Medical Negligence

 

Spinal injuries and assistive technology

Injuries to the spinal cord are life-changing. Spinal cord injuries can result in an extensive period of adjustment and rehabilitation for the injured person.

In addition to development in the physical recovery and rehabilitation process, there have been advances in assistive technology which can help the spinally injured patient improve their mobility and regain their independence after what is often a seriously debilitating injury.

Assistive technology covers a wide spectrum of different devices and equipment, so it is necessary considering the type of spinal cord injury to understand which type of technology could help. Whilst communication aids such as Eyegaze are becoming more commonplace, the technology to assist people to walk is less developed and, therefore, costly.

What is quadriplegia?

Quadriplegia occurs where there is a spinal cord injury above the first thoracic vertebra or within the cervical vertebrae C1-C8. A person with quadriplegia will have paralysis in both the legs and arms. The type of injury and rehabilitation will have a bearing on the extent of the paralysis. For example, a person with quadriplegia may be able to control some of their fingers or part of their hands. In more severe cases, quadriplegia can impair a person’s ability to breathe unaided.

What is paraplegia?

Paraplegia occurs where there is a spinal cord injury below the first thoracic spinal levels of T1-L5. An injury of this nature does not impact on a person’s ability to use their arms but will result in partial or complete paralysis of their legs. Again, the extent of the disability will depend on the type of injury.

Any injury to the spinal cord can result in ongoing permanent symptoms affecting the arms and legs and may involve paralysis, numbness and altered sensation.

 How can assistive technology help at home?

Adjusting from being fully independent to relying on family members or carers can be frustrating. Independent movement, which was previously taken for granted, disappears completely.  Assistive technology can help an individual to regain a degree of their past independence. It can enable a person confined to a wheelchair to be able to open doors, windows and curtains in their home, and move themselves throughout their own accommodation safely. Even simple things, such as turning on a light switch, can be done from a wheelchair by using an application on a mobile phone.

As with any significant debilitating injury, spinal injury increases vulnerability. It may be possible to insert a video surveillance system to control who is coming and going, or remotely operate electronic gates and garage doors, providing additional reassurance.

In preparing a claim for a client with a significant spinal injury it is necessary to consider and understand the various ways that technology may be of use. Lightweight computers or tablets are suitable for a person in a wheelchair to carry around, which will enable them to influence the world around them despite the significant restrictions they still face. Someone with a quadriplegic injury may need speech recognition software for communication, whereas a person with a paraplegic injury may be able to use a conventional keyboard and mouse.

How can assistive technology help in the outside world?

Losing the ability to drive can significantly curtail a person’s independence but vehicles can be adapted to allow the driver to drive from their own wheelchair, avoiding the need to transfer from wheelchair to car seat. Modern technology has developed so that voice activated controls can also be included in some adapted vehicles. A person with the use of their arms and/or hands can position themselves behind the wheel by accessing the vehicle from the back.

Social isolation is a significant hurdle for disabled individuals to overcome but assistive technology can help here too. For example, adapted golf clubs and specialist wheelchairs which support a person from seated to standing could enable a keen golfer to return to the sport they once loved. Such wheelchairs also help in social as well as sporting situations. For the more adventurous, organisations, such as The Scuba Trust, also enable people with quadriplegia, paraplegia and spinal injuries to scuba dive in a supported environment. There have also been great advances in assistive technology and gaming.

The Future

Assistive technology for those with a spinal injury continues to develop at a fast rate. Technology is becoming more accessible and the cost of such technology is likely to decrease as developments continue.

The future of assistive technology is exciting, constantly demonstrating that it is possible to expand the boundaries for disabled people, such as the participant who completed the London Marathon 2018 with the assistance of an exoskeleton.

Recently, electrical spinal implants enabled three men with spinal cord injuries to walk again. As specialist spinal cord injury solicitors, we would encourage our clients to consider the annual disabilities exhibition, Naidex, which showcases a range of new and upcoming technology to assist with every aspect of life.

The driving principle behind any claim is that compensation should, in so far as money can do so, put the injured person back in the position they would have been but for the negligent treatment which caused their injury. In cases of severe disability, this might appear to be an unrealistic exercise, but assistive technology can go some way towards improving independence, whilst ensuring that additional provision is made in the usual way for the costs of necessary care.

If you have suffered a spinal injury as a result of medical negligence and would like to discuss a potential claim, contact our spinal injury specialists by email at mednegclaims@boyesturner.com

Delay in diagnosing spinal tumours - Do I have a claim?

Spinal injuries have a devastating effect on lives. At a distressing time, our specialist spinal injury lawyers can offer straightforward and clear advice and assistance. Our approach is to work with our client and their family as necessary to ensure maximum compensation to help rebuild their lives.

What is a spinal tumour?

There are a range of different tumours which can affect the spinal cord including meningiomas and schwannomas. There are also other tumours which can affect the bones around the spinal cord such as Ewing’s sarcoma.

Surgery to remove a spinal cord or spinal bone tumour is usually the first line of treatment but it may also necessary to have radiotherapy and/or chemotherapy depending on the type of tumour. We obtained a six figure sum in compensation for a 17 year old boy following a delay in diagnosis of a Ewings sarcoma tumour of the spine.

Do I have a claim?

Our spinal injury claim specialists have helped clients who have experienced delays in diagnosis of a spinal tumour, resulting in a delay in treatment of their cancer. Delays in treatment can occur as a result of misinterpreting scans or a failure to investigate the symptoms of spinal cord compression, as well as other reasons.

Early diagnosis and treatment is essential for spinal tumours. The longer a tumour is present and pressing on the nerves in the spine, the more extensive any neurological symptoms will be and it will become less likely that a person will make a good recovery. In some cases, earlier treatment of the cancer by even a few hours or days can make a difference to recovery.

Where someone has experienced a delay in diagnosis of a spinal tumour, it is necessary to establish what injuries have been caused as a result of a delay in diagnosis and treatment of their cancer.

Demonstrating the extent of the damage caused by a delay can be challenging. In cases involving spinal tumours, even with an earlier diagnosis and treatment, often surgery is necessary to relieve any pressure on the nerves in the spine. Different tumours also grow at different rates. If a tumour is slow growing, it could be present for some time before any symptoms become apparent and some nerve damage could have occurred before the point of any potentially negligent treatment.

How we can help

Spinal tumours press on the nerves in the spine and this can result in neurological symptoms. The symptoms can vary depending on where the tumour is on the spine and the period of delay. The symptoms can include altered sensation such as numbness and pins and needles in the arms and hands and legs and feet. Tumours affecting the lower part of the spine can cause bladder and bowel dysfunction.

Following treatment there is a significant period of readjustment and adaptation to ongoing symptoms such as mobility issues. Compensation can help to provide therapies during rehabilitation, private care and specialist aids and equipment which may include assistive technology.

Complications arising from the treatment of spinal tumours can also occur for non-negligent reasons. If you would like to discuss whether you have a potential claim for medical negligence, we can assist you with this and advise whether you may be entitled to compensation which could help with your rehabilitation and recovery.

All #AGloHa for Child Brain Injury Trust

Over the last week, the staff at Boyes Turner Solicitors have been supporting #GloWeek and raising funds in support of the Child Brain Injury Trust. 

As the autumnal evenings draw in, the Child Brain Injury Trust (CBIT) work to highlight the message; “Be seen not hurt”

It is important to educate primary school age children across the UK about the need to stay safe on the roads, given that they will be making their way to and from school in darker conditions at this time of year. 

On Tuesday last week staff, friends and family took part in a #GloZumba event donning fluorescent clothing, fluorescent face paint and waving glow sticks whilst completing an hour-long fitness session. We would like to thank Vodka Revolution for providing a venue for the event, and our fitness instructor from Buzz Gyms for donating her time and giving us a great workout to some very Latin beats! 

On Thursday, solicitors from Boyes Turner’s medical negligence and personal injury claims teams, together with Partner, Laxmi Patel, and her colleague, Janata Ali, from the Special Educational Needs Team attended the #AGloHa event organised by @CBIT to raise funds to help children and families affected by brain injury.

The Child Brain Injury Trust provides invaluable help for parents and families of those affected by an acquired brain injury. They offer a child and family support service, as well as advice and information and online referrals to other organisations that can help support those affected by a brain injury.

Boyes Turner’s brain injury solicitors know that when a childhood brain injury strikes, the whole family is affected, as their entire way of life is irrevocably altered. The road to recovery can seem like a long and bumpy journey.

Boyes Turner are proud to participate in the Child Brain Injury Trust’s efforts to help brain- injured children and their families access invaluable advice and support at what is, for everybody in the affected family, a very difficult time.   

To read more about the work that Boyes Turner specialist solicitors do to help those with a brain injury please click here.

60 seconds with Fran Rothwell: What to expect when you call us with a medical negligence enquiry

After suffering a serious injury from inadequate medical care, the thought of contacting a solicitor to discuss a medical negligence claim can be daunting. At Boyes Turner we understand that you will have many questions about the process and prospects of success, which is why we have a team of qualified, experienced solicitors on hand to take your first call and to guide you through those important first steps.

We asked one of our solicitors, Fran Rothwell, to answer some of our new clients’ FAQs:

  • What information do you need to advise me whether I have a medical negligence case?

It is important for me to have a really clear and detailed account of what has happened. It helps to know why you are concerned about your treatment, how you have been injured and whether your condition is likely to be permanent.

It is also useful to have the relevant dates and the names of the treatment providers. I do appreciate, however, that you are not necessarily going to remember everything - exact dates, for example - especially if treatment has been carried out over a long period of time. In these cases, as long as I can obtain a general outline of the key events, concerns and dates, then that is sufficient for me to advise whether further investigation is needed.

The first call is very much a conversation back and forth and so you should not be worried at that stage if you can’t remember all of the information.

  • Do I need to make a complaint to the hospital and have my medical records before seeking advice?

No, this is not vital. In fact, most people come to us for advice before making a complaint. However, if a complaint or hospital investigation has already taken place, you should let us know, even if you disagree with the outcome, as it can provide valuable information.

If we accept a case then we can request the medical records on your behalf but, again, if you already have the records, please let us know when you call.

  • What happens next and how long does it take?

I will often be able to advise there and then whether we can take your enquiry forward.

Alternatively, if you do have additional information which I think will be helpful, such as, complaint correspondence or medical records, then it is often helpful for me to review the documentation with the medical negligence partners to establish whether you have a claim that we can help you with and call you back.

  • What determines whether a medical negligence case can succeed?

In order to bring a successful medical negligence claim there are two legal tests which need to be proved. Firstly, there must have been a breach of duty of care; this means that the medical treatment you received fell below an acceptable standard of care as viewed by a medical professional in the same field. Secondly, we must prove causation; this means that the breach of duty caused your injury. If I believe that we can prove both of these, I will then also need to consider the likely value of the claim. I will also need to ensure that we have enough time to thoroughly investigate your claim in line with the legal time limits.

  • What are the legal time limits?

Generally the time limit for a medical negligence claim is three years from the date of negligence. There are, however, notable exceptions. For example, in cases involving children who are under the age of 18 at the time they receive the treatment, the three year time limit starts to run on their 18th birthday and so will end on their 21st birthday. The time limit may also be extended for those who through mental incapacity cannot manage their own affairs.

  • Will I be charged for the initial call?

No.

  • If you accept my case, how will your fees be paid?

I will ask you to check whether you have legal expenses insurance, which is legal cover often provided as part of an insurance policy you will already have taken out for something else, such as home insurance. If the cover was in place at the time of the treatment and includes legal costs of a medical negligence claim then I can contact your insurer to find out whether Boyes Turner can work with them under the terms of your policy.

If you do not have legal expenses insurance then an alternative option is a conditional fee agreement, more commonly known as a ‘no win no fee’ agreement. This means that unless you win, there is no charge to you. If you are successful, then some of the costs involved to investigate your case will be deducted from your compensation.

If you are calling on behalf of a child or adult who has suffered a neurological injury resulting in a severe disability which happened either during the pregnancy, during their birth or the first eight weeks of life, then I will look into whether the case is eligible for public funding and we will make an application for Legal Aid.   

If you or a member of your family have suffered serious disability as a result of medical negligence, contact us by email at claimsadvice@boyesturner.com.

Valuing an amputation claim - prosthetic provision

At Boyes Turner, we understand that you cannot put a price on the loss of a limb. However, as experts in medical negligence and personal injury amputation claims, we also understand that it is imperative that any award of compensation fully takes into account the cost of the amputee’s current and future prosthetic needs.

How are personal injury damages calculated?

Under English Law, there are two main elements which make up the value of a personal injury compensation award. The first part of the compensation reflects pain, suffering and loss of amenity experienced by the injured person as a result of the defendant’s negligence, and is known as ‘general damages’. These awards generally follow set guidelines and are based on what the court has previously ruled as an appropriate level of compensation for that particular injury. The second part of the compensation reflects the individual’s additional past and future needs and financial losses arising from the negligence, set out as ‘heads of damage’ such as the cost of care, adapted housing and loss of earnings.

Can I claim for a bespoke prosthesis?

One category of damage that is unique to amputation claims is the cost of prosthetic (artificial) limbs. The NHS provides basic prosthetics for those who have suffered limb loss, however the law accepts that the amputee claimant is entitled to recover the reasonable cost of a bespoke prosthesis. Privately funded prosthetics come in a wider range than the NHS is able to provide and can be tailored to the individual’s particular pre-accident interests, including aquatic and sporting limbs. Finding the right prosthesis, which often means a privately funded prosthesis, can make a huge difference to the amputee’s independence and mobility, enabling them to return to work and sporting activities that would not otherwise be possible.

Each step of the process of choosing, fitting and ultimately using a bespoke prosthesis has associated costs which we can include and recover in our clients’ claims, so long as these are reasonable.

Where liability for the injury has been established, we can obtain interim payments to help meet the amputee’s urgent needs and to get their rehabilitation and trial of prosthetics underway as soon as possible, restoring independence, mobility and self-esteem, without them having to wait until the conclusion of the claim.

The sooner we are involved in our client’s journey towards restored mobility, the more thoroughly we can assess their needs and support them through the prosthetics process. Having established that the prosthetic trial has been a success and meets our client’s needs, we can then ensure that provision for ongoing costs, such as for servicing and renewal/replacement is included in the final settlement of the claim.

We also recognise, however, that no matter how good the prosthesis, there will be times when the individual will need additional mobility support. A claim for prosthetic limbs does not replace the claim for additional adapted vehicles and other mobility aids. We work with our medical experts to ensure that our clients’ needs for specialist equipment, such as wheelchairs, now and in the future, are also included in the claim.

If you have suffered amputation as a result of medical negligence or a traumatic injury caused by someone else, contact us by email at claimsadvice@boyesturner.com.

PACE Rehab Conference 2018 - Beyond the clinic room

Last week the annual PACE Rehabilitation Conference took place in London.  Julie Marsh, a specialist medical negligence claims solicitor at Boyes Turner, attended the event to learn more about transforming the lives of amputees.  

The aim of the day was to demonstrate the importance of enabling an amputee to live an active life through effective physiotherapy intervention, a trial of a prosthesis, occupational therapy input and most importantly, a multi-disciplinary approach to the rehabilitation process. 
Together with the team of PACE consultants, the programme included presentations from leaders in the field of prosthetics. Representatives from two mobility and prosthetics specialists, Ossur and Ottobock, talked about the newest developments in prosthetic provision and gave the audience a glimpse of the future, with implanted microprocessors controlling a lower limb device. 

There was a more detailed look at the Michelangelo hand, with a demonstration from two PACE clients.  Both had only been working with the upper limb prosthesis for about 12 months or so, and it became apparent just how much hard work and practice is needed to get the best from a prosthesis.  It was inspiring to watch the patients demonstrate using the hand to perform a variety of tasks, from the mundane picking up and opening a tin of beans, to the more complex task of taking apart and re-building a Lego tower. 

It was also interesting to be reminded of the benefit of a pre-amputation assessment, and how this gives the team at PACE Rehab an advantage and the patient a head start in the rehabilitation process.  The patient can look forward and focus much more on the next steps in their rehabilitation journey rather than becoming fixated on the loss of the limb – an additional and important psychological consideration. 

Another valuable reminder from the day was of how important it is to maintain awareness of the impact of a lower limb amputation on the remaining “good” limb, and the wear and tear that an amputee can place on that leg inadvertently through bad posture or altered gait. This highlighted the value of ongoing physiotherapy input to prevent the patient who successfully leaves the clinic room adopting bad habits to “make do” in an environment that challenges them with every step they take. 

Thank you to Scott Richardson and the PACE team for an interesting and thought-provoking programme. 

Our experienced amputation solicitors understand the importance of a multidisciplinary approach to rehabilitation and appropriate prosthetic provision. If you have suffered or expect to undergo an amputation caused by someone else’s negligence and want to find out more about how to claim, contact us at mednegclaims@boyesturner.com

What is Charcot foot?

Charcot foot is a serious, limb-threatening complication of diabetes in which the bones of the foot or ankle degenerate and become deformed, leading, if incorrectly treated, to disability and amputation.  

The condition arises from a combination of factors associated with diabetes. Diabetics with neuropathy (loss of sensation) have less feeling in their feet and may also have reduced muscle control and tissue damage. This affects their sense of balance and their walking gait and increases their risk of knocks, sprains and cuts, particularly to the soles of their feet. Diabetic neuropathy also reduces their ability to perceive pain following a minor injury to their feet, which means they can remain unaware of an easily treatable injury, such as a blister, until it becomes infected and ulcerated. As they continue to walk and put pressure on the affected foot , this increases the damage to the bones and tissues and their risk of serious disability.

Charcot foot develops over time but is often triggered by a minor injury, such as a sprain or twisted ankle, which remains untreated because it goes unnoticed.

Who is at risk of Charcot foot and resulting disability?

Diabetics are at risk of developing Charcot foot.

Their risk is increased by:

  • poorly controlled diabetes
  • reduced sensation (neuropathy) in the feet
  • impaired vision reducing the ability to carry out daily visual foot checks
  • existing ulceration

How can I reduce my risk of developing Charcot foot?

The key to reducing the risk of Charcot foot and other serious diabetic complications is good management of the diabetes, including good foot care, regular check-ups and prompt medical treatment of any injury (however minor) which could lead to more serious infection.

If an individual with diabetes has reduced sensation in their feet they must carry out daily visual foot checks to ensure that they seek help as soon as possible after a minor injury occurs. If they have impaired eyesight they should ask someone else to check their feet for them.  

They should see their GP immediately if their feet have:

  • Minor cuts
  • Blisters
  • Redness, warmth and swelling
  • Discharge or fluid oozing from the foot into socks or tights
  • Or if they feel generally unwell

Treatment from the GP might include:

  • Antibiotics
  • Advice to rest the foot
  • A review of their diabetic medication and management
  • Referral to a foot-care specialist
  • A personal care plan

What are the symptoms and treatment of Charcot foot?

Charcot foot symptoms can include:

  • Redness or swelling of the foot or ankle
  • The skin feels warmer at the site of the injury
  • A feeling of deep aching
  • Deformation of the foot

If an individual has a suspected or diagnosed Charcot foot, they should be referred immediately to a multidisciplinary foot care team. Treatment will involve reducing the pressure (or weight-bearing) and immobilising the foot in a plaster cast to allow it to heal in the correct position. The condition will be monitored by x rays and at regular appointments with a podiatrist.

Sufferers of Charcot foot and tissue damage through reduced blood supply are at high risk of limb-threatening infection. At the first sign of a new ulceration, wound, swelling or discolouration, the patient should be referred within 24 hours to a multidisciplinary foot care team for urgent treatment of their infection. Any delay can lead to amputation.

Boyes Turner’s clinical negligence team are experienced in acting for amputee clients who are living with serious disability caused by negligent medical treatment of diabetic complications, including Charcot foot.

If you have suffered or are expecting to undergo an amputation and would like to find out whether you have a claim, you can speak in confidence to one of our skilled amputation team at mednegclaims@boyesturner.com.

Amputation: What are the 3 most common causes we see?

Amputations are more common than you might think. The recent GIRFT report on vascular surgery puts the current number of lower limb amputations performed on the NHS each year at around 8,000, with an associated mortality rate of 7.5%. The good news is that with awareness, self-care and proper medical care, many amputations are preventable. For those whose avoidable amputations were caused by medical, employer or other road user negligence, financial help may be available through a legal claim.

Boyes Turner’s experienced amputation lawyers regularly help amputees restore their mobility and independence by securing funding to pay for rehabilitation, essential prosthetics, home adaptations and essential care and domestic assistance. Where the amputee is unable to return to their former employment, we can help alleviate the financial hardship that arises from their loss of earnings.

We asked our amputation specialist lawyers to tell us the most common causes of avoidable amputations which can give rise to a compensation claim:

Traumatic injury

Trauma, such as farm or factory accidents, where the injury arose as a result of unsafe working conditions or in an unsafe environment for visitors or children, are common causes of amputation claims against the employer or owner of the premises.

Road traffic accidents give rise to claims where a pedestrian, a cyclist, passenger in a car or taxi, pillion passenger on a motorbike or a bicycle, or another driver has been injured as a result of someone else’s negligent driving.

Complications of diabetes

With Type 2 diabetes on the increase, diabetes-related amputations are now performed at an alarming rate of 20 each day in England. Four out of five diabetes-related amputations are preventable, arising from minor foot conditions such as cuts, blisters, foot ulcers or sprains which develop into more serious infections or deformities such as Charcot foot.

Diabetes can lead to reduced blood circulation and loss of sensation in the sufferer’s feet, which means that they might not feel a blister or small cut until it has become infected or formed an ulcer. They might continue to walk on a sprained ankle until it develops signs of Charcot foot.

Diabetics and their health carers can reduce their risk of lower limb amputation by carrying out regular visual checks of their feet, promptly treating any signs of injury – cuts, blisters, discharge or oozing, redness, warmth or swelling – with rest, antibiotics if needed, and referral to foot care specialists.

Peripheral ischaemia

Peripheral ischaemia – a serious condition in which narrowing or blockage of the arteries restricts blood flow to a limb – was listed in a recent report on rising litigation costs by the Medical Protection Society (MPS) as one of the top five areas of substantial claims in GP practice.

If peripheral ischaemia is unrecognised or left untreated it can lead to ulcers, gangrene and amputation. Diabetics, smokers and sufferers of coronary artery disease are at increased risk, regardless of age, but 20% of adults over the age of 60 are believed to have some degree of peripheral artery disease.

Ischaemia to a limb can also be caused by surgical errors, such as mismanaged peri-operative anti-coagulation where the patient is known to be at risk of thrombosis or surgical injury to the popliteal artery.

If you have suffered an amputation or a serious injury with future risk of amputation as a result of someone else’s negligence, contact us on mednegclaims@boyesturner.com.

Vaginal birth after caesarean section (VBAC) - risks of rupture and RCOG recommendations

The RCOG Each Baby Counts programme’s recent report into the anaesthetic care which contributed to the serious brain injury, neonatal death and stillbirths suffered by 49 babies in 2015 highlights some of the highest risk areas in maternity patient safety. Aside from the essential teamwork, communication and forward planning which is needed to handle the multiple, time-sensitive, emergencies which occur in maternity units, the report emphasised that trial of vaginal birth after a previous caesarean (VBAC), if incorrectly counselled, undertaken and managed can result in uterine rupture, severely brain damaging the fetus and threatening the life of mother and baby. 

Serious injury was caused to a baby when signs of uterine rupture (including maternal tachycardia, breakthrough pain between contractions and a worrying CTG trace) were missed during a trial of VBAC labour. Despite these warning signs, the mother was incorrectly given syntocinon, a uterine stimulant, increasing the stress on her uterine scar. The report reiterated that pain breaking through a previously effective epidural in a woman with a history of uterine surgery must always trigger an obstetric review for scar rupture.

What are the risks of VBAC compared with a planned repeat caesarean section (ERCS)?

Assuming that delivery takes place at or after 39 weeks gestation in circumstances suitable for VBAC:

  • Planned VBAC has a 1 in 200 (0.5%) risk of uterine rupture, compared with 2 in 10 000 (0.02%) in a previously unscarred uterus. The risk increases when VBAC delivery is induced or labour is augmented with syntocinon.
  • The success rate for planned VBAC is 72-75% but increases if the mother has had a previous vaginal or successful VBAC delivery. If VBAC delivery is successful, it has fewer complications than ERCS.
  • Unsuccessful VBAC resulting in emergency caesarean section carries the greatest risk of adverse outcome.
  • The risk of unsuccessful VBAC and caesarean section increases if VBAC labour is induced or augmented.

Who is suitable for VBAC?

The RCOG guidelines for VBAC list the circumstances most suited to VBAC:

  • Singleton pregnancy (i.e. expecting one baby)
  • Cephalic presentation (baby is head down)
  • Pregnancy at 37 weeks or more
  • Single previous LSCS (lower segment caesarean section - scar across the lower part of the abdomen)

A successful VBAC delivery is more likely where the mother is taller, younger than 40, and has a BMI below 30, and the labour starts spontaneously before 40 weeks, and the baby is in vertex presentation with a birthweight below 4kg.

The risk of uterine rupture during VBAC increases with the mother’s age and the baby’s gestation and size, and where the mother’s last delivery took place less than 12 months previously.

Who can’t have a planned VBAC delivery?

Planned VBAC is contraindicated where there is:

  • A history of uterine rupture
  • Previous classical caesarean scar (scar goes vertically up the middle of the mother’s abdomen)
  • Placenta praevia (i.e. the placenta’s position would obstruct a vaginal delivery)
  • The mother has a history of other uterine surgery

Who decides whether the delivery will be by VBAC or ERCS?

The choice of delivery mode must be agreed by the mother and a senior obstetrician, based on her personal risk factors, before the planned date of delivery and after she has been counselled about the risks and the circumstances in which a trial of VBAC would be abandoned and caesarean section needed. All antenatal counselling must be documented in the medical records. If ERCS is planned, an agreed contingency plan for early spontaneous labour must be written in the records.

What additional safety measures are in place during VBAC delivery?

Labour must take place in a delivery suite equipped for continuous intrapartum care and monitoring, with facilities for immediate caesarean delivery and advanced neonatal resuscitation. The fetal heart must be continuously monitored electronically from onset of regular contractions throughout the VBAC, to ensure early detection of maternal or fetal compromise, obstructed labour or uterine scar rupture. The mother’s condition and progress of labour must be regularly monitored by one-to-one care.

What are the clinical signs of uterine rupture in labour?

The three classic signs of uterine rupture are pain, vaginal bleeding and fetal heart-rate abnormalities, but in 48% of all cases the scar breaks down without any maternal symptoms and is diagnosed later during surgery.

Clinical signs associated with uterine rupture include:

  • Abnormal CTG (most common sign)
  • Severe abdominal pain, particularly if the pain persists between contractions
  • Sudden scar tenderness
  • Abnormal vaginal bleeding
  • Haematuria (blood in the urine)
  • Previously efficient contractions stop 
  • Maternal tachycardia (elevated heart rate), hypotension (low blood pressure), fainting or shock
  • There is a change in abdominal shape and fetal heart-rate not detected at the previous transducer site
  • The fetus is no longer presenting properly

Suspected rupture of the uterine scar is an emergency requiring urgent caesarean section and neonatal resuscitation as the unborn baby is deprived of oxygen, leading to permanent brain damage or death.

As specialists in birth trauma claims, Boyes Turner’s medical negligence team are experienced in helping mothers and babies affected by uterine rupture during inappropriately counselled or managed VBAC deliveries.  

If you or your baby have suffered severe injury as a result of birth-related medical negligence contact one of our specialist solicitors by email mednegclaims@boyesturner.com.

Susan Brown awarded membership of exclusive Legal 500 Hall of Fame

Congratulations to Susan Brown, partner and clinical negligence team leader, from all at Boyes Turner, for her recent induction into the Legal 500 Hall of Fame.

Susan has long been recognised by all the major legal directories as one of the UK’s leading clinical negligence lawyers, but membership of the Legal 500 Hall of Fame is awarded exclusively to partners whose expertise places them at the pinnacle of the profession and who are constantly praised by their clients for continued excellence.

Susan’s immense experience and excellent judgement in high value child brain injury and maternal injury cases resulting from birth trauma and neonatal negligence regularly results in multi-million pound compensation awards for her clients. Her professionalism and incisive astuteness have earned her the respect and admiration of her colleagues, Counsel, medical experts and opponents, but it is her compassion for the injured children and her empathetic understanding of the devastating physical, emotional and financial impact of caring for a severely disabled child which results in such close and loyal relationships with her client families.

She has dedicated her career to making a lasting difference to the lives of severely disabled children and their families. We are delighted that Susan’s outstanding expertise and commitment to achieving the best possible results for her clients have been recognised in the Legal 500 Hall of Fame.

Read more about Susan Brown and the other partners who have been recognised in the Legal 500 Hall of Fame here.

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The service was personal, professional and considered. I was treated so kindly and in the end I knew that not only had I found the right organisation but also the right person.

Boyes Turner client

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