Boyes Turner’s birth injury solicitors secured a 75% liability judgment from an NHS trust for traumatic brain injuries caused to a baby by doctors’ negligent management of the birth complication known as impaction of the fetal head (IFH). Multiple attempts by the obstetric and gynaecological registrars to rotate the baby’s impacted head manually using forceps and ventouse suction caused traumatic injuries including skull fractures and intracranial haemorrhages (brain bleeds). Despite apparently normal development in early years, the young child now has subtle neurodevelopmental disability including memory and attention problems, emotional and behavioural difficulties and ADHD. Interim payments will meet the child’s needs during an adjournment of the case, as it is still too early in their development to assess the full impact of the brain injury. The liability settlement was secured at a pre-trial round table meeting (RTM) with NHS Resolution, despite their denial of liability throughout the case. Warning signs from delays in the late first stage of labour The child’s mother attended hospital with regular contractions 38 weeks into her first pregnancy. The fetal heart rate (FHR) was normal. Her cervix was 3cms dilated with the unborn baby’s head not engaged in the pelvis. She was assessed as not in established labour and sent home. Early the next morning her waters broke (spontaneous rupture of the membranes or SROM). She went back to the hospital and was noted to have regular, long-lasting, strong contractions. Her cervix was 5cm dilated and the baby’s head was 2cm above the ischial spines in a deflexed occipito-posterior position, a potential warning sign of difficulties in labour. She was admitted to the birth centre but progress slowed later in the first stage of labour that evening. She was transferred to the delivery suite where CTG monitoring revealed regular contractions and normal FHR. She was given an epidural and then IV fluids when her blood pressure dropped suddenly. The CTG recorded a 5-minute drop in FHR (bradycardia) before returning to normal. Overnight, labour was boosted with the uterine stimulant, Syntocinon. Second stage of labour was reached but the head did not advance after half an hour of pushing. The obstetric registrar reviewed her and decided to transfer her to the operating theatre for a trial of operative vaginal delivery. Multiple unsuccessful attempts to rotate the baby In theatre, the obstetric registrar made three attempts to manually rotate the baby to the correct position for vaginal delivery using forceps. Then, she called the gynaecological registrar who carried out a further unsuccessful manual rotation and then tried, unsuccessfully, to apply forceps before trying to pull and rotate the baby using ventouse suction. The obstetric registrar then tried to deliver the baby by emergency caesarean section but found that the baby’s head was very impacted (wedged into the mother’s pelvis). No attempt was made to push the baby’s head up vaginally, and the gynaecological registrar was called back to deliver the baby. The baby was pale, blue, floppy and not breathing at birth. They needed intensive resuscitation including cardiac compressions, and were intubated, ventilated and transferred to SCBU. The baby was then transferred to a more specialist hospital where they received cooling for hypoxic ischaemic encephalopathy (HIE), medication for seizures and a blood transfusion for a brain haemorrhage. CT and MRI brain scans later confirmed that the baby had suffered severe, traumatic injuries to their head, including two parietal fractures, a subgaleal haemorrhage, subarachnoid bleeding and bruising to the frontal and parietal lobes of the brain. NHS Resolution denied liability despite hospital’s own critical investigation report The hospital’s own investigation was highly critical of the care that the mother and baby had received, including the failure to recognise the long labour and anticipate the obstructed labour and difficult delivery, and the failure to involve a consultant. They criticised the repeated attempts at vaginal delivery without senior, experienced input, which breached both the trust’s own and the RCOG guidelines, and the management of the head impaction at the caesarean section. We helped the child’s family make a traumatic birth injury claim for compensation on the basis that the traumatic brain injury and neurological disability were caused by the multiple negligent attempts to manually rotate and deliver the baby, and by the excessive force used in those attempted rotations. Despite the NHS trust’s own highly critical investigation report, NHS Resolution responded to the claim denying that the doctors had been negligent or had caused the child’s traumatic brain injury. They maintained their defensive stance right up until the final weeks before the liability trial, when they finally agreed to a 75% liability settlement. We are now obtaining a substantial interim (advance) payment to meet the child's immediate needs whilst we work with the family and our experts to value the claim. If your child has cerebral palsy or neurological disability as a result of medical negligence or you have been contacted by HSSIB/MNSI or NHS Resolution, you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.
