Disclosure of documents subject to implied undertakings
The NHS Litigation Authority (NHS LA) is the body which manages legal claims made against the NHS in England. In October 2012 it published a report which examined a decade of legal claims arising from NHS maternity care. (see also Negligence in Maternity Care: Ten Years of Claims).
The report noted that between 2009 and 2010, a similar but shorter period, some 5.5 million babies were born in England and that only 5,087 maternity related claims for injury were made against the NHS during this same period – representing one claim per 1,000 births.
The “claims” figures would tend to suggest that childbirth on the NHS is relatively safe but I would venture to suggest that the 5,087 legal claims mentioned represent only the tip of the iceberg in terms of dissatisfaction with the quality of maternity services in England. I believe significantly higher numbers of women would say they were deeply unhappy about the quality of the care they received during childbirth. The “claims” figures represent only those cases where legal claims have been brought, no doubt cases where significant physical injury has been suffered by mother or child, or both, justifying the bringing of complex, lengthy and expensive litigation. But what about those women and children who have experienced inadequate care in woefully understaffed maternity units across the country? These are the women and children that do not get to be included in the statistics as fortunately no serious physical injury has occurred.
The NHS LA report revealed that of the 5,087 cases which resulted in claims, junior doctors and inexperienced midwives were often involved in the management of the labour, without adequate assistance from senior clinicians. The NHS LA very rightly recognises this as being unacceptable.
As a clinical negligence lawyer who specialises in claims related to childbirth, I have listened to many women describe how they found themselves in a maternity unit which was drastically short of staff and were either left unattended for many hours, so that the staff could attend the more “serious” cases, or were left in the hands of junior midwives or doctors who exhibited muddled obstetric management, poor communication skills and a general poor standard of care.
One of the consequences of being left unattended and unsupported by good quality, caring midwives can be a “terrified” mother and a traumatised and anxious father. Serious physical injury to mother or child does not always follow and hence legal claims are not brought, although they are frequently contemplated. Fortunately childbirth is a natural process and for many women a healthy baby will be born despite poor quality maternity care by reason of “Mother Nature” and a little luck. I for one do not believe women should have to fall back on the vagaries of good fortune alone when they choose to have their baby in a hospital setting.
I believe that the majority of women choose hospital to have their baby because they feel that this is the safest place to give birth, a place where they will be supported and cared for throughout what is quite possibly the most frightening experience they will ever encounter, particularly for first-timers, or those who have had a previous problematic birth. Women rightly wish to form a relationship with their midwife, a bond of trust. This is something which good, caring midwives recognise and no doubt wish to provide, but are sadly so often unable to deliver in understaffed units.
These concerns are shared by the Royal college of Midwives (RCM) which has recently warned that a record shortage of midwives around the country is putting mothers and babies at risk. The Royal College of Midwives says there is a massive shortage of midwives after some areas of the UK has seen a 50 per cent rise in the number of births in the last few years.
In a report published in January 2013 , the RCM warned that around 5,000 additional midwives were needed in England alone to deal with the highest birth rate in 40 years.
As a clinical negligence lawyer I also see cases where apparently “low risk” labours develop into “high risk” situations in a very short period of time. If these low risk mothers are left unattended, without adequate monitoring and checks, and without maternal reassurance and care, then serious problems will inevitably arise. These problems may not ultimately result in legal “claims” being pursued but the lack of care can and will result in unhappy and sometimes emotionally and psychologically damaged mothers. These are the unaccounted for victims of the crisis in maternity services in England and they are, in my view, the women who should not be forgotten.
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