A baby born by caesarean section after a 60-hour labour suffered cognitive and physical impairment, allegedly as a result of a delay in performing the procedure. The incident took place in 1965 but the GP involved only received notification of a claim in 2006, more than 40 years after the events and some 15 years after he had retired.
The mother went into labour at 42 weeks gestation, after an otherwise normal pregnancy. She was admitted to her local GP-led unit, where midwives cared for women in labour, with four-hourly visits by GPs. It was a Sunday lunchtime and labour was established within a few hours, but her contractions were weak. She remained in labour, visited every few hours during the day by a GP, until Tuesday, when a GP arranged for her transfer to the nearby specialist obstetric department for a possible caesarean section due to a failure to progress. This was within the 48 hour recommended time period before transfer to specialist care.
There, her labour was allowed to continue for a further 12 hours, to see if she would progress to a normal delivery. It was apparent that she wouldn't and with some signs of foetal distress, a caesarean section was performed. The baby girl was unresponsive for the first few days of life but rallied and was able to leave hospital after two weeks.
However, the child had suffered an hypoxic-ischaemic brain injury, which had left her with severe mental impairment and poor motor skills. In adulthood, she was unable to care for herself, work or live independently.
The parents brought a claim on behalf of their daughter against their family GP who had cared for the mother throughout her pregnancy and had attended her on several occasions at the maternity unit. The MDU denied liability on behalf of the GP. Very few notes existed after such a long period, so the defence was based largely on established practice at the time and the doctor's usual practice. Expert reports confirmed that in 1965, it was accepted that, in the absence of maternal and/or foetal distress, 48 hours was the cut off point for referring a patient to a specialist obstetric unit for failure to progress in labour. Furthermore it was reasonable to wait a further 12 hours following transfer before proceeding to caesarean section.
The MDU sent a strong rebuttal to the allegations on the basis that although very few patient records still existed, the doctor had clearly followed accepted practice at the time. The parents elected not to pursue the claim further.
David Pranklin
Technical claims controller
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