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Understanding the risks of negligence during antenatal care

Category: Birth Injuries

Last Updated: 20th Aug 2021

About the Author

Medical Negligence Solicitor - BSc (Hons) Biomedical Sciences, Queen Mary University

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Whether becoming a mother for the first, second or fifth time, during pregnancy a great deal of trust is placed in obstetricians, midwives and other healthcare professionals to support the health of mother and baby.

While this care is generally of a good standard and leads to a smooth, straightforward pregnancy, sometimes it falls below expected standards. This is a very critical time, and any mistake or oversight by a healthcare professional can have serious consequences for the birth itself and the wellbeing of both mother and baby.

Here we will outline the problems that can occur during antenatal care, the repercussions these can have, and how we can help you make a birth injury claim should these incidents affect you, your baby or a loved one.

What is antenatal care?

Antenatal care (also referred to as pregnancy care or maternity care) is the care an expectant mother receives from healthcare professionals during her pregnancy. Throughout pregnancy she will be offered a number of appointments with a midwife or obstetrician, where they will:

  • Check the health of both mother and baby

  • Offer advice on diet, exercise and more for a healthy pregnancy

  • Discuss care options during pregnancy, labour and birth

  • Answer any questions or concerns

In the UK, if it is the mother’s first pregnancy, they will usually be offered up to ten antenatal care appointments. For later pregnancies, this will drop to approximately seven, unless the mother has a health condition or a previous pregnancy supports the need for additional appointments.

Across these appointments, the midwife or obstetrician will perform several tests to assess the health of both mother and baby, including:

  • At least two ultrasound scans at 10-14 weeks and 18-21 weeks

  • Screening tests for a range of infections, inherited conditions or conditions such as Down’s Syndrome

  • Weight and height checks

  • Checking the baby’s pulse

  • Blood tests and blood pressure tests

  • Urine tests

  • Blood group and rhesus status

  • Iron deficiency checks

  • Gestational diabetes checks

A failure to perform these checks or identify any problems that the results indicate could form the basis for a birth injury claim if this directly causes harm to either the mother or baby.

Factors that healthcare professionals should be checking for

While pregnancy is far safer today than it was several decades ago, there are a number of factors that can increase the risk that a midwife, obstetrician or other healthcare professional should check for. These include:

The baby’s growth rate

It is important to monitor and track how quickly a baby is growing and whether it is hitting its expected targets. These targets will vary depending on the parents, but what is key is identifying whether the baby’s rate of growth increases or decreases.

An increase in the rate of growth can indicate that the mother may have developed gestational diabetes, as this can result in the baby growing to a larger size than expected. It is crucial to identify as it could lead to difficulties during labour such as shoulder dystocia, where the baby’s shoulder becomes stuck during delivery, which may endanger the health of mother and baby.

Spotting this increase early enough can mean alternatives such as an induced pregnancy or a caesarean section can be pursued to reduce the risk of birth trauma.

If the baby’s growth noticeably decreases, the most common cause is placental insufficiency. This means the baby is not receiving the nutrients they need to support their growth, and so requires action to try and avoid a poor outcome.

The baby’s heart rate

In pregnancies considered to be at greater risk of complications, it is common for a healthcare professional to check the baby’s heart rate using a CTG (cardiotocography) scan.

An elastic belt is placed around the mother’s abdomen, with two round, flat plates attached. One of these measures the baby’s heart rate, while the other assesses the pressure on the tummy to track when contractions happen and how strong they are. These determine whether a baby’s heart rate is:

  • Reassuring – the heart rate is in line with expectations

  • Suspicious – the heart rate is slightly abnormal, which will likely result in further monitoring and tests

  • Pathological – the heart rate is significantly abnormal so that the baby will require immediate delivery

While in most cases this test is conducted properly, it is possible to misread the CTG and overlook worrying signs as reassuring, or for the CTG to capture the mother’s pulse rather than the baby’s heart rate. These mistakes can mean that potential warning signs are overlooked, leading to further problems during pregnancy, labour or birth that could otherwise have been prevented or prepared for.

NICE guidelines outline the process for screening foetal anomalies, infections, and other clinical conditions, as well as steps to take if foetal growth is outside normal ranges.

Maternal health status

Checking the health and wellbeing of the mother is critical, as a number of illnesses or underlying conditions can have serious consequences if not identified and treated appropriately.

If they notice any signs, a midwife or obstetrician should check the temperature of the mother and swab for any potentially harmful bacteria, such as streptococcal bacteria, as any infection may endanger the health of their unborn child if not addressed.

It is also essential to check for signs of potentially dangerous pregnancy conditions such as pre-eclampsia and obstetric cholestasis.

Pre-eclampsia can be identified by taking blood pressure and testing for high protein levels in the mother’s urine. Severe cases affect 1-2% of pregnancies and cause high blood pressure during pregnancy and after labour. This can then lead to high-risk complications, including:

  • Eclampsia – convulsions or fits that may result in permanent disability, brain damage or the death of the mother, and potentially cause the unborn baby to suffocate during a seizure

  • HELLP syndrome – a rare liver and blood clotting disorder that can only be treated by delivering the baby immediately

  • A stroke

  • Organ problems such as pulmonary oedema

  • A blood clotting disorder

Furthermore, they should also undertake an accurate medical history of the mother to determine whether she has any health condition, such as diabetes or asthma, or if they are taking medication for an existing condition. These might greatly influence how their pregnancy is managed in order to preserve the wellbeing of both mother and baby.

A failure to act on any signs of illness or the effects of an underlying condition (or medication for that condition) could be viewed as negligent if it results in avoidable harm to the mother or baby.

Maternal and paternal family histories

In addition to checking the mother’s current health status, healthcare professionals are also expected to build a clear understanding of the family histories of both the mother and father, as this could also influence how the pregnancy is managed and the planning of the eventual birth.

The midwife or obstetrician may ask about:

  • The mother and father’s ethnic origins to assess the risk of any inherited conditions passing onto the baby

  • Any history of health conditions such as heart disease, diabetes or epilepsy

  • Any history of genetic conditions such as Down’s Syndrome or sickle cell disease

  • Whether the family has a history of twins or other multiple births

  • Any allergies in your family, including food allergies

  • Any history of miscarriages, stillbirths or difficult labours by other family members

They should also ask about any previous pregnancies that the mother has had, identifying if there were any difficulties or outcomes that they should be aware of when managing this pregnancy.

High BMI

If the mother has a high BMI score, this can increase the risk of a pregnancy in several ways:

  • Increased likelihood of developing gestational diabetes

  • It becomes harder to monitor the heart rate of the baby

  • Greater risk of miscarriage and stillbirth

  • Greater risk of high blood pressure and pre-eclampsia

  • Greater risk of cardiac problems

The midwife or obstetrician in these circumstances should recommend ways for the mother to reduce her BMI score, as well as plan for any complications this may have on the progress of the pregnancy.

Common mistakes and oversights during antenatal care

We are fortunate that the standard of antenatal care in the UK is extremely high, meaning most pregnancies progress without incident. However, during pregnancy it is possible that negligent care by a midwife, obstetrician or other healthcare professional can directly place the health of both mother and baby in serious jeopardy.

Here are some of the more common mistakes that can be interpreted as negligence:

  • Incorrect reading of CTG results, or tracking the mother’s pulse rather than the baby’s heart rate

  • Overlooking any signs or symptoms of infection in the mother, or failing to treat this appropriately

  • Overlooking any noticeable changes in the baby’s growth rate

  • Incorrect management of medication

  • Overlooking signs of preeclampsia or failing to address this with medication or induced delivery

  • Underplaying any bleeding or pain suffered by the mother during pregnancy – this could be a sign of placental abruption, which can deprive the baby of oxygen and nutrients

  • Lack of screening the baby for abnormalities, or failure to provide parents with options based on the results of these screenings

Making a birth injury claim

The antenatal period is a delicate time for both mother and baby. While this is expertly managed the vast majority of the time, occasionally mistakes happen – and when they do, the consequences can be life-altering or, in some cases, fatal.

At Gadsby Wicks, we understand how devastating the outcomes of negligence during antenatal care can be. Avoidable mistakes or oversights by a midwife or obstetrician can be the difference between a healthy, uncomplicated birth, and one that causes trauma to the mother and results in a baby being born with severe mental or physical disabilities.

If this applies to you, you are entitled to answers and the compensation you deserve. Our expert solicitors will investigate each detail of your case to determine whether you have a claim. Then, we will guide you through every step of making a birth injury claim, to reach a settlement that will help ease the burden of this incident for you and your loved ones.

If you have experienced birth trauma and would like to speak to someone about your options, get in touch today – we are here to listen and advise you on your next steps.

Disclaimer

All content contained within this article is meant for general information only – this should not be treated as a substitute for medical advice from your doctor or another healthcare provider. If you require legal advice specific to your situation, please contact our team directly.

Gadsby Wicks is not liable for any diagnosis made from the content of this article, nor does it endorse any service or external site linked to within the article.

Always consult your GP if you are concerned about your health and wellbeing, or speak to us if you require legal advice.