C is now aged 14 and suffered very severe brain damage before or around his birth at the D’s Hospital on 1.9.2011. [1]
This was the trial of a preliminary issue relating to breach and causation. The relevant events happened between 23.18 pm on 31 August 2011 and 10.19 am on 1.9.2011, a period of 11 hours. All timings below relate to the night of 31.8.2011 and the morning of 1.9.2011. For reasons which were unclear at the time, C suffered Acute Profound Hypoxic Ischaemia in M’s uterus and perhaps Chronic Partial Hypoxic Ischaemia as well, causing severe cerebral palsy (brain damage). C’s case is that this injury should have been avoided by an earlier midwife referral to obstetricians, continuous CTG monitoring and earlier caesarean section, because M had complained of heavy bleeding at home when her membranes ruptured. D’s case is that the standard of medical care given by the hospital staff was reasonable and, even if there was any breach, none caused the injury which would have arisen in any event. [3]
I find that there was no breach of duty by the midwives at night or in the morning. [88]
I find that there was a breach of duty by Mr Siddig at 08.48 am. I consider that he should have read the notes, examined M and decided that M and C need delivery by a category II CS as soon as possible, with as much continuing FHR monitoring as was possible. A different breach arose after 09.40 am due to Mr Siddig failing to ensure similar FHR monitoring but that adds nothing to the earlier breach. [89]
I find that C’s severe brain injury was caused silently and tragically in the night, between 05.15 and 07.50 am, probably ending at or close to 07.50 am. It was caused by APHI. It was caused by a reversible mechanism. This was probably due to cord compression. This was not anyone’s fault. It was not the midwives’ fault and it was not M’s fault. No one was to blame. By the start of the daytime CTG, at 08.30 am, the damage was either done or the course was set for the full damage to emerge over time in the usual 3 phase manner. Therefore, the breaches at 08.48 am and thereafter and those after 09.40 am made no difference to the outcome and made no contribution to it. The primary damage had been caused, although the normal further sequelae of APHI arose thereafter and further consequential damage would arise hours later. [90]
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