Spotlight on Birth Injuries

At Bush & Co we acknowledge the range of causation attributed to the term ‘birth injuries’ and understand that although strictly not classed as a birth injury some foetal injuries may only become evident at birth. Birth injuries in general are caused by the mother’s process of labour and the management of her delivery and that subsequently injuries to both the mother and the infant can be sustained.

Typically, these injuries to mother and baby can range from minor physical injuries such as bruising or swelling to more serious injuries.

Birth injury (to the mother)/Injury to the perineum

Women undertaking a vaginal birth may require an episiotomy (a surgical cut to the area between the vagina and anus) to assist delivery. They may also sustain a perineal tear. It is common for the perineum to tear to some extent during childbirth; tears can also occur inside the vagina, the vulva, and labia.

The Royal College of Obstetricians and Gynaecologists (RCOG) estimate that nine in every 10 first time mothers who have a vaginal birth will experience some sort of tear; for most women these are minor and will heal quickly.

Perineal tears classification

First-degree: Small tears affecting only the skin which usually heal quickly and without treatment.
Second degree: Tears affecting the muscle of the perineum and skin. These usually require stitches.
Third- and fourth-degree tears: For some women (3.5 out of 100 according to the RCOG) the tear may be deeper. Third- or fourth-degree tears, also known as an obstetric anal sphincter injury (OASI), extend into the muscle that controls the anus (anal sphincter). These deeper tears require repair in the operating theatre.

Birth injury (to the infant): brain injury

The most common cause of prenatal and perinatal brain injuries is hypoxia when the brain is deprived of sufficient oxygen. This can result from conditions related to either the mother or the baby and can happen during transit through the birth canal or through other complications. The brain damage can be mild, and symptoms may not present themselves immediately, but in other cases it can be identified instantly and include signs of cerebral palsy that can lead to long-term cognitive impairments and delays in development.

Acquired brain injuries (ABI) refer to damage to the brain and can happen at any time in life. ABI at birth are attributable to several factors but can be grouped into two main types: traumatic brain injuries or non-traumatic brain injuries. A traumatic brain injury can be attributed to an external source such as damage to the head due to the use of forceps or vacuum extraction. A non-traumatic brain injury is the result of something happening inside the brain or skull such as a stroke or an infection.

Bush & Co expert witness services

Establishing the cause of birth injuries to the mother and infant can be extremely difficult; it is important to establish if causation was unforeseen, unavoidable, and unpreventable.

In the event that birth injuries were acquired as a result from negligence on the part of medical professionals Bush & Co. can provide a full multi-disciplinary expert witness service to assist with any clinical negligence proceedings.

Experienced - over 35 years providing expert witness services to claimant and defendant solicitors and insurers
Professional – a team of more than 70 clinical specialists across the UK with an average of 23 years’ experience
Expertise - Quantum Expert Witness and Liability Expert Witness reports created for a number of specialist areas
Client focused – we our proud to have a 97% overall client satisfaction rate
Flexible - assessments undertaken to suit client, either face-to-face or via phone/video call

Our expert witness midwives apply objectivity when preparing quantum or liability reports, examining the available documentation and any additional materials to evaluate whether the right actions were taken at the right time by the right people.

Contact a member of our team on 01327 876210 for further details of our Expert Witness services or click here to find a suitable expert witness

The importance of early notification

The NHS Resolution’s Early Notification scheme is a national programme for the early notification and investigation of birth injuries. The scheme targets quick intervention in the hope a resolution can be found that allows the families and maternity staff affected to get the support they need at the earliest opportunity. In addition to the provision of much needed help and assistance, early notification can potentially moderate litigation and improve practices in the wider medical community through shared learning.

In the absence of early notification of avoidable birth injuries, families can be left without the support they need and protracted investigations, some initiated years after the traumatic event, prolong the stress for medical staff and increase the likelihood of higher costs associated with formal litigation in the courts.

The role of an expert witness

An expert witness midwife applies a helicopter view to determine the basic elements of who, what, where, and why, engaging a full risk assessment, study of medical records, case notes, and other relevant materials, and their own professional experience to confirm critical actions and timings to complete their report.

“Labour wards can be hectic environments and the quality and completeness of documentation can be as rich of source of information as the detail they contain when interpreted objectively”. Andrea Holton, Midwife and Bush & Co Associate Expert Witness.

A thorough evaluation of the key criteria of Quality, Safety, and Experience in relation to mother, baby, and all other relevant parties will help expose a clear picture of the level of care administered during labour and birth. Studying documentation will reveal answers to some fundamental questions and timings, such as results for cardiotocography (CTG) monitoring and Agpar testing, with accurate and complete notes helping to answer other basic questions:

What factors were present during labour and what actions were taken in response?
What issues, if any, occurred? If any, were they observed, or was action taken? What action and why?
What was the speed of reaction to identify, assess, and resource potential issues? Was it active or passive?
Who was requested to help respond to any issues? Did they respond? When?

Our midwives are experienced in examining the birth injury event in context, looking at medical and environmental considerations to establish whether wider influences related to human factors or culture may have been contributors:

What were the human interactions that contributed to specific actions being taken?
Did the culture promote the asking of help when needed, or did staff hesitate?
The quality and quantity of notes can give an insight into many factors including leadership style, process efficiency, and staffing levels.
Is there sufficient experience and knowledge in the team? Did the mother and baby receive the appropriate level of care?
Do staff feel valued and are their efforts recognised?
What guidelines were in place - different interpretations and terminologies exist between those issued by the National Institute for Health and Care Excellence (NICE) and the Institute of Clinical Excellence (ICE) which could have contributed to different decisions being taken. Are the same guidelines still in use? If not, when were they changed?

Your expert partner

Our expertise and knowledge of the medico-legal process enables us to offer expert witness reports for both quantum and liability to claimant and defendant solicitor and insurers. Written by qualified and objective professionals from a number of clinical specialisms, we offer several different reports to suit different client needs.

Expert Witness Liability reports – we can produce full liability reports that are CPR compliant (Part 35), or short form liability reports for screening. A specialist expert witness will be assigned and apply the appropriate legal tests, relevant professional guidelines, and evidence-based research to substantiate their expert opinion.

Expert Witness Quantum reports – Expert witness quantum reports can be tailored to your needs and provided as full, short form, or mid form reports. Full reports are suited to complex or high-value cases and our expert witness will complete an assessment using in-person or video link and write a comprehensive report suitable for use in court.

Short form reports utilise evidence and documents provided by the instructing party alongside details gathered from a telephone assessment. Ideal for lower value cases, or as preliminary reports in the early stages of larger cases, short form reports are not court compliant.

Contact a member of our team on 01327 876210 or instructions@bushco.co.uk for further details of our Expert Witness and other services