This appeal concerns the birth of a baby which went wrong… baby was uninjured but mother C suffered a serious injury to her womb and had to undergo a hysterectomy. She brought a claim alleging negligence on the part of those responsible for her care at D hospital but liability was denied on the issues both of breach of duty and causation. [1]
J found for C… D now appeals against his decision to this court. [2]
C was expecting her fourth child. She had a history of undergoing two previous caesarean sections and had also sustained a tear to her womb. As a result, her pregnancy was categorised as “high risk” and a plan for her treatment was drawn up which included “elective CS…emergency CS during labour” [4]
On 2 December 2014, her waters broke and she was admitted to the D’s hospital. It was decided that the way forward, unless C were to go into labour sooner, would involve her undergoing an elective caesarean section on the morning of 11 December. If she were to go into labour earlier, however, the section was to be carried out as an emergency. [5]
she was discharged from hospital on 9 December with instructions to return two days later at 7:00 am. [6]
…the planned timing of the elective caesarean was overtaken by events.At about 2:30 am on 11 December, C presented herself to the hospital about four and a half hours before her appointed hour. By then, she was in the latent stage of labour. This is the label given to the period during which contractions are occurring but the cervix has not yet dilated by more than 4 cm. Once this level of dilatation has been achieved, the labour is no longer regarded as being latent but established. [7]
C was assessed by D on four occasions: 2:40 am, 4:10 am, 5:35 am and 7:05 am. It was upon the last occasion that the decision was made to proceed to a caesarean section. C gave birth to a baby boy at 8:36 am. However, she was subsequently found to have sustained damage to the posterior wall of her uterus which was not susceptible of repair… a hysterectomy was performed. [8]
At trial, the central issue relating to breach of duty was as to whether a decision should have been made at 4:10 am to proceed to a caesarean section. It was agreed that such a decision was not mandated at 2:40 am, so soon after C’s arrival. At 5:35 am, on the other hand, preparations were already afoot to deal with another emergency caesarean and no criticism was made about the decision to prioritise the progress of that procedure. [9]
C concluded that no reasonable body of medical opinion could support the decision not to proceed to a caesarean section following the appraisal at 4:10 am. D concluded that a caesarean section was not mandated at this time. [10]
further argued on behalf of D on the issue of causation that the claimant was unable to prove on a balance of probabilities that the tear to her uterus occurred after the time at which the caesarean section would have been performed even had there been a decision to proceed with it at 4:10 am. [11]
once J had concluded that no reasonable clinician with adequate knowledge of the relevant medical history would have contemplated delaying the emergency section beyond 4:10 am then breach of duty was established. [51]
it was highly unlikely that contractions would continue following a rupture of the uterus… at 7:00 am the contractions were increasing in intensity and thus concluded, on a balance of probabilities, that the rupture probably occurred after that time.[53]
this appeal must be dismissed. [56]
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