The practice of obstetrics is somewhat different to other medical specialities in that the “patients”, the mother and baby, are healthy when they come under the care of the specialist. (This may not be strictly accurate; it is estimated that about 1% of babies have some form of defect).
Nevertheless, the specialist is answerable for any error of medical management in the care of one or both of the patients. See here.
There is a strong body of opinion that the medicalization of birth is damaging to mothers and babies.
There is a similar opinion relating to the practice of modern medicine generally. ((“Medical Nemesis” Ivan Illich; Calder & Boyars Ltd.1975)) The worst outcome of an error in management is cerebral palsy in the infant. Cerebral palsy is a condition or symptom, not a disease.
If the medical management of the birth is the cause of this condition, the obstetrician is liable for the injury. The level of compensation will not be minor.
However there are many other mishaps or conditions for which the obstetrician may be answerable. In every case, the proof of fault lies on the Plaintiff, the infant.
1. Even if the mother is suffering from some defect, say pre-eclampsia, it may be the responsibility of the obstetrician to discover the defect in time before the infant is injured. The reason for the hesitation in attributing responsibility to the obstetrician to diagnose pre-eclampsia is the difficulty in doing so. Hypertension and proteinuria are necessary for a diagnosis. Unusual swelling, particularly of the hands, feet or face, may be an indicator. The condition is very serious.
2. The baby may experience actual injury, including cerebral palsy, brachial plexus injury, facial scars or other soft tissue injuries, fractures of the skull or limbs. With the exception of the first of these, the injury will have been inflicted in the process of giving birth, typically from the obstetrician’s instruments.
Generally, however, obstetrician error is more often a failure to do something, that should be done, than to inflict direct injury.
An obstetrician is expected to detect or take account of, among other things:
a) Fetus infection (such as rubella);
b) Poor presentation of the fetus or any abnormality of the fetus or the circumstances of birth;
c) Factors indicating a high risk birth;
d) The well-being or otherwise of the fetus;
e) Placenta praevia;
f) Umbilical cord prolapse or mis-presentation;
g) Changes in the fetal heart rate;
h) The obligation to have anaesthetic and paediatric help available if necessary
Presentation
Proper presentation means the baby descends head first. Poor presentation may result in shoulder dystocia of the fetus. The fetus will require manipulation to avoid the obstruction and injury. Breech presentation happens when the baby is descending buttocks first instead of head first.
Infection
If the mother is infected by German measles, normally a mild disease, its effects on the baby may be severe. It is essential to monitor the situation and act swiftly in the event the infection is detected.
High risk birth
Poor presentation will indicate a high risk birth. A transverse lie, for instance will increase the chances of, and may lead to, umbilical cord prolapse. If the cord emerges before the baby, the blood vessels in the cord may go into spasm if touched or on meeting the relatively cold ambient air. If this happens, the baby is immediately at risk of hypoxia and consequent cerebral palsy. A high risk birth will exist where there is Rhesus incompatibility between the blood of the mother and the blood of the baby. It is the responsibility of the obstetrician to detect Rhesus incompatibility.
Anaesthetic and paediatric help
If a Caesarean delivery is required or the baby is born after a period of fetal distress either or both anaesthetic and paediatric help may be required. Arrangements to have that happen must be made in advance.
General misjudgment
If the obstetrician or the midwife/nurse is furnished with ,or compiles, inaccurate medical records the errors that can result will very likely injure the baby. There is an obvious duty to ensure that complete accurate records on the mother and baby are maintained and are to hand.
Misjudgment of timing
The obstetrician may recognise the salient factors to be taken into account but may make an error as to when he or she must act on that knowledge. If the action is wrongfully postponed and the baby is injured the obstetrician will be liable.
Traction
If the infant is not emerging readily the obstetrician may have to pull the baby out. The traction must not be excessive; the infant can be easily injured.
Monitoring
The mother must be monitored to ensure that fetal distress is not missed. Changes in the fetal heart rate are an indication of fetal distress. That distress may lead to hypoxia and cerebral palsy or death.
Instruments
If the doctor uses improper instruments and injures the baby, regardless of the reasons for the use of the instruments, liability will lie.
Nurses
It is the obligation of the doctor to ensure that the nursing staff have the correct supervision and access to necessary advice.