask many of our clients why they chose the stand alone birthing centre or the home birth they explain that they were seduced into it by a midwife or other birth support worker who extolled the virtue of the calm non clinical environment and did not mention that when the meconium hits the fan the ambulance would be delayed as it was not an emergency call as clinical staff are already with the mother.

It remains a matter of patient choice but the only place where risks can be reduced to a minimum is in a hospital setting, either in a birthing centre within the hospital, where when something happens you can be wheeled through the door for the surgical team to perform their magic and deliver your baby or in a Consultant led obstetrics unit in the first place.

For parents there is no need to listen to calming music and be heroes. You may have a wonderful experience, but you may not. Rarely will an obstetrican describe a birth as low risk, every birth has risks which often cannot be predicted. The problem is that the clinician talking about home births or the stand alone unit will not say that. All you will get from them is crystals, lovely mood music and a birthing pool. It is important that parents to be, understand the risks and that these risks multiply the further you are away from an obstetrics unit.

I would much rather never see another baby avoidably injured. I know that is not realistic. Therefore all I ask is that patients are given a true picture of where the risks lie.

Jerard Knott, Head of Clinical Negligence

The Clinical Negligence and Catastrophic Injury Team at Curtis Law is led by Jerard Knott, Senior Associate Solicitor, an APIL Accredited Senior Litigator and Clinical Negligence Specialist. We are committed to promoting Patient Safety. The team only acts for Claimants and is dedicated to providing a client care centered high level of service, providing the best possible advice and maximising damages. The department acts on a large number of fatal (including representation at Inquests) and high value cases.

The department regularly advises on cases with valuation exceeding £1,000,000. We can be contacted on 01254 297130 or