Birth injuries to mothers: Medical negligence claims

Birth related injuries to mothers can be absolutely devastating, and can have long-term effects. They can affect personal relationships, careers and mental health.

Some childbirth injuries are unavoidable, and they can be a natural part of having a baby. Childbirth injuries can have an impact on the psychological and/or physical well-being of a woman. Injury can occur during any pregnancy, even if the mother has no risk factors and the pregnancy is deemed to be normal. Sadly, some injuries are caused, or made worse, when midwives and doctors make mistakes during a mother’s pregnancy, labour or delivery.

Medical negligence claims for maternal birth injury

If you believe that you may have suffered a birth injury, or think that your labour and delivery may have been mismanaged or a mistake made during your care caused the problem, you might have a medical negligence claim.

Doctor or midwife negligence can cause birth injuries which affect mothers and their families for the rest of their lives.  The effects of childbirth injuries are very personal and individual, but possible consequences include:

  • physical symptoms which affect your quality of life, such as incontinence
  • mental health problems, such as postnatal post-traumatic stress disorder or depression
  • relationship breakdown
  • problems bonding with your new baby
  • being unable to return to work because of your symptoms

If you suffered a birth injury, are worried about the care you received, and think it might have caused a problem you may be eligible for birth injury compensation. Our maternal birth injury claims solicitors understand what you’re going through, and we can help you get answers about your care.

Find out more about childbirth injuries claims.

Common types & causes of birth injuries to mothers:

Vaginal tears during childbirth

About 9 in 10  women suffer perineal tears when the perineum (the skin between the vagina and anus) stretches as the baby is born. Most perineal tears are quite minor and should heal naturally within a short time after the baby is born. However, more serious tears can also extend to the vulva (external genitals) and muscles in the anus (back passage). These require repair, take longer to heal and may have long-term effects.

Types of tears during childbirth

First degree tears are skin-deep and only affect the outermost layer of skin around the vagina and perineum. You may need a few stitches, but normally they heal quickly. First degree tears have the best chance of quick recovery with minimal pain. Normally, there is no long term damage. Your midwife will decide in consultation with you, whether it is necessary to stitch your first degree tear or not.

Second degree tears are deeper tears, involving the muscles of the vagina and the skin around the anus. Stitches are normally required to help the tear to come together and heal. Dissolvable stitches are usually used, so that the mother doesn’t need to have them removed.  Second degree tears can be quite painful and recovery normally takes a few weeks. Your midwife will examine the tear from time to time to ensure that it is healing well. You should report any signs of unusual discomfort or signs of infection to your midwife.

Third and fourth degree perineal tears are the most serious form of tears during childbirth. These types of tears are typically deeper and more serious. Third degree tears damage the anal sphincter (the muscle which controls the anus).  Fourth degree tears also involve the lining/muscles of the anus. Third and fourth degree tears are unpredictable. The Royal College of Obstetricians and Gynaecologists (RCOG) lists the following as risk factors:

  • the mother’s first vaginal delivery
  • the second stage of labour is particularly long
  • shoulder dystocia during delivery
  • the baby is large (over 8 pounds 13 ounces)
  • labour is induced
  • an assisted delivery (for example, if forceps or ventouse are used).

If you are concerned about suffering a serious tear during birth, you can talk to your or midwife or doctor about it during your antenatal care. They may be able to recommend measures to help reduce the risk of a serious tear, such as perineal massage. Perineal massage helps the perineum to be more elastic and can help reduce the risk of it tearing as your baby is born. Another option is an episiotomy, a procedure designed to reduce the risk of a serious tear.

What is an episiotomy?

An episiotomy is a surgical incision made by a doctor or midwife during childbirth. It is a deliberate cut designed to expedite delivery and help reduce the risk of uncontrolled tearing of the perineum. This incision makes the opening of the vagina wider, so there’s more room for the baby to pass through.

There are two types of episiotomy you might hear about:

midline episiotomy – a cut from the vagina directly towards the anus (rarely done)
mediolateral episiotomy – a cut from the vagina, but angled off to one side of the perineum. Mediolateral episiotomies are more common in the UK.

Midwives and doctors should only recommend an episiotomy if there is a medical need, or the mother specifically requests one. It may be the best course of action if your baby is in distress and needs to be born quickly, if they are in a difficult position or if you are having an instrumental delivery using forceps or ventouse.

Some women may prefer an episiotomy over a spontaneous (natural) tear. Spontaneous tears can cause serious, lasting damage to the muscles around the vagina and anus but are said to heal better. Studies show that episiotomies reduce the risk of suffering a serious tear. Your doctor should explain the risks and benefits of an episiotomy to you before performing one.

Failure to identify and repair tears following childbirth

If you suffer a perineal tear, your caregivers should identify the tear at delivery and manage it appropriately. You can also find more information and support regarding perineal tears from the charity MASIC (Mothers with Anal Sphincter Injuries from Childbirth).

Following delivery and for the rest of your postnatal care, your midwife will ask you about the condition of your perineum and where necessary examine the perineum. Care of your perineum forms part of your post-natal midwifery follow up. Serious tears and episiotomies can, unfortunately, cause a great deal of suffering if they are unnoticed and not repaired at the time of delivery or if they’re repaired poorly.  For example, they can cause complications such as:

  • incontinence – lack of control to pass faeces (stool) and/or wind
  • rectovaginal fistula – a serious tear can cause a hole in the wall between your vagina and your anus, which can cause faeces to pass through into the vagina
  • pain and soreness – the tear may make it difficult for you to sit for a long time, or be very active
  • stinging pain when passing urine
  • pain during sexual intercourse.
  • scarring.

It may also mean you need another procedure to correct the damage (secondary repair), causing further pain and distress.

If you suffered a third or fourth degree tear, if this was not identified and repaired at the time of delivery, and if you suffer continuing problems as a consequence, please contact our Obstetric Anal Sphincter Injury experts, Janine Collier and Gwyneth Munjoma for compensation advice.

Post-natal depression (PND) and post-natal post-traumatic stress disorder (PTSD)

A negative experience before, during or shortly after childbirth (‘birth trauma’) can affect mental health and wellbeing. Negative experiences during childbirth are highly personal, and everyone reacts differently.  However there are some common signs and symptoms, for example:

  • difficulty bonding with the baby
  • a sense of ‘failure’ – that the circumstances surrounding baby’s birth were somehow their fault
  • feeling isolated or guilty
  • avoiding situations reminiscent of the birth (going to hospital, seeing birth depicted on television).

Many mothers suffer in silence. However, post-natal PTSD and post-natal depression needs the right treatment and support. Get further information about psychological damage after childbirth.

If you suffered post-traumatic stress disorder or post-natal depression following a traumatic delivery contact our experts Gwyneth Munjoma or Janine collier for advice.

Post-partum haemorrhage (PPH)

Women experience some blood loss after giving birth. Vaginal bleeding is normal for about 2 to 6 weeks after the baby is born. The bleeding is normally heaviest in the days immediately after delivery, becoming gradually lighter over time.

However, some women experience abnormally heavy bleeding, which can be dangerous. This is called a post-partum haemorrhage (PPH). There are two types of PPH:

  • primary or immediate PPH – heavy bleeding within 24 hours of the baby’s birth
  • secondary or delayed PPH – heavy bleeding after 24 hours, and up to 6 weeks after the baby’s birth.

Primary PPH happens in about 5 in 100 pregnancies. Normally, about 500ml (1 pint) of blood may be lost. However, in very rare cases, a particularly severe haemorrhage can lead to blood loss of around 2L (4 pints) or more.

Secondary PPH is rarer and affects less than 2 in 100 women. It normally happens if the mother suffers an infection following delivery. A major bleed can be life threatening. Midwives and doctors are trained to recognise situations where a mother is at high risk of suffering a PPH. They should take the necessary steps in order to reduce the chance of a haemorrhage – or prevent it altogether.  And, if a haemorrhage does occur it is important to treat it quickly.  Doctors and midwives are trained in controlling heavy bleeding.

If you suffered a post-partum haemorrhage and are concerned about the medical care you received contact Janine Collier  or Gwyneth Munjoma for advice.

Ruptured uterus

A ruptured uterus is a serious complication during pregnancy. It happens when the wall of the uterus (womb) tears during pregnancy. It’s more common in women who have previously had a caesarean section, at the site of their caesarean section scar.

It is very important that doctors and midwives diagnose and treat a uterine rupture promptly. A ruptured uterus is considered a medical emergency because it can be life-threatening to both the mother and the baby and cause serious damage to the health of the mother and baby.

First line treatment is urgent caesarean section and uterine repair if possible (hysterectomy if not).  Usually, the mother loses a lot of blood and needs a transfusion and antibiotics to reduce the risk of infection.  It can take a little time to recover from losing so much blood and the surgery itself.  Women who have more children in the future will need a caesarean section.

If you suffered a ruptured uterus and are concerned about the medical care you received contact our maternal birth injuries experts, Janine Collier  or Gwyneth Munjoma for advice. 

Prolapsed uterus

Childbirth can also cause pelvic organ prolapse. This is where one of more of the pelvic organs bulges into the vagina. It’s quite common, and the NHS states  that up to half of mothers are affected by some level of prolapse.

Pelvic organ prolapse is more likely in cases where labour was particularly long or difficult, or the baby was particularly large.

A prolapse of the uterus (womb) happens when the uterus slips out of its normal position and down into the vaginal canal. Most of the time, a prolapsed uterus or other pelvic organ isn’t life-threatening. However, it can affect the mother’s quality of life and general wellbeing significantly. Possible symptoms include:

  • urinary incontinence
  • pain during sex
  • a feeling of heaviness in the vagina and/or perineal area.

Many cases of a pelvic organ prolapse can be managed through pelvic floor exercises, treating any constipation and weight loss (if appropriate). However, if you suffer a serious prolapse it might require more invasive treatment such as a hysterectomy (removal of the womb, which means the woman cannot have any more children) or surgical repair of the pelvic floor muscles.

If you suffered a prolapsed uterus and are concerned about the medical care you received talk to our maternal birth injuries experts, Janine Collier  or Gwyneth Munjoma. 

Medical negligence claims for maternal birth injuries

If you believe that you may have suffered a birth injury, or think that your labour and delivery may have been mismanaged or a mistake made during your care caused the problem, you might have a medical negligence claim.

Doctor or midwife negligence can cause birth injuries which affect mothers and their families for the rest of their lives.  The effects of childbirth injuries are very personal and individual, but possible consequences include:

  • physical symptoms which affect your quality of life, such as incontinence
  • mental health problems, such as postnatal post-traumatic stress disorder or depression
  • relationship breakdown
  • problems bonding with your new baby
  • being unable to return to work because of your symptoms

If you suffered a birth injury, are worried about the care you received, and think it might have caused a problem you may be eligible for birth injury compensation. Our maternal birth injury claims solicitors understand what you’re going through, and we can help you get answers about your care.

Caesarean Section Requests

A report on the variations in practice and procedure across NHS Trusts in the UK

At Tees, we are increasingly supporting women who, despite requesting a caesarean section or raising concerns about vaginal delivery, have been counselled in a way that steers them toward a vaginal birth.

Many of these women are unaware that nearly 40% of births in the UK involve either instrumental assistance or a caesarean section. For first-time mothers, this figure rises to 50%. Furthermore, around 4% of women experience third or fourth-degree perineal tears during childbirth, which can result in life-changing, long-term issues with bowel control and incontinence.

Sadly, many go on to endure traumatic births, often leading to serious and lasting physical and/or mental health problems. In some cases, their babies also suffer injury.

Read Tees Law’s own report

The copyright in this report belongs to Tees Law. Tees Law gives permission for extracts from the report to be used provided a suitable credit to Tees Law is given and a link to the full report published.

In 2018, Birthrights  – a charity dedicated to promoting women’s rights in childbirth, published a report into Maternal Request Caesarean (MRCS). These are planned caesarean sections requested by pregnant women without a medical indication.

The report revealed that, despite NICE Guideline CG132, nearly 75% of NHS Trusts did not have written policies supporting a woman’s right to choose a caesarean.

It concluded that “the majority of Trusts in the UK made the process of requesting a caesarean lengthy, difficult or inconsistent, adding anxiety and distress to women at a vulnerable time.” The report called for greater transparency around the variation in policies and procedures between NHS Trusts.

Three years have passed since the Birthrights report was published. With no further research on this issue that we were aware of—and with our Medical Negligence team continuing to support women like Niamh and Anna, who have faced disempowerment and difficulty when giving birth—we undertook our own investigation in May 2021. Our goal was to assess whether practices and procedures regarding MRCS had changed across NHS Trusts since 2018.

 

What is a child arrangements order during divorce or separation?

A child arrangements order is a legal document that formalises childcare agreements between parents who are going through a divorce or separation. It determines critical aspects such as where the children will live and how much time they will spend with each parent.

This type of court order is typically necessary when parents cannot reach a mutual agreement on childcare arrangements. Ideally, parents should try to resolve these issues amicably, often with the assistance of a mediator. However, if disputes remain unresolved, applying for a Child Arrangements Order through the court may be the best option.

Why might you need a child arrangements order?

You may require a Child Arrangements Order if:

  • You are unable to agree on custody or visitation arrangements.
  • One parent is not adhering to a previously agreed-upon schedule.
  • There are concerns about a parent neglecting their responsibilities.
  • Mediation has failed to resolve disagreements.

If both parents are cooperating and the existing arrangements are working, a court order is typically unnecessary.

How to apply for a child arrangements order

  1. Attempt mediation first:
    • Before applying for a child arrangements order, you are legally required to attend a Mediation Information and Assessment Meeting (MIAM) unless there are valid reasons not to do so, such as instances of domestic abuse.
  2. Seek legal advice:
    • A solicitor can guide you through the process, helping you prepare your application and submit it to the court.
  3. Attend court hearings:
    • Both parents will need to attend a court hearing, where a judge or magistrate will assess the situation.
    • A representative from the Children and Family Court Advisory and Support Service (CAFCASS) may also provide input by producing a safeguarding report and making recommendations.
  4. Decision making:
    • The court will prioritise the child’s welfare, considering factors like their wishes, feelings, and overall needs.
    • If an agreement cannot be reached during the initial hearing, further evidence may be required before a final decision is made.

Specific issue orders and prohibited steps orders

In addition to Child Arrangements Orders, the court may issue:

  • Specific issue orders: For resolving specific disputes, such as which school a child should attend or whether they should follow a particular religion.
  • Prohibited steps orders: To prevent a parent from taking certain actions, like relocating a child abroad without consent.

Child arrangements orders vs. special guardianship orders

A Special Guardianship Order (SGO) grants parental responsibility to someone other than the child’s parents, often in cases where parents are unable to provide proper care. Unlike a Child Arrangements Order, an SGO allows the guardian to make decisions without requiring parental approval, although some significant decisions still require consent.

Can grandparents apply for a child arrangements order?

Yes, grandparents or other relatives can apply for a Child Arrangements Order, although they need the court’s permission first. This may be relevant if they have been acting as the child’s primary caregivers or if they wish to establish visitation rights.

How to change a child arrangements order

While Child Arrangements Orders are intended to provide long-term stability, circumstances can change. If significant changes occur, such as a parent relocating, remarrying, or experiencing financial difficulties, you can apply to modify the order. The court will reassess the child’s best interests before making any adjustments.

Expert legal support for child arrangements orders

Navigating the complexities of child custody during a separation can be challenging. Seeking the advice of our specialist family law solicitor can ensure that your child’s best interests remain the priority. Professional legal support can help formalise arrangements and provide clarity and reassurance during this difficult time.

For further guidance on child arrangements orders, contact our experienced family law team today.