29 November 2023

The State Claims Agency (SCA) reports on 5-year review of concluded claims relating to catastrophic injuries to babies in maternity services.

The report discusses 80 catastrophic claims concluded between 2015 and 2019, 74 of which related to incidents that occurred before or during birth and 6 of which related to incidents that occurred in the neonatal period.

A catastrophic birth injury is defined by the SCA as one where a birth injury results in serious disability/permanent incapacity to a baby, or where the estimated liability is over 4 million.

Key findings of the report included the age and BMI of the women involved, how they presented (i.e. in labour, planned, or due to concerns), weight of the babies and the percentage delivered by caesarean section. Interestingly, no home births, water births or elective caesarean sections featured.

In 64% of cases, absent or poor documentation was noted. The SCA has highlighted the need to maintain legible, complete and contemporaneous clinical documentation and note the use of retrospective note keeping should only be when necessary and should clearly identity as being made in retrospect. The SCA advises that a staff member should be nominated, where possible, during emergencies to record timing of the medication administration, interventions, personnel present, additional assistance summoned etc.

Failure to interpret or recognise an abnormal CTG occurred in 61% of the 74 women, with failure to monitor fetal heart/uterine contractions occurring in appropriately 51% of cases. The SCA outline the following guidelines that staff caring for women in the antenatal and intrapartum period should follow;

  • Recognise that CTG interpretation should not occur in isolation and should be undertaken as part of a holistic assessment of fetal and maternal wellbeing;
  • Ensure appropriate and timely intervention/decision making when abnormalities are present;
  • Ensure the fetal heart rate is confirmed by a pinard stethoscope before and during electronic fetal monitoring, in addition to taking the mother’s pulse manually;
  • Ensure the CTG recording is complete and that it includes the fetal heart rate, tocograph, accurate date and time, and maternal pulse. The midwife should document the CTG findings on a regular basis, and should document more frequently with a suspicious or pathological CTG;
  • Ensure the correct placement of tocograph transducer for accurate detection of uterine activity in conjunction with manual palpation of uterine contractions;
  • Ensure alarms are enabled, audible and maintained on all CTG machines; and
  • Consider a “fresh eyes and ears” approach to fetal monitoring; have a colleague perform a fresh review of the fetal heart rate during intermittent or continuous fetal monitoring, which is documented with time and signature.

The report further outlines that 43% of the women had labour accelerated by oxytocin, artificial rupture of the membranes or both. Inappropriate use of oxytocin accounted for 36% of the incidents that occurred before or during labour. On foot of this finding, the SCA advises that staff should know when oxytocin is indicated/contradicted, the appropriate dose and method of administration for the different clinical scenarios in which it is used.

The final two other prominent issues identified involve delay in escalation (50%) and inadequate assessment (31%).

It is evident from the report that a systems driven process is required and advised by the SCA. For further information, the report is available in full at Claims-Review-Report-Catastrophic-Claims-relating-to-Babies-in-Maternity-Services.pdf (stateclaims.ie)

If you would like any further information or advice, please contact Emma Duffy from our Healthcare team.

*This information is for guidance purposes only and does not constitute, nor should be regarded, as a substitute for taking legal advice.

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