From general practitioners to hospital doctors and midwives in maternity units, UK medical professionals are adept at dealing with pregnancy complications. In the overwhelming majority of cases, the standard of health care is high and deliveries are relatively straightforward, with a positive outcome for mother and infant.
Inevitably, the final stages of pregnancy require careful management. In particular, a new mother’s first labour could be longer than average as well as tiring – both for her and the unborn baby. Rigorous monitoring is essential, therefore, especially when the midwives or doctors have decided to intervene and induce the childbirth – typically with prescription drugs. It is vital that staff remain watchful and ready to recognise any abnormalities in the mother’s labour; emergency surgical intervention in the form of a Caesarean section (C-section) might become necessary.
The circumstances that require a C-section include:
- Pelvic disproportion: the mother’s pelvis is not wide enough for a safe delivery, without crushing the baby.
- Poor orientation of the baby in the uterus, such as in the breech position (bottom first).
- Prolapsed umbilical cord, i.e. slipped, out of place and possibly squashed.
- Abruption of the placenta, i.e. detached from the uterus wall before birth.
- Placenta praevia, where the membrane blocks the uterus and obstructs birth.
- Distress to the foetus: heart rate is slow to recover after contractions, or the labour becomes unduly protracted.
- Attempts to assist delivery by forceps or ventouse instruments have failed.
- Uterine rupture, i.e. when the uterus opens – usually at the scar site from a previous Caesarean delivery.
Notably, a significant number of C-sections are for the above emergency reasons. Thankfully, however, the procedures usually deliver healthy babies while minimising further risk to the mothers.
Classifying the Urgency of Caesarean Sections
In April 2010, the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Anaesthetists published a paper that aimed to introduce a system to classify urgency more accurately and effectively. Experts considered the previous binary choice too simplistic – either elective or emergency. In contrast, the improved method would collate data and facilitate communication nationally. Enhanced reporting would enable auditing of outcomes, whether successful or otherwise. Additionally, the spectrum of urgency used colour coding to classify four degrees of risk, in accordance with the symptoms and circumstances of each case.
Today, using elements from the system previously endorsed by the RCOG, the classification system highlights cases that require immediate Category 1 emergency delivery. Also, the colour codes integrate well with existing hospital conventions. The categorisation of patients takes foetal and maternal compromise into account and assigns a priority from 1 to 4 ranging from an immediate mortality risk down to early delivery at a time to suit the patient and maternity services.
Usefully, the new clinical categorisation and reporting also measure the decision to delivery interval (DDI). In urgent cases, this period may be as short as fifteen minutes. Typically, a more representative 75 minutes should not necessarily compromise the viability of the foetus and, subsequently, the health of the newly born baby. Accordingly, medical specialists have adopted thirty minutes as the suggested limit for measuring and auditing care team performance in most emergency cases.
Types of C-section Errors and Mismanagement
As is the case in any major surgical procedure, Caesarean section childbirth – although sometimes necessary – is not totally without risk to the mother or baby. Post-operative issues might arise in a few unfortunate circumstances. In particular, blood clots, wound infections or problems with stitches may occur around the area of abdominal incisions. With proper medical attention and treatment, the outcomes are usually favourable. Fortuitously, such instances are relatively few – but if mismanaged or managed negligently, the consequences and prognosis can be problematic.
In a small number of negligently performed C-sections, the unborn baby might suffer oxygen starvation (hypoxia). In severe occurrences, the results could be chronic or lifelong – or perhaps even fatal. Such a serious lack of care or medical negligence may come about due to the failure to perform a C-Section, or if surgeons carry out the procedure incorrectly or inadequately.
Problems might include:
- Pre-natal indications: failure to recognise that a C-Section is necessary.
- Undue delay: injuries caused by the failure to operate and deliver the baby in time.
- Foetal distress: injury or deprivation of oxygen during labour.
- Botched surgery: inadequate technique or errors while performing a C-section, perhaps lacerating internal organs or closing wounds improperly, with increased probability of follow-on infections.
Cerebral palsy affects one in 10,000 babies born in the UK and can result from delays in Caesarean section procedures. Another possible complication is Erb’s palsy, an obstetric disorder associated with upper arm nerve damage, typically caused by shoulder dystocia during a difficult birth.
If you have experienced problems after C-section surgery and would like further information, or wish to discuss your case with an expert solicitor, we can help. Our experienced solicitors specialise in medical malpractice, including errors during childbirth by Caesarean section. You will receive free initial advice and – where applicable – our solicitors will assess your case and investigate the medical history and circumstances. If you would like to go ahead, please call us on 020 3510 0205.