Decision awaited in shoulder dystocia case

A decision is now awaited from the court in relation to a medical negligence proof held over the course of four weeks in February of this year at the Court of Session. The allegation of negligence relates to damage which occurred during the birth of a baby boy in 1999.

Evidence was heard from several witnesses including the child's parents, the midwifery staff involved on the day, as well as midwifery and obstetric experts for both the pursuer and the defender - Lanarkshire Acute Hospitals NHS Trust. Evidence was also heard from an expert with a speciality in peripheral nerve surgery.

Submissions were made by both parties on the morning of the 27^th February and it is hoped that the court's decision may be issued within the year. 

The case for the pursuer is that, during an incidence of shoulder dystocia (an obstetric emergency whereby, following delivery of the baby's head, its shoulder becomes impacted on the mother's pelvic bone, hindering delivery), the senior midwife involved in the delivery failed to follow the hospital procedure and carried out an inappropriate and unsafe manoeuvre to deliver the child. The child was subsequently diagnosed as having suffered a brachial plexus injury and consequent permanent weakening and loss of function in his right arm, which the pursuer alleges was caused by excessive traction having been exerted on the baby's head during delivery.

The court heard evidence from the pursuer and her husband relating to their impression of the level of force used by the midwife when delivering their son. Evidence was also heard from the three midwives who were in the room at the time. It was accepted by all three midwives that the medical notes did not give as much information about the sequence of events as they perhaps should.

Counsel for the pursuer then led evidence from an independent midwifery expert who felt that, having heard the evidence of the pursuer, her husband, and the three midwives present at the birth, she was of the view that there was a shoulder dystocia in this case. The pursuer's obstetric expert also held this view. He felt that this was supported not only by the contemporaneous records and the evidence, but also that this was consistent with the extent of the brachial plexus injury sustained by the baby.

The defenders' position is that: there was not, in fact, an incidence of shoulder dystocia; that the baby's shoulders were simply a 'snug fit'; and that the subsequent injury was caused by the maternal propulsive forces of labour. Evidence was led from a midwifery expert and obstetric expert in support of this position.

The issues for the court are as follows:

• Was the baby's delivery complicated by shoulder dystocia?
• If so, was the management of this negligent (according to the test for medical negligence outlined in the leading authority, Hunter v Hanley)?
• On a balance of probabilities, did the traction administered during delivery of the baby's shoulders cause his subsequent injury, or was the injury caused by maternal propulsive forces of labour?

Agreement has been reached between parties on the value of the claim so the court must now deal with questions of liability and causation alone.

Watch this space….