Birth pains that end in tragedy

Medical negligence results in unacceptably high levels of death and brain damage in newborns.

According to recent reports, an unacceptably high number of babies are dying owing to treatment by inexperienced doctors and midwives. This will come as no surprise to the many hundreds of parents every year who lose a baby in Britain's understaffed and overcrowded maternity wards, or to the even greater number of parents whose babies are left with brain damage.

Confidential research has shown that clinical errors contribute to two- thirds of all deaths in healthy babies, brought about, for the main part, by staff shortages that leave under-trained and overworked doctors in charge, with consultants seldom on hand to make critical decisions. Both the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives are calling for urgent changes to "revolutionise" Britain's labour wards.

Culpability aside, it's unlikely even these changes could compensate for the sheer trauma of an unforeseen complication during birth. Kathy MacCarthy's son Finlay was born in October 1996 after Kathy underwent an emergency Caesarean following complications in the last stages of labour. "Basically Finlay was born dead, but was resuscitated after 24 minutes," says Kathy. "He was taken into intensive care but was so profoundly brain-damaged that they detached him from the life support machines."

In the event Finlay was a strong baby, and he survived. He is now two years old and suffers from severe cerebral palsy. He has extreme quadriplegia and limited spatial awareness, needs round-the-clock care and has to be fed by tube.

Because Kathy had been given an emergency Caesarean under general anaesthetic, and her husband had been barred from the operating theatre, at first they were unaware of the exact circumstances surrounding Finlay's birth. Although both the consultant and the hospital manager paid a visit to Kathy's room within 24 hours of the delivery, the hospital was not forthcoming with information. "They kept saying they didn't know what had happened," says Kathy, "and we weren't sure whether that was the stock response or whether they genuinely didn't know."

Given the extent of the damage Kathy and her husband, David, believe that medical staff should have let Finlay die. She believes that neither she nor her husband were ever properly consulted either about the resuscitation, or about switching off the life support machine. "They should at least have asked us, because then it would have been our decision to live with," she says.

Kathy is well aware that if her lawyers give her the go-ahead to fight this case she will have to prove that if there was negligence surrounding Finlay's birth, it was not just about inappropriate treatment, but about whether or not doctors made a proper and informed decision about resuscitating him.

In general, medical negligence cases are difficult to win; hospital records get lost and it's hard to prove that a doctor has not acted with due care. It is also a process of considerable trauma. Many people give up along the way - the few that pursue their case often have a lengthy legal fight on their hands.

"This is where patients are so badly let down," says Joyce Robins, of the Patients' Association. "They write to the complaints manager of the Trust, plotting out their story with dates and correspondence, and still they get fobbed off." Significantly, an overwhelming 90 per cent of cases where there has been an avoidable medical error do not take the matter any further.

Those that do aren't necessarily looking for compensation, but simply for an explanation and apology. Russell Levy, a medical negligence specialist from Leigh Day and Co, says, "Often my most satisfied clients are those for whom I've done a thorough investigation and come back with the answer that no one could have prevented the outcome. Just knowing that seems to make it easier for some people."

It's perhaps no surprise that medical negligence cases most often involve childbirth. One of the most common problems arises over how doctors and midwives interpret the baby's heart monitor.

This was certainly an issue in Veronica and Nigel Williams's case; their son, Iwan, was born on 16 May 1993 and declared dead when doctors failed to resuscitate him after 25 minutes.

When two different foetal monitors failed to obtain a heartbeat the midwives went back to using an external CTG machine. Investigations later showed that the CTG had in fact showed that Iwan was in distress. "I pointed out to the midwife that the baby's heartbeat looked unusual. The doctor then said she'd examine me in the theatre, which I presumed meant I was going to be given a Caesarean," says Veronica, "but then at the last minute she said that I'd dilated sufficiently to have a forceps delivery.

"I was placed with my feet in stirrups, and then all hell broke lose. Paediatricians gathered round, a midwife pressed down hard on my stomach, and the doctor started shouting, `for God's sake, push'."

Veronica knew it was bad, but she didn't know how bad. When she and Nigel learnt that their son was dead, they believed it was because of shoulder dystocia - a rare complication of labour in which the shoulders get stuck.

Initially Veronica accepted this explanation, but when her GP suggested that she look further into the matter she began to have her doubts. "Nigel and I would go to Foyles's medical section and read up about shoulder dystocia and CTG readings. We began to piece together the facts surrounding everything that had happened, until finally we agreed that shoulder dystocia was too simple an explanation."

When they wrote a letter of complaint to the hospital, they weren't satisfied with the reply that came back. So they took the case to an independent review, where two outside consultants were brought in to present their judgement to the regional health authority.

"It was at this point that the hospital admitted that a mistake had been made," says Nigel. "After the consultants' findings they declared that the death had been avoidable, that a Caesarean section should have been carried out, and that there had been a breakdown in communication between medical staff and ourselves."

Once the hospital had admitted that an "avoidable tragedy" had occurred, Nigel and Veronica let the case rest for a while, unsure as to whether or not to instruct their lawyers to seek personal injury damages. In the end they did, but the small sum received for Iwan's death has been little compensation for the loss of a child.