Substantial damages have been awarded in an out of court settlement for a woman whose first child was sadly stillborn as a consequence of admitted negligent failures in care.

A woman from London has been awarded substantial damages after her daughter was tragically stillborn in May 2020, which was found to be as a result of negligent failures in care.

The woman, who wish to remain anonymous, instructed Adam Wright, a specialist Clinical Negligence Solicitor at Setfords Solicitors, to investigate the standard of treatment she had received during her pregnancy and labour, in order to understand whether her daughter’s stillbirth might have been avoidable.

The woman and her partner successfully conceived and were immensely excited when they discovered that they were expecting a baby girl. The pregnancy was considered to be low risk and she was managed by the antenatal team at Kings College Hospital, part of the Kings College Hospital NHS Foundation Trust.

The pregnancy progressed uneventfully and upon each review, their baby was found to be healthy and growing in line with predicated growth patterns.

During an antenatal appointment at 39 + 4 weeks, birthing options were discussed with the Mother. Due to reduced iron in her blood, she was offered induction of labour at 41 + 3 weeks in the event that she had not progressed into spontaneous labour.

However, at 40 + 3 weeks, the Mother attended the Maternity Assessment Unit (MAU) complaining of headaches and abdominal pain. A urine test found traces of protein in her urine and some blood, which raised concerns for possible pre-eclampsia. Her baby was assessed by CTG, which was normal, and a speculum examination confirmed that her waters were still intact and her cervix closed.

She was discharged home and told to re-attend if she developed worsening abdominal pain, headaches, disturbances in her vision or reduced fetal movements.

The Mother attended the labour ward the following day as she was under the impression that her waters had ruptured a couple of hours earlier in the day. She was again assessed and a CTG confirmed that her baby was well. She was advised that her labour would be induced within the next 24 hours if contractions did not start. She was sent home with the advice to contact the labour ward if she had any concerns.

Contractions started the following morning and the Mother re-attended the Labour Ward. She was again assessed and her baby’s heart was listed to with a handheld Doppler, which was reassuring. A vaginal examination revealed that she was 2-3 cm dilated. She was advised to go home and return when her labour had established, but the Mother asked to stay in hospital, which was agreed.

Later that evening, the Mother’s contractions increased in frequency and she was transferred to the delivery suite, where a CTG was commenced to monitor her baby. This demonstrated drops in her baby’s heartbeat, known as “decelerations”, and so a review by an Obstetrician was requested. The Obstetrician reviewed her 5 minutes later and felt that the CTG trace was suspicious, potentially pathological. A suspicious or pathological CTG trace is an indication of poor fetal wellbeing, and if there is no improvement, delivery is usually expedited.

A vaginal examination found the Mother to be 4cm dilated. A decision was made to prepare the Mother for theatre for a caesarean section, however, a different Obstetrician reviewed the CTG trace shortly thereafter and categorised it as being normal. Plans for a caesarean section were stood down.

The CTG trace was then reviewed at different times over a period of 7 hours, throughout the night and into the next morning, by a range of clinicians, including Midwives, Obstetricians and Registrars. They all interpreted the CTG trace to be normal, and reassuring.

However, in the early hours of the morning, the Mother was reviewed again by the Obstetric team. Whilst the CTG trace was again categorised as being normal, this doctor recognised that the fetal baseline (baby’s heartbeat) was very similar to that of the Mother’s pulse. A decision was made to perform an ultrasound scan to check the baby’s wellbeing.

Tragically, the ultrasound scan was unable to detect the baby’s heartbeat and it was confirmed a short time later that the baby had died. Condolences were offered to the Mother, before she was advised to start pushing to deliver her baby.

The Mother and her Partner were then informed that their baby had likely passed away sometime during the previous evening, and that they had erroneously been recording the Mother’s heartbeat on the CTG trace and which had falsely reassured them that her baby was well.

After the birth, a post-mortem report found that the likely cause of their daughter’s death was an infection, secondary to an ascending genital tract infection in the Mother.

The incident was reported to the HSIB (Healthcare Investigation Safety Branch) to investigate what had happened and to identify if there were any missed opportunities or shortfalls in care to learn from. The HSIB made several important findings, particularly:

• That the Mother did not receive any information regarding Group B Streptococcus in her pregnancy, which prevented her from making an informed decision following pre-labour spontaneous rupture of membranes.
• That the clinical notes indicate that the Mother was offered the options of immediate or delayed induction of labour following spontaneous rupture of membranes in line with national guidance, however, she was not given any information regarding the possible risks and benefits of the timing of induction of labour following spontaneous rupture of membranes. This prevented her from making an informed decision about induction of labour.
• That clinical factors and the possible cause of the initial suspicious / pathological CTG trace were not properly considered when the CTG appeared to become normal.
• That there was no differentiation of the Mother’s and Baby’s heart rate throughout the labour. This led to a delay in the recognition that the baby had died.

Adam Wright, a Senior Clinical Negligence Solicitor at Setfords Solicitors, was then instructed to investigate these errors in care and to determine if they caused or contributed to the stillbirth of the Mother’s baby.

The Mother’s medical records were obtained, a witness statement was taken and an expert Obstetrician & Gynaecologist was instructed to examine the medical records and to form an opinion as to whether the errors in care amounted to negligence, and if so, whether they directly caused or contributed to the stillbirth.

The expert formed the opinion that the Trust had breached its duty of care to the Mother. He opined that there was a negligent failure to provide the Mother with sufficient information regarding Group B Streptococcus infection following rupture of membranes which prevented her in making an informed decision on delivery options; that there was a negligent failure to provide the Mother with sufficient information on the risks and benefits between immediate induction of labour compared with waiting 24 hours to assess progress; there was a negligent failure to perform maternal and fetal observations for a period of around 5 hours especially when the Mother was requesting pain relief; there was a negligent failure to appreciate that the CTG trace was pathological; that there was a negligent failure by the Registrar in delaying a vital review; that there was a negligent failure to not to have proceeded to an emergency caesarean section when the Registrar recorded the CTG trace as being “suspicious / pathological” when it was certainly pathological; and there were negligent failures by all the clinicians involved who reviewed the CTG trace and recorded it to be normal, when it wasn’t, over the course of around 7 hours.

The expert formed the opinion that the cause of the baby’s death was due to infective Group B Strep infection, but that a lack of oxygen (hypoxia) also contributed to her demise. He formed the opinion that, absent the above negligent failings in care, delivery of the baby would have been expedited. He opined that in such circumstances, with an earlier delivery, the baby would have been born alive and treatment could have been commenced to treat the Group B Strep infection, which would have been less severe following earlier delivery.

Following receipt of the expert evidence, formal allegations of breach of duty and causation were submitted to the Trust. Their lawyers investigated these allegations and served a formal response admitting that the Trust had breached its duty of care and that, in the absence of these failings, the stillbirth would have been avoided. The Trust also made a formal apology to the Mother for their failures in care and the loss of her baby.

Understandably, the Mother had been traumatised by these events and so, upon receiving the admission of liability, an interim payment was secured so that she could access counselling services and to embark upon her recovery.

Further expert evidence was obtained from an expert Psychiatrist, to comment upon the nature of the Mother’s psychiatric injuries. The expert determined that she was suffering from a Post Traumatic Stress Disorder (PTSD) as a direct consequence of losing her baby. He advised that she would benefit from trauma focussed psychological therapy, and that following this treatment, he felt that she would make an eventual recovery from her PTSD injury.

Thereafter settlement negotiations commenced with the Trust’s lawyers, and a substantial damages award was agreed in an out of court settlement.

It is important to recognise however that no amount of money will ever adequately compensate the Mother for such a sudden and tragic loss. Having conceived at the same time as a friend, she is regularly reminded of her loss when she meets with her friend and observes her baby thriving.

Upon securing the settlement the Mother said “I hope that the Trust and the clinicians involved reflect upon how they treated me, learn from their mistakes, and ensure that this never happens again to any other woman. The damages I have been awarded will be fully utilised in trying to recover from these events. For me, the most valuable outcome of my case are that lessons must be learned. I am grateful to Adam and the team at Setfords Solicitors for the support they have given me at such a difficult time.”