Case study: compensation for mother who lost baby after hospital ignored RCOG guidance

Barcan+Kirby is proud to support Baby Loss Awareness Week 2024, which aims to help people understand the impact of baby loss so that no one feels alone.

One in two of us are affected by baby loss each year. Many of those who have lost pregnancies and babies need support. This can take the form of counselling, specialised bereavement support, or help organising funerals, for example.

In this case study, we look at a claim settled by Charlotte Tracy, a Senior Associate in our Clinical Negligence department, and how our team can support those who need a lawyer because their loss was the result of medical negligence. The case study is written with the consent of our client, Ellie*.

Please note, this case study includes details of stillbirth which may be triggering for some, particularly those who have experienced baby loss. We do, however, hope it is helpful for those who are wondering how legal support may assist them.

Background

Our client, Ellie fell pregnant in Summer 2019. She had two children already and a history of several miscarriages. At the start of her pregnancy, she was diagnosed with a pulmonary embolism (a blood clot in her lung) meaning she would have to inject with an anti-coagulant throughout her pregnancy.

Because Ellie was considered high-risk due to the pulmonary embolism and some complications in her previous pregnancies/deliveries, she was booked for consultant-led care under a major hospital in the South West (the Defendant).

When Ellie was around 15 weeks pregnant, she saw a consultant, at which time the risks of her pregnancy were discussed. These included risks associated with her weight, including the risk of pre-eclampsia and post-partum haemorrhage. It was recommended that Ellie should have growth scans at 28, 32 and 36 weeks. There was a plan, at this time, for her to deliver between 38 and 39 weeks.

Ellie continued to have appointments throughout her pregnancy, at which everything appeared normal, and both the baby and Ellie seemed well. It was decided in early January 2020 that she would have a C-section.

Changing PI value and growth scans

In late February 2020, Ellie was seen for the 32-week growth scan. An ultrasound scan of the umbilical artery was performed, and a measurement known as ‘pulsatility index’ (‘PI’) was taken.

PI is a calculation related to how blood is moving in the artery (flow velocity). In a normal pregnancy, you would expect PI value to follow a certain pattern. There is evidence that in a significant number of pregnancies where the baby is growth-restricted (not growing as expected), the PI will be higher than normal. It can, therefore, be a predictor of a poor outcome for the baby.

At Ellie’s 32-week scan, her PI value was raised. Her baby’s growth was good, and he was active. A consultant reviewed her and planned to repeat the scan at 34 weeks. At this time Ellie was booked for a C-section at 38 weeks + 3 days.

Ellie attended hospital in early March 2020, thinking her baby was moving less than normal. A CTG (continuous monitoring) was performed, and the baby was fine. She had a further scan at 33 weeks + 3 days, at which time the PI value was within a normal range.

At 34 weeks + 4 days, Ellie had another scan. The baby was active and Ellie felt well. The baby’s growth was normal, but the PI value was raised. There was a plan to do another ultrasound of the artery and, if the PI value remained raised, to deliver the baby by C-section between 37 and 38 weeks.

In mid-March 2020 Ellie underwent another scan, at which time the baby was active, and the PI value was apparently normal.

Negligence

At 36 weeks + 2 days, Ellie had another scan. This showed significantly slowed growth of the baby’s estimated weight and static growth (no increase in measurements) of the baby’s abdomen. In addition, the PI value was raised. These results were only reviewed the next day when Ellie saw her consultant. The C-section date was brought forward to 37 weeks + 3 days.

This represented substandard care. National guidance from the Royal College of Obstetricians and Gynaecologists recommends that where there is growth restriction and raised PI value diagnosed after 34 weeks of pregnancy then delivery should be planned by 37 weeks of pregnancy.

At the very end of March 2020, when Ellie was 37 weeks + 1 day pregnant, she experienced pain and heavy bleeding at the home of a relative. She was taken to hospital by a rapid response vehicle and assessed in the delivery suite. An ultrasound was performed and, very sadly, her baby’s death was confirmed. Ellie was experiencing a life-threatening haemorrhage and complete placental abruption. She was taken to theatre to be treated, and her baby boy was delivered stillborn.

Aftermath

Ellie was discharged from hospital two days later. Very early she started asking questions about her baby’s death, particularly about the C-section date and whether, if he had been delivered earlier, he would have lived.

Ellie was suffering from nightmares. She avoided pregnant women and babies, and her relative’s home where she had started bleeding. Ellie felt angry and sad, and her mood was very low. She experienced feelings of guilt. She avoided one of her children for a short while, as he reminded her of her baby.

As a result of the negligence, Ellie was diagnosed with PTSD. Before she had the opportunity to seek private treatment for this, she suffered a further pregnancy loss and then fell pregnant again. She was very anxious about the outcome of another pregnancy. These experiences further entrenched her PTSD, making it more severe.

Hospital investigations

In May 2020, Ellie received an Investigation Report from the hospital. In the report, it was noted that, in Ellie’s case, there was a national recommendation to deliver the baby by 37 weeks. It also noted that Ellie’s C-section had been booked for 37 weeks + 3 days. Despite the obvious difference between those two dates, and a specific question from Ellie to the investigators asking why her baby was not delivered earlier, no explanation was offered as to why Ellie’s C-section had not been booked before the 37-week deadline.

In August 2020, Ellie had a telephone call to discuss the stillbirth, and a follow-up letter was sent to her. This noted that the C-section date had been brought forward to 37 weeks + 3 days. Again, there was no explanation as to why the C-section date was not booked for before 37 weeks, or that failing to do this was substandard.

Claiming for medical negligence

Ellie instructed our specialist medical negligence solicitors to investigate and bring a claim on her behalf. An initial Letter of Notification was sent to the hospital Trust requesting an admission. Standard investigations followed, including obtaining Ellie’s medical records.

An expert Consultant Obstetrician was instructed to give an opinion on liability. He was supportive of the case, finding that Ellie’s care was substandard and that if her baby had been delivered by 37 weeks, she would have avoided the placental abruption and the stillbirth.

A Letter of Claim was prepared and sent to the hospital, setting out the allegations, but also alleging that the hospital had failed in their Duty of Candour by writing to Ellie twice in 2020 about the stillbirth and not properly explaining, at the very least, that not delivering the baby by 37 weeks was against national guidance and this may be related to the cause of the stillbirth.

A Consultant Psychiatrist was instructed. It was important to the claim that this expert specialised in perinatal psychiatry and understood well psychiatric injuries arising from obstetric care. He assessed Ellie and provided a report on her PTSD.

Several months later, the Defendant hospital admitted liability in full.

Settlement

Ellie’s claim settled for £55,000, which includes:

• An award for pain and suffering, particularly relating to Ellie’s psychiatric injury;
• An award similar to a Statutory Bereavement Award for the stillbirth of Ellie’s baby boy;
• Funeral costs;
• Costs of memorial items like flowers for the baby’s grave and the cost of travel to the grave (including for the future);
• The cost of the emotional and household support of family members immediately after the stillbirth and as Ellie dealt with her PTSD (including for the future); and
• The cost of private psychiatric treatment (including for the future).

Ellie did not lose any earnings as she was forced by financial circumstances soon after the stillbirth to return to work. Consideration was given to the future, and the significant private cost of being managed privately for any future pregnancy and having additional psychiatric treatment during that pregnancy. The experts supported this, but in the end, Ellie opted not to have any more children.

Ellie said:

“It was very helpful to have a solicitor to help with legal issues to bring the case. It had been years without any resolution but now it’s settled, and we can have peace of mind after the loss of my son.

Regarding the settlement, it did help us a lot to get the gravestone. This also helps to make memories that remind us that justice is served.

The therapy helped a lot, as a mother, to get peace of mind, along with my other kids. I highly appreciate the assistance and support from the solicitors.”

Further information

If you or a loved one have suffered a pregnancy or baby loss, and are concerned something may have gone wrong, our medical negligence solicitors may be able to help you claim compensation.

Call us on 0117 325 2929 or fill out our online enquiry form and a member of our team will be in touch.

Read more about our birth injury and maternity compensation claims expertise here.

* Names are changed to protect our client’s privacy.