“One of the most important jobs in the world.” How midwifery care falls below the standard required and the duties they need to uphold

Nadia Valentine, Trainee Solicitor in the Clinical Negligence department at Express Solicitors

By Nadia Valentine, Trainee Solicitor in the Clinical Negligence department at Legal Futures Associate Express Solicitors

Midwives play an essential role in the care provided to a pregnant woman and the delivery of new-born babies. They are responsible for ensuring not only the safe delivery of a new-born child but also the well-being of the mother during labour, childbirth, and postpartum birth. A midwife who is negligent is one who fails to exercise reasonable care and skill in their duties as a registered professional which causes serious injury or harm to mother and/or baby.

There are several instances whereby a midwife can be negligent, including but not limited to, misdiagnosis of serious conditions such as pre-eclampsia, incorrect administration of medications such as Syntocinon and failure to recognise signs of foetal distress. These can all lead to serious, potentially life-threatening and life changing situations.

A client of Express Solicitors unfortunately suffered an acute hypoxic injury which led to a later diagnosis of cerebral palsy. The midwives in charge of our client’s mother during labour failed to listen to her mother’s cries of severe abdominal pain, failed to perform a CTG and failed to send for an obstetrician for review. Her mother complained of severe abdominal pain for over 4 and a half hours before action was taken, a uterine rupture was diagnosed, and our client’s mother was taken to theatre for an emergency caesarean section. But by then it was sadly too late.

A midwife may also be negligent postpartum (after childbirth); this includes failing to correctly repair a labial tear. Another real-world example is that of another client of Express Solicitors who suffered a labial tear, which was later, negligently stitched by a midwife. The midwife in question left two sutures inside the client’s vagina causing her to suffer serious infection and unnecessary pain, suffering and loss of amenity.

Midwives are also responsible for the care provided to a new-born baby after it has been born. One of Express Solicitors’ youngest clients suffered an ‘extravasation injury’ when she was just 3 days old caused by the omissions of a negligent midwife. The midwife responsible for her care failed to monitor our client’s infusion levels correctly which, shockingly, caused the drip to pool onto her tiny arm, leading to serious burns which were totally avoidable.

One may not realise this, but even from the minute a woman announces that she is pregnant, the responsibilities of a midwife begin. A midwife who fails to diagnose or consider a mother’s pre-existing health condition or fails to correctly interpret a pre-natal scan is negligent. A midwife who fails to diagnose a mother with gestational diabetes for example, puts the mother at risk of a premature birth or suffering pre-eclampsia. In addition, a midwife who fails to recognise and report that the foetus is in breach position puts the mother at risk of complications during birth.

Not all midwives are of course negligent. There are those who provide excellent, personalised care and support to pregnant women. They monitor the mother’s health throughout their pregnancy and provide education and counselling, helping them to make informed decisions. During labour and delivery, they monitor the progress of labour, provide pain relief and coach the mother on breathing techniques. They ensure the baby is delivered safely and conduct any necessary medical intervention correctly. Even after delivery, they continue to ensure that both mother and baby are healthy and provide the required treatment depending on the circumstances. These midwives are fit to practise as they have the required knowledge, skill, and character. They prioritise the safety of the mother and the child and act in their best interests.

Midwives are trained under the Nursing and Midwifery Council and must follow the ‘Code of Practice.’ Midwives must listen to the mother and report any signs of concern that she is raising.

They must actively communicate with the mother, examine her regularly to check for signs of danger and correctly administer her medication where appropriate. Examination includes an internal vaginal examination and consistent monitoring of the foetus’ heart rate by CTG. The duty of communication extends to other medical professionals. Midwives must work with others and report any concerns to a senior member of staff such as a Registrar or an obstetrician. They must accurately record and keep all information including interpreting and recording CTG traces and a mother’s pre-existing health conditions.

Furthermore, they must not do anything to put the mother or the baby in danger during birth and must exercise reasonable care and skill if medical intervention is required, taking care not to cause irreversible damage to the mother or the new-born infant. The midwife must also ensure that the placenta is delivered. Failure to do this can cause serious harm to the mother. Should injury occur to either mother or baby, the midwife must again use reasonable care and skill to perform the treatment required. For example, in such cases where haemorrhaging occurs, the midwife must administer lifesaving drugs and fluids and transfer her for her higher level of care. In such cases where a child is born premature and saturated of oxygen, the midwife must resuscitate the child and transfer them immediately to the neonatal unit.

Everything a midwife does from the beginning of a woman’s pregnancy to the end is essential. One small error or omission can cause life-changing consequences. There is a large amount of pressure on a midwife to perform their duties correctly, but they must perform them correctly, to avoid causing irreparable harm to mothers, new-born babies and the reputation of the Trust they work for.

As the claims for compensation against negligent midwives continue to rise, so does the need for midwives all over the country to recognise, understand and reflect on the cases of negligence being brought, to minimise the risk of further negligence and increase the standard of care provided.

Important lessons need to be learnt from mistakes at Mid Staffordshire hospital maternity services and to adopt recommendations by Donna Ockenden in her significant review into maternity services.


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